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(Circulation. 1999;100:II-194.)
© 1999 American Heart Association, Inc.

Surgery for Congenital Heart Disease

Cardiac Arrest in Infants After Congenital Heart Surgery

John F. Rhodes, MD; Andrew D. Blaufox, MD; Howard S. Seiden, MD; Jeremy D. Asnes, MD; Ronda P. Gross, RN, MSN; Julianna P. Rhodes, RN, BSN; Randall B. Griepp, MD; Anthony F. Rossi, MD

From the Departments of Pediatric Cardiology and Cardiothoracic Surgery, The Mount Sinai Medical Center, New York, NY. Dr Rhodes is currently at The Cleveland Clinic, Cleveland, Ohio.

Correspondence to Howard S. Seiden, MD, The Division of Pediatric Cardiology, The Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1201, New York, NY 10029. E-mail howard_seiden{at}smtplink.mssm.edu

Background—The survival rate to discharge after a cardiac arrest in a patient 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 cardiac arrest after congenital heart surgery are unknown.

Methods and Results—Infants in our pediatric cardiac intensive care unit database were identified who had a postoperative cardiac arrest between January 1994 and June 1998. Parameters from the perioperative, prearrest, and resuscitation periods were analyzed for these patients. Comparisons were made between survivors and nonsurvivors. Of 575 infants who underwent congenital heart surgery, 34 (6%) sustained a documented cardiac arrest; of these, 14 (41%) survived to discharge. Perioperative parameters, ventricular physiology, and primary rhythm at the time of arrest did not influence outcome. Prearrest blood pressure was lower in nonsurvivors than in survivors (P<0.001). 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 higher minimal arterial pH (P<0.02) and received a smaller total dose of medication during the resuscitation. Although survivors had an overall shorter duration of resuscitation, 5 of 22 patients (23%) survived to discharge despite 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 after cardiac arrest. Infants with more hemodynamic compromise before the arrest as demonstrated with lower mean arterial blood pressure and higher inotropic support were less likely to survive. The use of predetermined resuscitation end points in this subpopulation may not be justified.

Key Words: heart defects, congenital • cardiopulmonary resuscitation • pediatrics • surgery