title: Incidence and management of life-threatening adverse events during cardiac catheterization for congenital heart disease.
abstract: Continued advancements in congenital cardiac catheterization and interventions have resulted in increased patient and procedural complexity. Anticipation of life-threatening events and required rescue measures is a critical component to preprocedural preparation. We sought to determine the incidence and nature of life-threatening adverse events in congenital and pediatric cardiac catheterization, risk factors, and resources necessary to anticipate and manage events. Data from 8905 cases performed at the 8 participating institutions of the Congenital Cardiac Catheterization Project on Outcomes were captured between 2007 and 2010 [median 1,095/site (range 133-3,802)]. The incidence of all life-threatening events was 2.1 % [95 % confidence interval (CI) 1.8-2.4 %], whereas mortality was 0.28 % (95 % CI 0.18-0.41 %). Fifty-seven life-threatening events required cardiopulmonary resuscitation, whereas 9 % required extracorporeal membrane oxygenation. Use of a risk adjustment model showed that age <1 year [odd ratio (OR) 1.9, 95 % CI 1.4-2.7, p < 0.001], hemodynamic vulnerability (OR 1.6, 95 % CI 1.1-2.3, p < 0.01), and procedure risk (category 3: OR 2.3, 95 % CI 1.3-4.1; category 4: OR 4.2, 95 % CI 2.4-7.4) were predictors of life-threatening events. Using this model, standardized life-threatening event ratios were calculated, thus showing that one institution had a life-threatening event rate greater than expected. Congenital cardiac catheterization and intervention can be performed safely with a low rate of life-threatening events and mortality; preprocedural evaluation of risk may optimize preparation of emergency rescue and bailout procedures. Risk predictors (age < 1, hemodynamic vulnerability, and procedure risk category) can enhance preprocedural patient risk stratification and planning.
authors.affiliation: Methodist DeBakey Heart and Vascular Center, Houston, TX, USA, clin@tmhs.org.
authors.forename: C Huie
authors.initials: CH
authors.lastname: Lin
authors.forename: Sanjeet
authors.initials: S
authors.lastname: Hegde
authors.forename: Audrey C
authors.initials: AC
authors.lastname: Marshall
authors.forename: Diego
authors.initials: D
authors.lastname: Porras
authors.forename: Kimberlee
authors.initials: K
authors.lastname: Gauvreau
authors.forename: David T
authors.initials: DT
authors.lastname: Balzer
authors.forename: Robert H
authors.initials: RH
authors.lastname: Beekman
authors.forename: Alejandro
authors.initials: A
authors.lastname: Torres
authors.forename: Julie A
authors.initials: JA
authors.lastname: Vincent
authors.forename: John W
authors.initials: JW
authors.lastname: Moore
authors.forename: Ralf
authors.initials: R
authors.lastname: Holzer
authors.forename: Laurie
authors.initials: L
authors.lastname: Armsby
authors.forename: Lisa
authors.initials: L
authors.lastname: Bergersen
mesh_terms: D000367:Age Factors; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000379:methods / Q000592:standards; D016638:Critical Illness / Q000453:epidemiology / Q000628:therapy; D019468:Disease Management; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006330:Heart Defects, Congenital / Q000145:classification / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D006439:Hemodynamics; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007431:Intraoperative Complications / Q000145:classification / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D008297:Male; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D058996:Quality Improvement; D020379:Risk Adjustment / Q000379:methods; D012307:Risk Factors; D017751:Safety Management / Q000458:organization & administration*; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology
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