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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).
A retrospective single centre review of cardiac catheterisation procedures was done between 1 January, 2003 and 30 April, 2013.
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.
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.
To report procedural characteristics and adverse events on data collected in the registry.
The IMPACT – IMproving Paediatric and Adult Congenital Treatment – Registry is a catheterisation registry of paediatric and adult patients with CHD undergoing diagnostic and interventional cardiac catheterisation. We are reporting the procedural characteristics and adverse events of patients undergoing diagnostic and interventional catheterisation procedures from January, 2011 to March, 2013.
Demographic, clinical, procedural, and institutional data elements were collected at the participating centres and entered via either a web-based platform or software provided by American College of Cardiology-certified vendors, and were collected in a secure, centralised database. Centre participation was voluntary.
During the time frame of data collection, 19,797 procedures were entered into the IMPACT Registry. Procedures were classified as diagnostic only (35.4%); one of six specific interventions (23.8%); other or multiple interventions (40.7%); and were further broken down into four age groups. Anaesthesia was used in 84.1% of diagnostic procedures and 87.8% of interventional ones. Adverse events occurred in 10.0% of diagnostic and 11.1% of interventional procedures.
The IMPACT Registry is gathering data to set national benchmarks for diagnostic and certain specific interventional procedures. We are seeing little differences in procedural characteristics or adverse events in diagnostic procedures compared with interventional procedures overall, but there is significant variation in adverse events amongst age categories. Risk stratification and patient acuity scores will be required for further analysis of these differences.
We sought to use techniques of decision analysis to compare values or preferences for balloon angioplasty versus surgery for treatment of aortic coarctation in children.
Balloon angioplasty and surgery for aortic coarctation have a differing spectrum and prevalence of outcomes and complications, making direct comparison difficult.
From articles reporting treatment outcomes of native aortic coarctation from 1984 through 2005, we determined the baseline probabilities of successful treatment, complications, recoarctation and aneurysmal formation. Decision trees with baseline probabilities of these outcomes were formulated. Standard gamble interviews of medical professionals determined the preferences for the various outcomes. Final cumulative preference scores were further adjusted for both perceived mortality and procedural disutility. Sensitivity analyses determined threshold probabilities at which the score advantage changed.
Final preference scores for balloon angioplasty, with a mean of 0.8999, and standard deviation of 0.0236, were significantly higher than for surgery, at a mean of 0.8873, and standard deviation of 0.0246. The score advantage for balloon angioplasty did not change when adjusted for disutility, or mortality. Sensitivity analysis showed that even if the probability of periprocedural death or major complications for surgery was reduced to none, balloon angioplasty would still be preferred, expect for neonates, where if surgical mortality were reduced below 4%, then surgery would be preferred. Probabilities for periprocedural death or major complications associated with balloon angioplasty would have to exceed plausible thresholds before surgery would be preferred.
After accounting for preference-weighted probabilities of outcomes, balloon angioplasty is preferred over surgery for all plausible situations as the initial treatment for native aortic coarctation in children.