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

Abstract

Introduction In patients with parallel circulation, early risk factor identification for adverse outcome can facilitate prevention. This retrospective study compares vital sign parameters, near infrared spectroscopy, central venous pressure, hemoglobin, serum lactate, and vasoinotrope score in the first 48 hours between those with parallel circulation with and without a composite adverse outcome after Blalock-Taussig-Thomas shunt placement. Methods Hemodynamic variables were collected at the following postoperative timepoints: admission to the cardiac intensive care unit, 6 hours, 12 hours, 24 hours, and 48 hours after. Outcomes of interest included cardiopulmonary arrest, need for extracorporeal membrane oxygenation, or inpatient mortality during the admission. Results Of the 39 neonates in the study, 10 experienced the composite outcome. Four variables had a receiver operator curve analysis area under the curve of > 0.60. The resulting risk score was as follows, with 1 point being assigned for a central venous pressure greater than 7.8, 1 point for a serum lactate greater than 1.8, renal oxygen extraction ratio of greater than 32, and vasoinotrope score of greater than 8.7. A score of 0 was associated with a 0% risk of the composite outcome, a score of 1 or 2 a 15% risk, and a score of 3 or 4 a 60% risk. Conclusion A combination of increased central venous pressure, increased serum lactate, increased renal oxygen extraction ratio, and increased vasoinotrope score are highly accurately associated with risk of cardiopulmonary arrest, need for extracorporeal membrane oxygenation, or inpatient mortality after a Blalock-Taussig-Thomas shunt in patients with parallel circulation.