O033 / #1238: PAEDIATRIC CARDIAC CRITICAL CARE IN A MIDDLE INCOME COUNTRY: EMERGENCY AND ELECTIVE PICU ADMISSIONS

Abstract

Aims & Objectives: There is a paucity of data on paediatric cardiac critical care (PCCC) patients in South Africa. This study describes PCCC patients profiles and outcomes in a tertiary PICU. Methods: A 12-month prospective review of consecutive PICU admissions. Results: A total of 472 PCCC PICU admissions included (34.6% of the total annual PICU population). Of the PCCC admissions, 58% (n=274) were elective cardiac surgery, 7.8% (n=37) post elective general surgery and 34% (n=161) unplanned emergency admissions. Indications for emergency admission included: shock (28%), respiratory failure (22%), cyanosis (18%), decompensated cardiac failure (18%), post cardiac arrest (8%) and life-threatening arrhythmias (3%). Comparing elective admissions with emergency admissions: median age of admission was 24 v. 5 months (p<0.0001); length of PICU stay 3 v. 6 days (p<0.0001); length of ventilation 1 v. 2 days (p=0.13), length of inotrope use 1 v. 2 days (p=0.08); and median maximum inotrope score 1 v. 9 (p=0.46). Eighty-one patients (19.8%) needed PICU readmissions. Complications in the elective group v. the emergency group included failed extubation 5.7% v. 13% (p=0.006), infection on admission 20.6% v. 45.0% (p<0.0001), CLABSI 3.8% v. 17.4% (p<0.0001), AKI 17.4% v. 32.9% (p=0.001), liver impairment 3.5% v. 19.3% (p<0.0001), neurological sequelae 1.9% v. 14.9% (p<0.0001) and PICU readmission 10.3% v. 30.4% (p<0.0001). In both groups 4.1% suffered a cardiac arrest during PICU stay (p<0.0001). PICU mortality for the elective v. emergency admission group was 1.6% v. 12.4% (p<0.0001) and standardised mortality 0.25 v. 0.80. Conclusions: Unplanned emergency PCCC admissions have a higher morbidity and mortality in our setting.