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Unanticipated admissions to paediatric cardiac critical care after cardiac catheterisations

Published online by Cambridge University Press:  14 June 2019

Erin Peebles ,
Michael R. Miller ,
Lee N. Benson  and
Tilman Humpl
Erin Peebles
Affiliation:
Department of Pediatrics, Children’s Hospital London Health Science Center, Western University, London, Canada Department of Critical Care Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
Michael R. Miller
Affiliation:
Department of Pediatrics, The Children’s Hospital, Children’s Health Research Institute, Western University, London, Canada
Lee N. Benson
Affiliation:
Department of Pediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
Tilman Humpl*
Affiliation:
Department of Critical Care Medicine and Department of Pediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
*
Author for correspondence: Dr. Tilman Humpl, The Hospital for Sick Children, 555 University Avenue, Toronto ON, M5G 1X8, Canada. Tel: +1 416 813 4918; Fax: +1 416 813 7299; E-mail: tilman.humpl@sickkids.ca
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Abstract

Objectives:

Cardiac catheterisation is commonly used for diagnosis and therapeutic interventions in paediatric cardiology. The inherent risk of the procedure can result in unanticipated admissions to critical care. Our goals were to provide a qualitative description of characteristics and evaluation of children admitted unexpectedly to the cardiac critical care unit (CCCU).

Methods:

A retrospective single centre review of cardiac catheterisation procedures was done between 1 January, 2003 and 30 April, 2013.

Results:

Of 9336 cardiac catheterisations performed, 146 (1.6%) were admitted from the catheterisation laboratory to the CCCU and met inclusion criteria. Of these 146 patients, 117 (1.3%) met criteria for unexpected admission and 29 (0.3%) were planned admissions. The majority admitted unexpectedly were below 1 year of age without co-morbidity aside from heart disease. Patients with planned admissions were significantly more likely to have single ventricle physiology, undergoing angiography or transferred for observation. Most unplanned admissions were triggered by interventional catheterisations or procedure-related complications. Patients received mechanical ventilation as the main CCCU management. Eighteen patients needed either cardiopulmonary resuscitation and/or extracorporeal membrane oxygenation during their catheterisation. About 106/117 (90.6%) patients survived to hospital discharge with no deaths in the planned admission group.

Conclusions:

Admission to CCCU following cardiac catheterisation was uncommon and tended to occur in younger children undergoing interventional procedures. Outcomes did not differ between patients experiencing planned and unplanned CCCU admission. Ongoing development of risk stratification tools may help to decrease unplanned CCCU admissions. Further studies are needed to determine whether unplanned admission following paediatric cardiac catheterisation should be utilised as a quality indicator.

Keywords

Childrencardiac catheterisation critical careextracorporeal membrane oxygenation
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 6 , June 2019 , pp. 777 - 786
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Copyright
© Cambridge University Press 2019 

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