Cardiac arrest in infants after congenital heart surgery

• Published in: Circulation (New York, N.Y.) Vol. 100; no. 19; pp. II194 - II199
• Main Authors: RHODES, J. F, BLAUFOX, A. D, SEIDEN, H. S, ASNES, J. D, GROSS, R. P, RHODES, J. P, GRIEPP, R. B, ROSSI, A. F
• Format: Conference Proceeding Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 09-11-1999; American Heart Association, Inc
• Subjects: Biological and medical sciences; Blood Pressure; Cardiac Surgical Procedures - adverse effects; Female; Heart Arrest - etiology; Heart Arrest - mortality; Heart Arrest - physiopathology; Heart Defects, Congenital - surgery; Humans; Infant, Newborn; Intensive Care, Neonatal; Male; Medical sciences; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Survival Analysis; Human; Heart; Intensive cardiocirculatory care; Cardiocirculatory arrest; Congenital; Cardiovascular disease; Congenital disease; Plasty; Newborn; Treatment; Surgery; Heart disease; Complication; Evolution
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.cir.100.suppl_2.ii-194

The survival rate to discharge after a cardiac arrest in a patient in the pediatric intensive care unit is reported to be as low as 7%. The survival rates and markers for survival strictly regarding infants with cardiac arrest after congenital heart surgery are unknown.
Infants in our pediatric cardiac intensive care unit database were identified who had a postoperative cardiac arrest between January 1994 and June 1998. Parameters from the perioperative, prearrest, and resuscitation periods were analyzed for these patients. Comparisons were made between survivors and nonsurvivors. Of 575 infants who underwent congenital heart surgery, 34 (6%) sustained a documented cardiac arrest; of these, 14 (41%) survived to discharge. Perioperative parameters, ventricular physiology, and primary rhythm at the time of arrest did not influence outcome. Prearrest blood pressure was lower in nonsurvivors than in survivors (P<0.001). A high level of inotropic support prearrest was associated with death (P=0.06). Survivors had a shorter duration of resuscitation (P<0.001) and higher minimal arterial pH (P<0.02) and received a smaller total dose of medication during the resuscitation. Although survivors had an overall shorter duration of resuscitation, 5 of 22 patients (23%) survived to discharge despite resuscitation of >30 minutes.
The outcome of cardiac arrest in infants after congenital heart surgery was better than that for pediatric intensive care unit populations as a whole. Univentricular physiology did not increase the risk of death after cardiac arrest. Infants with more hemodynamic compromise before the arrest as demonstrated with lower mean arterial blood pressure and higher inotropic support were less likely to survive. The use of predetermined resuscitation end points in this subpopulation may not be justified.