Original ArticleChanging Risk of In-Hospital Cardiac Arrest in Children Following Cardiac Surgery in Victoria, Australia, 2007–2016
Introduction
Recent single centre studies and registry reports suggest that in-hospital cardiac arrest (IHCA) occurs in 3% to 4% of children following cardiac surgery [1], [2], [3]. This rate is much higher in high risk groups, such as children undergoing complex operations and those who have had a previous cardiac arrest, with IHCA rates reaching up to 20% in these children [1], [3], [4], [5]. While the majority of IHCA following cardiac surgery occurs in the highly monitored intensive care setting, outcomes are still poor with hospital mortality approaching 30–50% and poor neurological outcomes in up to 25% of survivors [4], [6], [7].
Collected reviews from several investigators over the last 15 years suggest that both the incidence of, and survival following, IHCA after cardiac surgery is improving. Incidence has fallen to 3–4% from 6–10% and survival has risen to 70% from 19% [1], [3], [4], [8], [9], [10], [11]. These estimates, however, come from different regions, with studies conducted at different time periods and utilising differing definitions of IHCA. Genuine changes in IHCA rates after cardiac surgery over time can only be inferred from such reports. In addition, there has been limited discussion about factors that might have had an impact on changes in IHCA rate. Monitoring IHCA trends and understanding factors that may have influenced these trends is a high priority for quality improvement. In this report, we analyse changes in the rates of IHCA and mortality in children experiencing IHCA following cardiac surgery, and discuss factors which may have influenced these changes over a 10-year period.
Section snippets
Study Population and Setting
The study was undertaken at the Royal Children’s Hospital, Melbourne (RCH), Australia. The institution is a referral centre for specialised paediatric cardiac services and performs all major paediatric cardiac surgeries for children from the Australian states of Victoria, Tasmania, South Australia, Northern Territory and Western Australia, encompassing a population of approximately eight million. The Paediatric Intensive Care Unit (PICU) is a 30-bed multidisciplinary unit with a dedicated
Study Population and Baseline Characteristics
We analysed data from 3,781 children with congenital heart disease who underwent 4,938 surgeries during a 10-year period. A total of 382 episodes of IHCA were identified. After 171 exclusions (Figure 1), there were 211 IHCA events following surgery that met inclusion criteria. Children who had IHCA were younger, more likely to be female, to have had a preterm birth and to have an underlying chromosomal or genetic syndrome association (Table 1). Children who experienced IHCA suffered
Major Findings
In this analysis involving 3,781 children who underwent 4,938 cardiac surgeries, we noted a 52% reduction in the rate of IHCA over a 10-year period. The IHCA rate based on the most recent period (2015–16) was 2.6%. However, this decrease was only seen in low to moderate risk surgeries (RACHS-1 categories 1–4), with no change in high risk surgeries. Children undergoing high risk surgeries were 13.6 times more likely to experience IHCA and were less likely to survive to hospital discharge
Conclusions
In conclusion, data from this single, large centre study shows that there was a 52% reduction in the rate of IHCA in children following cardiac surgery over the 10-year study period. This reduction was likely possible for many reasons, including personnel and organisational factors and evolving developments in the care of children requiring cardiac surgery. The fall in IHCA rate, along with a fall in mortality among patients experiencing an IHCA, is likely to have contributed to reductions in
Conflicts of Interest
No potential conflicts of interest exist for any of the authors.
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Acknowledgements
We would like to thank the PICU data research team and staff in the Paediatric Intensive Care Unit and Cardiac services at the Royal Children’s Hospital, Melbourne. Dr Siva Namachivayam is supported by a Health Professional Scholarship (ID: 101603) from the National Heart Foundation of Australia.
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