Cardiac arrest in infants after congenital heart surgery

Background-The survival rate to discharge after a cardiac arrest in a patie nt in the pediatric intensive care unit is reported to be as low as 7%. The survival rates and markers for survival strictly regarding infants with ca rdiac arrest after congenital heart surgery are unknown. Methods and Results-Infants in our pediatric cardiac intensive carl unit da tabase were identified who had a postoperative cardiac arrest between Janua ry 1994 and June 1998. Parameters from the perioperative, prearrest, and re suscitation periods were analyzed for these patients. Comparisons were mode between survivors and nonsurvivors. Of 575 infants who underwent congenita l heart surgery, 34 (6%) sustained a documented cardiac arrest; of these, 1 4 (41%) survived to discharge. Perioperative parameters, ventricular physio logy, and primary rhythm at the time of arrest did not influence outcome. P rearrest blood pressure was lower in nonsurvivors than in survivors (P<0.00 1). A high level of inotropic support prearrest was associated with death ( P=0.06). Survivors had a shorter duration of resuscitation (P<0.001) and hi gher minimal arterial pH (P<0.02) and received a smaller total dose of medi cation during the resuscitation. Although survivors had an overall shorter duration of resuscitation, 5 of 22 patients (23%) survived to discharge des pite resuscitation of >30 minutes. Conclusions-The outcome of cardiac arrest in infants after congenital heart surgery was better than that for pediatric intensive care unit populations as a whole. Univentricular physiology did not increase the risk of death a fter cardiac arrest. Infants with more hemodynamic compromise before the ar rest as demonstrated with lower mean arterial blood pressure and higher ino tropic support were less likely to survive. The use of predetermined resusc itation end points in this subpopulation may not be justified.