title: Epidemiology and outcomes after in-hospital cardiac arrest after pediatric cardiac surgery.
abstract: BACKGROUND
  Multicenter data regarding cardiac arrest in children undergoing heart operations are limited. We describe epidemiology and outcomes associated with postoperative cardiac arrest in a large multiinstitutional cohort.
  
  
  METHODS
  Patients younger than 18 years in the Society of Thoracic Surgeons Congenital Heart Surgery Database (2007 through 2012) were included. Patient factors, operative characteristics, and outcomes were described for patients with and without postoperative cardiac arrest. Multivariable models were used to evaluate the association of center volume with cardiac arrest rate and mortality after cardiac arrest, adjusting for patient and procedural factors.
  
  
  RESULTS
  Of 70,270 patients (97 centers), 1,843 (2.6%) had postoperative cardiac arrest. Younger age, lower weight, and presence of preoperative morbidities (all p < 0.0001) were associated with cardiac arrest. Arrest rate increased with procedural complexity across common benchmark operations, ranging from 0.7% (ventricular septal defect repair) to 12.7% (Norwood operation). Cardiac arrest was associated with significant mortality risk across procedures, ranging from 15.4% to 62.3% (all p < 0.0001). In multivariable analysis, arrest rate was not associated with center volume (odds ratio, 1.06; 95% confidence interval, 0.71 to 1.57 in low- versus high-volume centers). However, mortality after cardiac arrest was higher in low-volume centers (odds ratio, 2.00; 95% confidence interval, 1.52 to 2.63). This association was present for both high- and low-complexity operations.
  
  
  CONCLUSIONS
  Cardiac arrest carries a significant mortality risk across the stratum of procedural complexity. Although arrest rates are not associated with center volume, lower-volume centers have increased mortality after cardiac arrest. Further study of mechanisms to prevent cardiac arrest and to reduce mortality in those with an arrest is warranted.
authors.affiliation: Division of Pediatric Critical Care, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas. Electronic address: pgupta2@uams.edu.
authors.forename: Punkaj
authors.initials: P
authors.lastname: Gupta
authors.affiliation: Johns Hopkins Children's Heart Surgery, All Children's Hospital, St. Petersburg, Florida; Division of Cardiac Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Jacobs
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, Michigan.
authors.forename: Sara K
authors.initials: SK
authors.lastname: Pasquali
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Hill
authors.affiliation: Department of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: J William
authors.initials: JW
authors.lastname: Gaynor
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Sean M
authors.initials: SM
authors.lastname: O'Brien
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Max
authors.initials: M
authors.lastname: He
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Shubin
authors.initials: S
authors.lastname: Sheng
authors.affiliation: Division of Pediatric Critical Care, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Schexnayder
authors.affiliation: Department of Anesthesia and Critical Care, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Berg
authors.affiliation: Department of Anesthesia and Critical Care, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Vinay M
authors.initials: VM
authors.lastname: Nadkarni
authors.affiliation: Division of Cardiothoracic Surgery, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Michiaki
authors.initials: M
authors.lastname: Imamura
authors.affiliation: Division of Cardiac Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Marshall L
authors.initials: ML
authors.lastname: Jacobs
mesh_terms: D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000453:epidemiology* / Q000209:etiology; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011184:Postoperative Period; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology