HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Suominen, P. Articles by Räsänen, J. Search for Related Content PubMed PubMed Citation Articles by Suominen, P. Articles by Räsänen, J. Related Collections Cardiac - other Congenital - cyanotic

Eur J Cardiothorac Surg 2001;19:127-134
© 2001 Elsevier Science NL

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

^a Helsinki University Central Hospital, Department of Anaesthesia and Intensive Care, Hospital for Children and Adolescent, University of Helsinki, Stenbäckinkatu 9, Finland 00029 HUS, Finland
^b Department of Pediatric Surgery, Hospital for Children and Adolescents, University of Helsinki, Stenbäckinkatu 9, Finland 00029 HUS, Finland
^c Department of Anaesthesia and Intensive Care, University of Helsinki, Finland 00029 HUS, Finland
^d Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA

Received 15 May 2000; received in revised form 20 November 2000; accepted 6 December 2000.

Corresponding author. Tel.: +358-9-471-73724; fax: +358-9-471-76711
e-mail: pertti.suominen{at}huch.fi

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 cardiopulmonary 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 patients 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 DHCA in 1994 (n=278). Results: Eighty-two children experienced CA during postoperative 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 intra-cardiac surgery without DHCA, and 27% for operations involving DHCA. Thirty-three per cent of patients with CA arrested during the first 24 postoperative 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 control groups. Patients in whom CPR was attempted were younger than the 1994 controls (0.4 vs. 1.2 years; P<0.04), had longer mean aortic-cross-clamp times (76 vs. 51 min; P<0.0001) and cardiopulmonary bypass times (124 vs. 85 min; P<0.0002), and required more inotropic support upon leaving the operating room (P<0.0001). Patients who received CPR had significantly longer DHCA times (53 vs. 32 min; P<0.0002) and required more inotropic support than patients in the DHCA control group (P<0.002). Conclusions: CA after pediatric cardiac surgery is associated with repair of complex congenital heart anomalies in patients who require preoperative mechanical ventilation and vasoactive agents, prolonged aortic cross-clamp, circulatory arrest; and heavy postoperative inotropic support.

Key Words: Cardiac arrest • Paediatric resuscitation • Aortic-cross-clamp • Cardiopulmonary bypass • Deep hypothermic circulatory arrest • Inotropes