Aims & Objectives:
In-hospital cardiac arrest (IHCA) in children following cardiac surgery carries high mortality, however, it is not known how timing of arrest impacts outcome. This project aimed to identify potential associations between time to IHCA and outcomes.
Between 2007 and 2016, 3911 children underwent cardiac surgery, 179 suffered an IHCA (4.6%). Median age was 19 days (IQR 5–101), median weight was 3.5kgs (IQR 2.8–4.6). Time to IHCA following cardiac surgery was categorised as <12 hours (n=78, 44%), 12–48 hours (n=32, 18%) and >48 hours (n=69, 38%). Multivariable logistic and linear regression models (controlled for age, sex, surgical complexity, admission vasoactive inotropic score and cardiopulmonary bypass time) examined associations between time to IHCA with hospital survival and intensive care length of stay (ICU LOS).
Hospital survival was 70% among those who suffered IHCA and 98% among those who did not arrest. Longer time to IHCA was associated with lower survival: [reference <12 hours]: for 12–48 hours adjusted OR 0.32 [95% CI 0.09–1.1]; for >48 hours, adjusted OR 0.13 [95% CI 0.04–0.39]. Among survivors, late timing of IHCA was associated with longer ICU LOS: [reference <12 hours]; for 12–48 hours: 98% longer stay (95% CI 27–208); for >48 hours 50% longer stay (95% CI 2–119). Location and aetiology of IHCA also varied between the groups.
Over one-third of IHCAs occur >48 hours after surgery. These children have both lower survival rates and longer ICU stays. This important information could be further explored for both prognostication and quality improvement.