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The Frequency of Cardiac Arrests in Patients with Congenital Heart Disease Undergoing Cardiac Catheterization

Odegard, Kirsten C. MD; Bergersen, Lisa MD, MPH; Thiagarajan, Ravi MD; Clark, Laura RA; Shukla, Avinash MBBS; Wypij, David PhD; Laussen, Peter C. MBBS

doi: 10.1213/ANE.0b013e3182908bcb
Pediatric Anesthesiology: Research Report

BACKGROUND: Cardiac catheterization for patients with congenital heart disease has shifted from diagnostic to predominantly interventional procedures because of advances in catheter-based technologies. Children undergoing therapeutic catheterization may be at higher risk of adverse events, and the purpose of our study was to determine the incidence of cardiac arrest (CA) in patients with congenital heart disease undergoing cardiac catheterization at a large pediatric tertiary referral center.

METHODS: All CAs from January 2004 through December 2009 occurring in the cardiac catheterization laboratory were reviewed. A CA was defined as an event in which cessation of circulation required chest compressions. Procedure, patient, practitioner, and system-related factors were examined.

RESULTS: Over the study period, during 7289 catheterization procedures, 70 procedures were associated with a CA (0.96 [99% confidence interval, 0.7–1.3] per 100 procedures); 48 events (69%) were successfully resuscitated to a perfusing rhythm, 18 events (26%) resulted in need for extracorporeal membrane oxygenation, and 4 events (6%) resulted in unsuccessful resuscitation. Sudden onset of cardiac arrhythmia led to CA during 38 events (54%). The duration of resuscitation after CA was ≤11 minutes in 71%. Occurrence of CA was associated with interventional procedures (P < 0.001) and younger age (P < 0.001). A change in systems for scheduling and communication of cases was associated with a significant reduction in the incidence of CA (1.5% vs 0.7%; P = 0.002).

CONCLUSIONS: The incidence of CA in children undergoing cardiac catheterization is high compared with pediatric noncardiac surgery. Procedural and system factors were associated with occurrence of CA in this cohort. These issues highlight the need for close communication, anticipation, and preparation.

Published ahead of print June 7, 2013

From the Department of Cardiac Anesthesia, Boston Children’s Hospital, Boston, Massachusetts.

Accepted for publication February 20, 2013

Published ahead of print June 7, 2013

Funding: Not applicable.

The authors declare no conflicts of interest.

This report was previously presented, in part, at the ASA.

Reprints will not be available from the authors.

Address correspondence to Kirsten C. Odegard, MD, Department of Cardiac Anesthesia, Boston Children’s Hospital, 300 Longwood Ave., Boston, MA 02115. Address e-mail to

© 2014 International Anesthesia Research Society