Description and Management of Cardiac Arrests in Congenital Cardiac Patients Undergoing Cardiac Surgery, Cardiac Catheterization, and Cardiac Imaging

Objective

To describe cardiac arrest during anesthesia care provided by a pediatric cardiac anesthesiologist in patients with congenital heart disease and identify predictors of outcome.

Design

Retrospective chart review.

Setting

Quaternary children’s hospital.

Participants

Patients with congenital cardiac disease undergoing cardiac procedures or imaging between January 2016 and December 2022

Interventions

None.

Measurements and Main Results

Seventy-six patients experienced cardiac arrest during anesthesia care. The median patient age was 424 days (interquartile range [IQR], 75-4596 days), and the median weight was 7.6 kg (IQR, 4.7-44.1 kg). Twenty-five patients had single ventricle physiology (34%), and 50 patients had normal systemic ventricular function (66%). Cardiac arrest occurred in the cardiac catheterization laboratory in 43 patients (57%) and in the cardiac operating room in 25 patients (33%). Cardiac arrest occurred most frequently during the procedure (n = 60; 79%). The etiology was arrhythmia in 29 patients (38%) and low cardiac output or ischemia in 21 patients (28%). The median duration of cardiopulmonary resuscitation (CPR) was 4 minutes (IQR, 1-11 minutes). Thirty-one patients (44%) received a code dose of epinephrine (10 µg/kg or 1 mg), and 25 patients (33%) required extracorporeal membrane oxygenation (ECMO). Death or neurologic injury within 7 days occurred in 18 patients (24%). On multivariable analysis, only the use of ECMO (adjusted odds ratio, 16, 95% confidence interval, 2.1-93.2; p = 0.006) was independently associated with the composite outcome of neurologic injury or death.

Conclusions

Patients who experienced cardiac arrest while under the care of a pediatric cardiac anesthesiologist had a median CPR duration of 4 minutes. The sole independent predictor of death or neurologic injury within 7 days was the use of ECMO.