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Epidemiology and outcomes after in-hospital cardiac arrest after pediatric cardiac surgery.

Publication ,  Journal Article
Gupta, P; Jacobs, JP; Pasquali, SK; Hill, KD; Gaynor, JW; O'Brien, SM; He, M; Sheng, S; Schexnayder, SM; Berg, RA; Nadkarni, VM; Imamura, M ...
Published in: Ann Thorac Surg
December 2014

BACKGROUND: Multicenter data regarding cardiac arrest in children undergoing heart operations are limited. We describe epidemiology and outcomes associated with postoperative cardiac arrest in a large multiinstitutional cohort. METHODS: Patients younger than 18 years in the Society of Thoracic Surgeons Congenital Heart Surgery Database (2007 through 2012) were included. Patient factors, operative characteristics, and outcomes were described for patients with and without postoperative cardiac arrest. Multivariable models were used to evaluate the association of center volume with cardiac arrest rate and mortality after cardiac arrest, adjusting for patient and procedural factors. RESULTS: Of 70,270 patients (97 centers), 1,843 (2.6%) had postoperative cardiac arrest. Younger age, lower weight, and presence of preoperative morbidities (all p < 0.0001) were associated with cardiac arrest. Arrest rate increased with procedural complexity across common benchmark operations, ranging from 0.7% (ventricular septal defect repair) to 12.7% (Norwood operation). Cardiac arrest was associated with significant mortality risk across procedures, ranging from 15.4% to 62.3% (all p < 0.0001). In multivariable analysis, arrest rate was not associated with center volume (odds ratio, 1.06; 95% confidence interval, 0.71 to 1.57 in low- versus high-volume centers). However, mortality after cardiac arrest was higher in low-volume centers (odds ratio, 2.00; 95% confidence interval, 1.52 to 2.63). This association was present for both high- and low-complexity operations. CONCLUSIONS: Cardiac arrest carries a significant mortality risk across the stratum of procedural complexity. Although arrest rates are not associated with center volume, lower-volume centers have increased mortality after cardiac arrest. Further study of mechanisms to prevent cardiac arrest and to reduce mortality in those with an arrest is warranted.

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Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

December 2014

Volume

98

Issue

6

Start / End Page

2138 / 2143

Location

Netherlands

Related Subject Headings

  • United States
  • Retrospective Studies
  • Respiratory System
  • Prognosis
  • Prevalence
  • Postoperative Period
  • Male
  • Infant, Newborn
  • Infant
  • Incidence
 

Citation

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MLA
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Gupta, P., Jacobs, J. P., Pasquali, S. K., Hill, K. D., Gaynor, J. W., O’Brien, S. M., … Jacobs, M. L. (2014). Epidemiology and outcomes after in-hospital cardiac arrest after pediatric cardiac surgery. Ann Thorac Surg, 98(6), 2138–2143. https://doi.org/10.1016/j.athoracsur.2014.06.103
Gupta, Punkaj, Jeffrey P. Jacobs, Sara K. Pasquali, Kevin D. Hill, J William Gaynor, Sean M. O’Brien, Max He, et al. “Epidemiology and outcomes after in-hospital cardiac arrest after pediatric cardiac surgery.Ann Thorac Surg 98, no. 6 (December 2014): 2138–43. https://doi.org/10.1016/j.athoracsur.2014.06.103.
Gupta P, Jacobs JP, Pasquali SK, Hill KD, Gaynor JW, O’Brien SM, et al. Epidemiology and outcomes after in-hospital cardiac arrest after pediatric cardiac surgery. Ann Thorac Surg. 2014 Dec;98(6):2138–43.
Gupta, Punkaj, et al. “Epidemiology and outcomes after in-hospital cardiac arrest after pediatric cardiac surgery.Ann Thorac Surg, vol. 98, no. 6, Dec. 2014, pp. 2138–43. Pubmed, doi:10.1016/j.athoracsur.2014.06.103.
Gupta P, Jacobs JP, Pasquali SK, Hill KD, Gaynor JW, O’Brien SM, He M, Sheng S, Schexnayder SM, Berg RA, Nadkarni VM, Imamura M, Jacobs ML. Epidemiology and outcomes after in-hospital cardiac arrest after pediatric cardiac surgery. Ann Thorac Surg. 2014 Dec;98(6):2138–2143.
Journal cover image

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

December 2014

Volume

98

Issue

6

Start / End Page

2138 / 2143

Location

Netherlands

Related Subject Headings

  • United States
  • Retrospective Studies
  • Respiratory System
  • Prognosis
  • Prevalence
  • Postoperative Period
  • Male
  • Infant, Newborn
  • Infant
  • Incidence