Central Venous Oxygen Saturation/Lactate Ratio and Prediction of Major Adverse Events after Pediatric Heart Surgery

Abstract

Introduction Major adverse events (MAE) are unexpected but undesirably frequent after pediatric congenital heart surgery and contribute to poorer outcomes. The aim of this study was to test the predictive value of a ratio between central venous oxygen saturation and arterial lactate (ScvO2/lactate) for MAE after pediatric congenital heart surgery in a Brazilian university hospital. Methods We conducted a retrospective observational study in a tertiary care university hospital, including 194 infants and children submitted to surgery for congenital heart disease. The predictive value of ScvO2, lactate, and ScvO2/lactate ratio were assessed by the area under the receiver operating characteristics curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results The incidence of MAE was 16% — cardiac arrest/death, unplanned reoperation, and low cardiac output syndrome were the most common events. Overall, ScvO2/lactate ratio discriminated patients with and without MAE very well (AUC 0.842), performing better than either variable alone, with sensitivity of 48%, specificity of 94%, PPV of 60%, and NPV of 91%. Conclusion A ScvO2/lactate ratio > 5 can accurately identify patients at low risk of MAE after pediatric congenital heart surgery, with very good specificity and NPV, but poor sensitivity and PPV.

Clinical parameters to predict adverse outcomes in patients with shunt-dependent physiology with a Blalock–Taussig–Thomas shunt

“…Previous studies have identified factors associated with cardiopulmonary arrest in critically ill children. Previous studies have demonstrated ST-segment variability, vasoactive-inotrope score, higher inadequate oxygen delivery index, venous saturation, serum lactate, cerebral dysfunction by electroencephalography, a history of a previous cardiac arrest, specific cardiac lesions, and specific cardiac surgeries among others[ 3 4 5 6 7 8 9 10 11 12 13 14 15 16 ] as risk factors for adverse outcomes. Risk factors for mortality have often mirrored the risk factors for cardiac arrest.…”

The prognostic value of cerebral oxygen saturation, lactate and mixed venous oxygen levels in predicting the major adverse events during pediatric cardiac surgery

“…The survival rate in children that underwent congenital heart surgery has steadily increased in the past several decades due to technological developments and appropriate postoperative care to the point that the perioperative mortality rate has decreased below 5%. However, major adverse events (MAEs), which develop unexpectedly and adversely affect surgical outcomes, continue to be a major concern (2). MAEs include sudden cardiac arrest/death, unscheduled emergency re-operation, and low cardiac output syndrome (LCOS).…”

“…The complexity of CHDs and many different complications that may develop after congenital heart surgeries pose serious difficulties in managing the patients and making the right decision about the treatment approach to be adopted. To overcome these difficulties, different methods are employed, including physical examination, non-invasive/invasive hemodynamic measurements, scoring systems, measurement of cerebral oxygen saturation levels by near-infrared spectroscopy (NIRS-ScO2), and measurement of lactate and mixed venous blood oxygen saturation (MVO) levels (2)(3)(4). Serum lactate, MVO, and NIRS-ScO2 levels are used as indirect markers secondary to tissue hypoxia, which is used to assess the insufficiency of oxygen transport to the periphery.…”

“…In addition, they found that high lactate levels, extended CPB durations, high CO2 difference, and base deficit values in patients followed up in ICU were associated with MAE. Rocha et al(2) found the incidence of MAE to be 16% in their series of 194 cases, and they concluded that MVO/lactate >5 is a good marker for low MAE risk. In a series of 257 cases that underwent pediatric cardiac surgery by Murni et al,(17) the incidence of MAE and mortality were found as 19% and 13%, respectively.…”

Clinical parameters to predict adverse outcomes in patients with parallel circulation with a Blalock-Taussig-Thomas shunt

“…The resulting score had an area under the curve of 0.84 with an optimal Previous studies have identi ed factors associated with cardiopulmonary arrest in critically ill children. Previous studies have demonstrated ST-segment variability, vasoinotrope score, higher inadequate oxygen delivery index, venous saturation, serum lactate, cerebral dysfunction by electroencephalography, a history of a previous cardiac arrest, speci c cardiac lesions, and speci c cardiac surgeries among others[3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Risk factors for mortality have often mirrored the risk factors for cardiac arrest.…”