Perioperative determinants and outcome of cardiopulmonary arrest in children after heart surgery

Objectives: To identify perioperative factors associated with postoperative cardiopulmonary arrest (CA) in the pediatric intensive care unit (PICU) in children undergoing cardiovascular surgery, and to report the outcome of c ardiopulmonary resuscitation (CPR) in these patients. Methods: We reviewed the medical records of all patients under 16 years of age who had undergone cardiovascular surgery and sustained CA in PICU in an urban, tertiary care children's hospital over a 5-year period. We used two control groups of pa tients who recovered without CA. (1) Sixty-five patients, who were operated under deep hypothermic circulatory arrest (DHCA) during the study period. (2) All patients who underwent repair of congenital heart lesions without D HCA in 1994 (n = 278). Results: Eighty-two children experienced CA during p ostoperative care in PICU, mainly from cardiovascular causes. Thirty-four ( 41%) were declared dead without attempted resuscitation, CPR was initiated in 48 (59%). The primary survival rate was 56% and 1 year survival rate was 19%. The incidence of CA was 3.6% for closed heart operations, 4.9% for in tra-cardiac surgery without DHCA, and 27% for operations involving DHCA. Th irty-three per cent of patients with CA arrested during the first 24 postop erative h. Preoperative mechanical ventilation (P = 0.03), prostaglandin E1 (P = 0.001) and inotropic support (P = 0.04) were given significantly more frequently to patients who postoperatively required CPR, compared to contr ol groups. Patients in whom CPR was attempted were younger than the 1994 co ntrols (0.4 vs. 1.2 years; P < 0.04), had longer mean aortic-cross-clamp ti mes (76 vs. 51 min; P < 0.0001) and cardiopulmonary bypass times (124 vs. 8 5 min; P < 0.0002), and required more inotropic support upon leaving the op erating room (P < 0.0001). Patients who received CPR had significantly long er DHCA times (53 vs. 32 min: P < 0.0003) and required more inotropic suppo rt than patients in the DHCA control group (P < 0.002). Conclusions: CA aft er pediatric cardiac surgery is associated with repair of complex congenita l heart anomalies in patients who require preoperative mechanical ventilati on and vasoactive agents, prolonged aortic cross-clamp, circulatory arrest; and heavy postoperative inotropic support. (C) 2001 Elsevier Science B.V. All rights reserved.