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Cardiopulmonary Resuscitation in the Pediatric Cardiac Catheterization Laboratory: A Report From the American Heart Association’s Get With the Guidelines-Resuscitation Registry*

Lasa, Javier J. MD1; Alali, Alexander MD2; Minard, Charles G. PhD3; Parekh, Dhaval MD2; Kutty, Shelby MD, PhD4; Gaies, Michael MD, MPH5; Raymond, Tia T. MD6; Guerguerian, Anne-Marie MD, PhD, FRCPC; Atkins, Dianne MD; Foglia, Elizabeth MD, MSCE; Fink, Ericka MD; Roberts, Joan MD; Duval-Arnould, Jordan MPH, DrPH; Bembea, Melanie MD, MPH; Kleinman, Monica MD; Gupta, Punkaj MBBS; Sutton, Robert MD, MSCE; Sawyer, Taylor DO, Med; for the American Heart Association’s Get With the Guidelines-Resuscitation Investigators

Pediatric Critical Care Medicine: November 2019 - Volume 20 - Issue 11 - p 1040-1047
doi: 10.1097/PCC.0000000000002038
Cardiac Intensive Care
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Objectives: Hospitalized children with underlying heart disease are at high risk for cardiac arrest, particularly when they undergo invasive catheterization procedures for diagnostic and therapeutic interventions. Outcomes for children experiencing cardiac arrest in the cardiac catheterization laboratory remain under-reported with few studies reporting survival beyond the catheterization laboratory. We aim to describe survival outcomes after cardiac arrest in the cardiac catheterization laboratory while identifying risk factors associated with hospital mortality after these events.

Design: Retrospective observational study of data from a multicenter cardiac arrest registry from November 2005 to November 2016. Cardiac arrest in the cardiac catheterization laboratory was defined as the need for chest compressions greater than or equal to 1 minute in the cardiac catheterization laboratory. Primary outcome was survival to discharge. Variables analyzed using generalized estimating equations for association with survival included age, illness category (surgical cardiac, medical cardiac), preexisting conditions, pharmacologic interventions, and event duration.

Setting: American Heart Association’s Get With the Guidelines-Resuscitation registry of in-hospital cardiac arrest.

Patients: Consecutive patients less than 18 years old experiencing an index (i.e., first) cardiac arrest event reported to the Get With the Guidelines-Resuscitation.

Interventions: None.

Measurements and Main Results: A total of 203 patients met definition of index cardiac arrest in the cardiac catheterization laboratory composed primarily of surgical and medical cardiac patients (54% and 41%, respectively). Children less than 1 year old comprised the majority of patients, 58% (117/203). Overall survival to hospital discharge was 69% (141/203). No differences in survival were observed between surgical and medical cardiac patients (p = 0.15). The majority of deaths (69%, 43/62) occurred in patients less than 1 year old. Bradycardia (with pulse) followed by pulseless electrical activity/asystole were the most common first documented rhythms observed (50% and 27%, respectively). Preexisting metabolic/electrolyte abnormalities (p = 0.02), need for vasoactive infusions (p = 0.03) prior to arrest, and use of calcium products (p = 0.005) were found to be significantly associated with lower rates of survival to discharge on multivariable regression.

Conclusions: The majority of children experiencing cardiac arrest in the cardiac catheterization laboratory in this large multicenter registry analysis survived to hospital discharge, with no observable difference in outcomes between surgical and medical cardiac patients. Future investigations that focus on stratifying medical complexity in addition to procedural characteristics at the time of catheterization are needed to better identify risks for mortality after cardiac arrest in the cardiac catheterization laboratory.

1Divisions of Critical Care Medicine and Cardiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX.

2Division of Cardiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX.

3Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX.

4Division of Cardiology, Bloomberg Children’s Center, Johns Hopkins School of Medicine, Baltimore, MD.

5Division of Cardiology, C.S. Mott Children’s Hospital, Ann Arbor, MI.

6Section of Pediatric Cardiac Intensive Care, Medical City Children’s Hospital, Dallas, TX.

*See also p 1092.

The full list of the American Heart Association’s Get With the Guidelines-Resuscitation Investigators are listed in Appendix 1.

The full list of the American Heart Association’s Get With the Guidelines-Resuscitation Investigators are listed in Appendix 1.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/pccmjournal).

Supported, in part, by grant from the Texas Children’s Hospital departmental funds were used for this study. The scientific advisory board of the American Heart Association (AHA) provided review and approval of the article, and the Executive Database Steering Committee of the AHA provided additional peer review of the article before submission.

Part of the content of this article was presented in poster abstract format at the American Heart Association’s Scientific Sessions, November 12, 2017, Anaheim, CA.

The authors have disclosed that they do not have any potential conflicts of interest.

Address requests for reprints to: Javier J. Lasa, MD, FAAP, Department of Pediatrics, Divisions of Critical Care Medicine and Cardiology, Texas Children’s Hospital/Baylor College of Medicine, MC: E1420, 6651 Main Street, Houston, TX 77030. E-mail: jjlasa@texaschildrens.org

Copyright © 2019 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies