Risk Factors for Adverse Events in Children with Pulmonary Hypertension Undergoing Cardiac Catheterization

Vaiyani, Danish; Kelleman, Michael; Downey, Laura; Kanaan, Usama; Petit, Christopher J.; Bauser‐Heaton, Holly

doi:10.1007/s00246-020-02535-4

Cited by 9 publications

(13 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In general, this approach appears safe, with serious adverse event rates similar to previous reports. [6][7][8][9][10][11]15,[20][21][22][23]36 However, limitations of this report are noteworthy, particularly its retrospective nature and small sample size. Thus, conclusions regarding differences in hemodynamics and outcomes associated with the choice of an invasive versus noninvasive airway cannot be made or insinuated.…”

Section: Discussionmentioning

confidence: 87%

“…Most importantly, a careful, thoughtful overall anesthetic approach with an experienced pediatric cardiac anesthesiology and PH collaborative team, that includes specialized areas for pre-and postprocedural monitoring, is vital to reducing adverse events and optimizing data acquisition. [6][7][8][9][10][11][15][16][17][20][21][22][23][24][25]36,43,44 AUTHOR CONTRIBUTIONS Each author has participated sufficiently in the work including substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data, and has drafted or revised this manuscript critically for important intellectual content and final approval of the version to be submitted and published. Each author takes full responsibility for the integrity of the work as a whole, from inception to published article.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8][9][10][11][15][16][17][18][19][20][21][22][23] Identified risk factors during cardiac catheterization include younger age, longer duration of procedure, suprasystemic pulmonary arterial pressures, right ventricular dysfunction, advanced functional class (III/IV), and treatment naiveté. [6][7][8][9][10][11][15][16][17][18][19][20][21]23 However, the type of anesthesia or respiratory support utilized has not been clearly identified as a risk factor. 11,17,[19][20][21][22][23][24][25] Thus, there is a lack of consensus regarding the optimal anesthetic regimen and respiratory support for pediatric pulmonary vascular disease cardiac catheterization.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A single institution anesthetic experience with catheterization of pediatric pulmonary hypertension patients

Morell,

Colglazier,

Becerra

et al. 2024

Pulm. circ.

View full text Add to dashboard Cite

Cardiac catheterization remains the gold standard for the diagnosis and management of pediatric pulmonary hypertension (PH). There is lack of consensus regarding optimal anesthetic and airway regimen. This retrospective study describes the anesthetic/airway experience of our single center cohort of pediatric PH patients undergoing catheterization, in which obtaining hemodynamic data during spontaneous breathing is preferential. A total of 448 catheterizations were performed in 232 patients. Of the 379 cases that began with a natural airway, 274 (72%) completed the procedure without an invasive airway, 90 (24%) received a planned invasive airway, and 15 (4%) required an unplanned invasive airway. Median age was 3.4 years (interquartile range [IQR] 0.7–9.7); the majority were either Nice Classification Group 1 (48%) or Group 3 (42%). Vasoactive medications and cardiopulmonary resuscitation were required in 14 (3.7%) and eight (2.1%) cases, respectively; there was one death. Characteristics associated with use of an invasive airway included age <1 year, Group 3, congenital heart disease, trisomy 21, prematurity, bronchopulmonary dysplasia, WHO functional class III/IV, no PH therapy at time of case, preoperative respiratory support, and having had an intervention (p < 0.05). A composite predictor of age <1 year, Group 3, prematurity, and any preoperative respiratory support was significantly associated with unplanned airway escalation (26.7% vs. 6.9%, odds ratio: 4.9, confidence interval: 1.4–17.0). This approach appears safe, with serious adverse event rates similar to previous reports despite the predominant use of natural airways. However, research is needed to further investigate the optimal anesthetic regimen and respiratory support for pediatric PH patients undergoing cardiac catheterization.

show abstract

Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A single institution anesthetic experience with catheterization of pediatric pulmonary hypertension patients

Morell,

Colglazier,

Becerra

et al. 2024

Pulm. circ.

View full text Add to dashboard Cite

show abstract

“…1,10,11,15,16 The incidence of cardiac arrests during cardiac catheterisation procedures has been reported to be as high as 0.3 to 3.0% in the literature. [21][22][23][24][25][26] Our cohort consisted of 35 (55.6%) catheterisation procedures in patients with heart disease; 19 cardiac arrests were related to the cardiology wire and successfully resuscitated in the operating room.…”

Section: Discussionmentioning

confidence: 99%

Incidences and outcomes of intra-operative vs. postoperative paediatric cardiac arrest

Rattana-Arpa,

Chaikittisilpa,

Srikongrak

et al. 2023

European Journal of Anaesthesiology

View full text Add to dashboard Cite

Postoperative cardiac arrest resulted in significantly longer cardiopulmonary resuscitation duration and higher mortality rates than intra-operative cardiac arrest. Fifty-nine percent of postoperative cardiac arrests were airway and respiration-related. Cardiac arrest is often the last event after progressive deterioration, and may be preventable in some cases by a higher level of care. A high level of care should be extended up to 24 h after anaesthesia completion.

show abstract

“…While previous studies have reported on the morbidity and mortality risk of RHC in patients with pulmonary hypertension [8,14,24] not all of them were focused solely on pediatric patients, and to our knowledge, this is the largest study assessing morbidity and mortality as well as risk factors for adverse outcomes in a large contemporary Chinese population.…”

Section: Discussionmentioning

confidence: 99%

Right Heart Catheterization in Pediatric Pulmonary Arterial Hypertension: Insights and Outcome from a Large Tertiary Center

Zhang

Arvanitaki

et al. 2022

JCM

View full text Add to dashboard Cite

Aim: To define the clinical characteristics, hemodynamics, and adverse events for pediatric patients with pulmonary arterial hypertension (PAH) undergoing right heart catheterization (RHC). Methods: The large referral single center data of 591 diagnostic RHC procedures performed between 2005 and 2020 on pediatric PAH patients was retrospectively collected and analyzed. Results: A total of 591 RHC procedures performed on 469 patients with congenital heart disease (CHD)-PAH (median age 8.8 years, 7.9% New York Heart Association (NYHA) class > II, 1.5% with syncope) and 122 patients with idiopathic PAH (median age of 9.0 years, 27.0% NYHA class > II, 27.0% with syncope) were included. Of those, 373 (63.1%) procedures were performed under general anesthesia. Eighteen patients (18/591, 3.0%) suffered adverse events (mainly pulmonary hypertensive crisis, PHC, n = 17) during the RHC procedure, including 14 idiopathic pulmonary arterial hypertension (IPAH) patients and 4 CHD-PAH patients, and one IPAH patient died in hospital 63 hours after RHC. The risk of developing PHC was significantly increased in patients with IPAH (OR = 14.02, 95%CI: 4.49–43.85, p < 0.001), atrial blood gas pH < 7.35 (OR = 12.504, 95%CI: 3.545–44.102, p < 0.001) and RAP > 14 mmHg (OR = 10.636, 95%CI: 3.668–30.847, p < 0.001). Conclusions: RHC is generally a low-risk procedure in pediatric patients with PAH. However, PHC occur in approximately 3% of patients. Therefore, RHC should be performed in a large, experienced referral pediatric cardiology center, especially in pediatric patients with IPAH requiring general anesthesia.

show abstract

Risk Factors for Adverse Events in Children with Pulmonary Hypertension Undergoing Cardiac Catheterization

Cited by 9 publications

References 28 publications

A single institution anesthetic experience with catheterization of pediatric pulmonary hypertension patients

A single institution anesthetic experience with catheterization of pediatric pulmonary hypertension patients

Incidences and outcomes of intra-operative vs. postoperative paediatric cardiac arrest

Right Heart Catheterization in Pediatric Pulmonary Arterial Hypertension: Insights and Outcome from a Large Tertiary Center

Contact Info

Product

Resources

About