School of Medicine and Health Sciences Poster Presentations

Title

Impact of a Dedicated Cardiac Anesthesiology Team on Peri-Operative Outcomes in Children with Congenital Heart Disease Undergoing Non-Cardiac Procedures

Poster Number

171

Document Type

Poster

Status

Medical Student

Abstract Category

Clinical Specialties

Keywords

Cardiac Anesthesia, Congenital Heart Disease

Publication Date

Spring 2018

Abstract

Children with Congenital Heart Disease (CHD) undergoing noncardiac surgery are at higher risk for adverse perioperative (Ramammorthy, 2010, Faraoni, 2016) and less likely to survive cardiac arrest (Ramammorthy, 2010). The perioperative team is often confronted with the question about who should care for these patients when undergoing non cardiac surgery. Our objective was to identify those patients at highest risk for adverse outcomes and to examine if using a risk stratified approach to allocate care of these patients would mitigate the risk of adverse events under anesthesia.

We conducted a single center retrospective cohort study of children with CHD who underwent non cardiac surgery between June 2014 - December 2015. Perioperative outcomes and survival data were reviewed and compared to that reported in the literature.

We identified 131 patients with CHD undergoing a total of 171 non-cardiac surgical procedures during the study period all cared for by a cardiac anesthesiologist. The majority of patients taken care of by the cardiac anesthesia team had either major (45%) or severe (45%) CHD when utilizing the ACSNSQIP classification system. Patients with severe CHD represented the highest risk for perioperative events accounting for all intra-and post- operative cardiac arrest events at 0.6% (CI 0.0-3.2) and 1.7% (0.4-5.0) respectively. Moreover, patients with severe CHD accounted for the majority (83.3%) of the 3.5% (CI 1.3-7.5) of patients requiring post-operative reintubation. There was no correlation between age, sex, type of surgery and perioperative arrest/30 day mortality.

Children with severe CHD are at increased risk of perioperative complications including cardiac arrest, death, and reintubation. At Children’s National Medical Center these patients undergo a comprehensive risk stratification and multidisciplinary planning which includes intraoperative care by a dedicated cardiac anesthesia team and the incidence of intraoperative cardiac arrest is below what has been reported in the literature.

References:

Faraoni, D., Zurakowski, D., Vo, D., Goobie, S. M., Yuki, K., Brown, M. L., & DiNardo, J. A. (2016). Post-operative outcomes in children with and without congenital heart disease undergoing noncardiac surgery. Journal of the American College of Cardiology, 67(7), 793-801.

Ramamoorthy C Haberkern CM Bhananker SM, et al. Anesthesia-related cardiac arrest in children with heart disease: data from the Pediatric Perioperative Cardiac Arrest (POCA) registry, Anesth Analg, 2010, vol. 110 (pg.1376-82)

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Open Access

1

This document is currently not available here.

Share

COinS
 

Impact of a Dedicated Cardiac Anesthesiology Team on Peri-Operative Outcomes in Children with Congenital Heart Disease Undergoing Non-Cardiac Procedures

Children with Congenital Heart Disease (CHD) undergoing noncardiac surgery are at higher risk for adverse perioperative (Ramammorthy, 2010, Faraoni, 2016) and less likely to survive cardiac arrest (Ramammorthy, 2010). The perioperative team is often confronted with the question about who should care for these patients when undergoing non cardiac surgery. Our objective was to identify those patients at highest risk for adverse outcomes and to examine if using a risk stratified approach to allocate care of these patients would mitigate the risk of adverse events under anesthesia.

We conducted a single center retrospective cohort study of children with CHD who underwent non cardiac surgery between June 2014 - December 2015. Perioperative outcomes and survival data were reviewed and compared to that reported in the literature.

We identified 131 patients with CHD undergoing a total of 171 non-cardiac surgical procedures during the study period all cared for by a cardiac anesthesiologist. The majority of patients taken care of by the cardiac anesthesia team had either major (45%) or severe (45%) CHD when utilizing the ACSNSQIP classification system. Patients with severe CHD represented the highest risk for perioperative events accounting for all intra-and post- operative cardiac arrest events at 0.6% (CI 0.0-3.2) and 1.7% (0.4-5.0) respectively. Moreover, patients with severe CHD accounted for the majority (83.3%) of the 3.5% (CI 1.3-7.5) of patients requiring post-operative reintubation. There was no correlation between age, sex, type of surgery and perioperative arrest/30 day mortality.

Children with severe CHD are at increased risk of perioperative complications including cardiac arrest, death, and reintubation. At Children’s National Medical Center these patients undergo a comprehensive risk stratification and multidisciplinary planning which includes intraoperative care by a dedicated cardiac anesthesia team and the incidence of intraoperative cardiac arrest is below what has been reported in the literature.

References:

Faraoni, D., Zurakowski, D., Vo, D., Goobie, S. M., Yuki, K., Brown, M. L., & DiNardo, J. A. (2016). Post-operative outcomes in children with and without congenital heart disease undergoing noncardiac surgery. Journal of the American College of Cardiology, 67(7), 793-801.

Ramamoorthy C Haberkern CM Bhananker SM, et al. Anesthesia-related cardiac arrest in children with heart disease: data from the Pediatric Perioperative Cardiac Arrest (POCA) registry, Anesth Analg, 2010, vol. 110 (pg.1376-82)