Background-The management of neonates with complex congenital anomalies depends on careful interpretation of arterial blood gas values. Improved interpretation of these oxygen parameters may allow clinicians to avoid unexpected cardiovascular events. This study examined whether systemic oxygen delivery (DO 2 ) can be maximized by the use of indices derived from oxygen saturation measurements in neonates with hypoplastic left heart syndrome. Methods and Results-For the single-ventricle heart with both circulations in parallel, we used a previously developed computer simulation to obtain DO 2 as a function of systemic arterial (SaO 2 ) and venous (SvO 2 ) oxygen saturation, arteriovenous oxygen difference (Sa-vO 2 ), or pulmonary-to-systemic flow ratio (Qp/Qs). We also examined the oxygen excess factor, SaO 2 /Sa-vO 2 (⍀). We found that (1)

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 (PϽ0.001). A high level of inotropic support prearrest was associated with death (Pϭ0.06). Survivors had a shorter duration of resuscitation (PϽ0.001) and higher minimal arterial pH (PϽ0.02) 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 Ͼ30 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. (Circulation. 1999;100[suppl II]:II-194-II-199.

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We were not able to detect a difference in postoperative morbidity or mortality associated with the presence of a dedicated CICU for children undergoing heart surgery. There may be a survival benefit in certain subgroups .

Cardiac operations in a selected group of infants weighing 2 kg or less can provide acceptable hospital survival. In most instances, complete repair is possible with good medium-term outcome in the survivors. Investigation into neurologic outcomes in these patients is warranted.