Abstract
IntroductionMajor 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.MethodsWe 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).ResultsThe 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%.ConclusionA 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.
Highlights
Major adverse events (MAE) are unexpected but undesirably frequent after pediatric congenital heart surgery and contribute to poorer outcomes
The study followed the Brazilian regulations for research on human subjects[4], it was approved by the local institutional review board (Research Ethics Committee HCFMRPUSP, protocol #CAAE: 99316918.0.0000.5440), and informed consent was waived
The relative risks of a patient with a ScvO2/lactate ratio < 5, < 9, or < 17 experience a MAE were 6.33 (95% confidence interval [CI] 3.60–11.2), 5.40, and 3.64, respectively
Summary
Major adverse events (MAE) are unexpected but undesirably frequent after pediatric congenital heart surgery and contribute to poorer outcomes. Identifying patients at risk for MAE is challenging, but it could help physicians and nurses to monitor and allocate more resources to specific patients to prevent or rapidly address and treat a MAE. This has been attempted with the use of clinical examination (capillary refill time, pulses, urine output, core-toe temperature gradient), classical (heart rate, arterial blood pressure, central venous pressure, etc) and more advanced (cardiac index, systemic or pulmonary vascular resistance) hemodynamic variables, and laboratorial tests
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