Pediatric Cardiac Catheterization Research Articles

Novel Uses of the SwiftNinja Steerable Microcatheter for Pediatric Cardiovascular Interventions.

In the present era, the intricacy of procedures undertaken by a pediatric interventional cardiologist has increased, primarily attributed to dealing with smaller, younger patients with more complex anatomies. To adapt to these smaller and more complex patients, we must adapt our interventions and our equipment to perform these procedures. This article outlines various innovative applications of the SwiftNinja steerable microcatheter within the pediatric cardiac catheterization laboratory.

Medical staff dose estimation during pediatric cardiac interventional procedures.

The purpose of this study is to evaluate the occupational doses (eye lens, extremities and whole body) in paediatric cardiac interventional and diagnostic catheterization procedures performed in a paediatric reference hospital located in Recife, Pernambuco. For eye lens dosimetry, the results show that the left eye receives a higher dose than the right eye, and there is a small difference between the doses received during diagnostic (D) and therapeutic (T) procedures. The extrapolated annual values for the most exposed eye are close to the annual limit. For doses to the hands, it was observed that in a significant number of procedures (37 out of 45 therapeutic procedures, or 82%) at least one hand of the physician was exposed to the primary beam. During diagnostic procedures, the physician's hand was in the radiation field in 11 of the 17 catheterization procedures (65%). This resulted in a 10-fold increase in dose to the hands. The results underscore the need for optimization of radiation safety and continued efforts to engage staff in a radiation safety culture.&#xD.

OR12-7 | Reducing Red Blood Cell Transfusions Following Pediatric Cardiac Catheterization

OR12-7 | Reducing Red Blood Cell Transfusions Following Pediatric Cardiac Catheterization

Evaluation of Practices about Pediatrics Cardiac Catheterization among Nurses at District Head Quarter Hospital

Pediatric cardiac catheterization is a critical procedure that plays a vital role in diagnosing and treating congenital heart defects and other cardiac conditions in children. This procedure involves inserting a catheter into the heart chambers or vessels through a vein or artery. Nurses play multifaceted roles throughout the continuum of cardiac catheterization. Objective: To evaluate the practices of nurses about pediatrics cardiac catheterization. Methods: This study employed cross-sectional descriptive design at pediatric department of a District Head Quarter (DHQ) Hospital. Target population was registered nurses of age above 20 years and who had at least 6 months of practical experience with cardiac pediatric patients. Data were collected conveniently through observational checklist and analysis was done through SPSS Version 24.0. Results: Majority nurses were not encouraging bed rest to the pediatric patients nor keep affected extremity bend for 2-4 hours (80%) after catheterization. Moreover, they did not regularly check the vitals of the children and unable to monitor in every 15 minutes /hour or 30 minutes for next hour (81%). Nurses were unable to educate the pediatric parents for the removal of pressure dressing and nor assess the dressing site appropriately (92%). Conclusions: The present study findings suggested that majority nurses have poor practices before and after cardiac catheterization procedure while some have an average level of practices during the procedure. So, training programs should be arranged to enhance the practices of nurses about cardiac catheterization in pediatric population.

Catheterization for Congenital Heart Disease Adjustment for Risk Method II.

Current metrics used to adjust for case mix complexity in congenital cardiac catheterization are becoming outdated due to the introduction of novel procedures, innovative technologies, and expanding patient subgroups. This study aims to develop a risk adjustment methodology introducing a novel, clinically meaningful adverse event outcome and incorporating a modern understanding of risk. Data from diagnostic only and interventional cases with defined case types were collected for patients ≤18 years of age and ≥2.5 kg at all Congenital Cardiac Catheterization Project on Outcomes participating centers. The derivation data set consisted of cases performed from 2014 to 2017, and the validation data set consisted of cases performed from 2019 to 2020. Severity level 3 adverse events were stratified into 3 tiers by clinical impact (3a/b/c); the study outcome was clinically meaningful adverse events, severity level ≥3b (3bc/4/5). The derivation data set contained 15 224 cases, and the validation data set included 9462 cases. Clinically meaningful adverse event rates were 4.5% and 4.2% in the derivation and validation cohorts, respectively. The final risk adjustment model included age <30 days, Procedural Risk in Congenital Cardiac Catheterization risk category, and hemodynamic vulnerability score (C statistic, 0.70; Hosmer-Lemeshow P value, 0.83; Brier score, 0.042). CHARM II (Congenital Heart Disease Adjustment for Risk Method II) risk adjustment methodology allows for equitable comparison of clinically meaningful adverse events among institutions and operators with varying patient populations and case mix complexity performing pediatric cardiac catheterization.

Doğumsal Kalp Hastalıklı Çocuklarda Kalp Kateterizasyonu Sırasında Aktive Edilmiş Pıhtılaşma Zamanı Testi ile 100 IU/Kg Fraksiyone Olmayan Heparin Yükleme Dozunun Yeterliliğinin Araştırılması

Purpose: This study investigated whether an activated clotting time (ACT) between 200 and 300 sec could be achieved with a100 IU/kg unfractionated heparin (UHF) loading dose in patients with congenital heart disease (CHD) during pediatric cardiac catheterization. Materials and Methods: We included 264 patients aged 0-18 years with CHD undergoing cardiac catheterization between January 2022-March 2023. Data on patient characteristics, UHF doses, and ACT values were retrospectively obtained. The patients were intravenously administered 100 IU/kg UFH after sheath placement. We aimed to obtain a value between 200 and 300 sec according to the ACT measured at the 5th minute. If the measured ACT value at the 5th min was &amp;lt; 200 sec, additional heparin doses between 20 and 50 IU/kg were administered such that the total heparin loading dose did not exceed 150 IU/kg. Patients were divided into two groups based on whether the ACT value was below or above 200 sec. Results: Median age, weight, and ACT value at procedure were 6.41(IQR:2.01–32.21) months, 6.13(IQR:3.79-11.9) kg, and 212(IQR:190-240) sec, respectively. The ACT value of 170(64.4%) of the 264 patients was between 200-300 sec, which was considered the target value. The ACT value of 86(32.6%) of the 264 patients was below the target value and that of eight (3%) patients was above the target value. Hematoma occurred at the access site in four patients (1.5%). We did not detect retroperitoneal hematoma, other bleedings at location, or thromboembolism in any of the patients. No significant differences were observed in comparisons between age subgroups and ACT distribution, or between age subgroups and ACT subgroups (p&amp;gt;0.05) Conclusion: This study revealed that a 100 IU/kg UFH loading dose produced the target ACT value in 64.4% of the patients and that the UFH loading dose should be individualized according to the ACT value in the remaining patients.

Evaluation of Radiation Exposure and Image Quality in Congenital Catheterization Laboratory; A Single Centre Comparative Study Using Different Acquisition Modes

Abstract Background The exposure to ionizing radiation delivered during the catheterization procedures has various negative biological effects to the patient, so concern has risen sharply about radiation hazards over the past decade.While angiography imaging system vendors have all made great strides with new technologies that reduce the amount of x-rays needed while maintaining excellent image quality, the procedures have become more complex, lasting longer and require more imaging than standard procedures. Aim of the Work To study the effect of lowering radiation dose by using a fluoro angiography on image quality in pediatric cardiac catheterization. Patients and Methods We studied 90 patients who underwent cardiac cath. for CHD at Ain Shams University hospital. Patients were randomized into three groups according to mode of acquisition used in procedure (fluro angiography only–cine angiography only–mixed). Radiation indices were measured, also image quality questionnaire was filled by operators after each procedure. Results statistically significant difference between three modalities of acquisition as regard the radiation indices (DAP, total air kemra, fluoroscopy time) with p value &amp;lt;0.005. While operators satisfaction with image was nearly the same in the three groups with median score 68.5 (p value 0.681). Conclusion Based on the results of the current study it can be concluded that: Mixed imaging acquisition had highest radiation exposure indices in comparison with other two acquisition modalities (fluro angiography only – cine angiography only), with statistically significant difference with fluro only mode (p value &amp;lt;0.005), and no statistically significant deference with cine only mode. Complexity of the procedures &amp; increased the cath. lab machine imaging protocol to 30 fps and repeat the same injection in the cine mode after fluro mode were the most important factors that made mixed acquisition had the highest radiation indices and exposure. Image quality and operators satisfaction were nearly the same in three acquisition modes (fluro-cine-mixed) with median image score 68.5 (p value 0.681), in expense of more radiation exposure in mixed mode. Increase operators awareness to radiation and continuous monitoring of radiation exposure with application of ALARA principles is important to reduce radiation exposure.

Measured Oxygen Consumption During Pediatric Cardiac Catheterization is More Accurate than Assumed Oxygen Consumption.

When calculating cardiac index (C.I.) by the Fick method, oxygen consumption (VO2) is often unknown, so assumed values are typically used. This practiceintroduces a knownsource of inaccuracy into the calculation. Using a measured VO2 (mVO2) from the CARESCAPE E-sCAiOVX module provides an alternative that may improve accuracy of C.I. calculations. Our aim is to validate this measurement in a general pediatric catheterization population and compare its accuracywith assumed VO2 (aVO2).mVO2 was recorded for all patients undergoing cardiac catheterization with general anesthesia and controlled ventilation during the study period. mVO2 was compared to the reference VO2 (refVO2) determined by the reverse Fick method using cardiac MRI (cMRI) or thermodilution (TD) as a reference standard for measurement of C.I. when available. 193 VO2 measurements were obtained, including 71 with a corresponding cMRI or TD measure of cardiac index for validation. mVO2 demonstrated satisfactory concordance and correlation with the TD- or cMRI-derived refVO2 (ρc = 0.73, r2 = 0.63) with a mean bias of -3.2% (SD ± 17.3%). Assumed VO2 demonstrated much weaker concordance and correlation with refVO2 (ρc = 0.28, r2 = 0.31) with a mean bias of + 27.5% (SD ± 30.0%). Subgroup analysis of patients < 36months of age demonstrated that error in mVO2 was not significantly different from that observed in older patients. Many previously reported prediction models for assuming VO2 performed poorly in this younger age range. Measured oxygen consumption using the E-sCAiOVX module is significantly more accurate than assumed VO2 when compared to TD- or cMRI-derived VO2 in a pediatric catheterization lab.

Frequency and Predictors of Acute and Persistent Femoral Artery Occlusion in Infants with Congenital Heart Disease: A Study Using Ultrasonography for Arterial Access and the Diagnosis of Arterial Occlusion.

Femoral arterial access is challenging in infants. Furthermore, after cardiac catheterization, femoral arterial occlusion (FAO) can be underestimated and easily missed on physical examination. Ultrasound is recommended for femoral arterial access and the correct diagnosis of FAO; however, few studies have reported its effectiveness.To investigate the frequency and risk factors of acute loss of the arterial pulse (ALAP) and persistent femoral arterial occlusion (PFAO) in infants with congenital heart disease who underwent ultrasound-guided femoral arterial access (US-GFAA) and were diagnosed with FAO by ultrasound.We obtained data related to patient characteristics, access variables of US-GFAA, and ultrasonography findings of the femoral artery from our pediatric cardiac catheterization database between August 2017 and August 2022. We divided the patients into groups based on the presence of ALAP and PFAO. We identified ALAP in 99 (19%) patients and PFAO in 21(4%) of 522 patients in the study. The median patient age was 132days (interquartile range: 75-202days). The logistic regression analysis identified younger age, aortic coarctation, previous catheterization of the same femoral artery, larger sheath size (5F), and longer duration of cannulation as independent risk factors for ALAP and younger age as an independent risk factor for PFAO (all p < 0.05). This study showed that younger age at procedure was a risk factor for both ALAP and PFAO, while aortic coarctation, previous arterial catheterization, use of a larger sheath and longer duration of cannulation were risk factors for ALAP in infants. The majority of FAO is reversible and secondary to arterial spasm, and the of FAO increases inversely with patient age.

Educational Videos to Reduce Parental Rejection of Pediatric Cardiac Catheterization during the COVID-19 Pandemic.

During the COVID-19 pandemic, people voluntarily reduced their necessary healthcare. We examined whether supplying educational digital versatile discs (DVDs) before admission can reduce parental rejection of pediatric cardiac catheterization for congenital heart disease (CHD). Parents of 70 children with CHD selected for cardiac catheterization were randomly allocated to the DVD (received pre-admission DVDs in the outpatient department; 70 parents of 35 children) or non-DVD groups (did not receive the DVDs; 70 parents of 35 children). The parents could reject the admission of their children within 7 days. Cardiac catheterization was rejected by 14 (20.0%) and 26 (37.1%) parents in the DVD and non-DVD groups, respectively (p = 0.025). Parent Perceptions of Uncertainty Scale scores were lower in the DVD (128.3 ± 8.9 points) than in the non-DVD group (134.1 ± 7.3 points; p < 0.001). Decreased uncertainty due to pre-admission DVD watching could have contributed to the increased parental willingness for cardiac catheterization. The effects of pre-admission educational DVDs were more significant among parents with a lower education, rural residence, with only one child, female child, or younger child. Offering educational DVDs to parents of children selected for cardiac catheterization for CHD may decrease the parental rejection rate of the treatment.

Analysis of anesthesia related severe adverse events in congenital catheterization cases from a single institution.

Analysis of anesthesia related severe adverse events in congenital catheterization cases from a single institution.

The Need for Surgery After Vascular or Cardiac Trauma, or Technical Adverse Events in the Congenital Cardiac Catheterization Laboratory.

Data on the frequency and outcome of surgical interventions as a result of adverse events (AE) encountered in the pediatric and congenital cardiac catheterization laboratory are limited. This study analyzes the outcomes of specific types of AE that are most likely to require immediate surgical intervention. Data from the C3PO registry were analyzed to identify specific types of significant vascular/cardiac trauma or technical adverse events (stent/device/coil embolization/migration). The relationship between these AE and an "adverse outcome" (defined as either surgery, ECMO, or death) were analyzed. Between 01/2014 and 12/2017, 25,731 cases were entered into the C3PO registry. Vascular or cardiac trauma were observed in 92 cases (0.36% cases in C3PO), and technical adverse events were observed in 176 cases (0.68% cases in C3PO). The two highest procedure type risk categories (PREDIC3T) accounted for 61% of the cases in the cardiac/vascular trauma cohort, and 34% in the technical AE cohort. For vascular/cardiac trauma, 24 (26%) had an adverse outcome, with ECMO in 8 (9%), surgery in 19 (20%), and death in 9 (10%). For technical AE 25 (14%) had an adverse outcome, with ECMO in 3 (2%), surgery in 23 (13%), and death in 3 (2%). Survival after cardiac surgery secondary to an AE was 68% for cardiac/vascular trauma, and 96% for technical adverse events. RF perforation of the pulmonary valve was the procedure most likely to result in cardiac/vascular trauma (10%), with 57% of those having an adverse outcome. Atrial septal interventions accounted for 29% of all adverse outcomes in the cardiac/vascular trauma cohort. Non-elective or emergent cases were associated with a significantly higher incidence of an adverse outcome for both, cardiac/vascular trauma (OR 7.1) and technical adverse events (OR 2.7). Surgery within the last 30days was associated with a significantly higher incidence of an adverse outcome for cardiac/vascular trauma only (OR 4.2). Significant cardiac/vascular trauma or stent/device/coil embolization/migration are rare, but high consequence AE. With appropriate surgical and ECMO backup, a high survival can be achieved. The potential need for and impact of immediate surgical backup seems to be higher for cardiac/vascular trauma (in particular after specific case types), than for device/coil migration/embolization, and as such case specific backup arrangements are required.

Impact of 3D-printed models in meetings with parents of children undergoing interventional cardiac catheterisation.

Paediatric interventional catheterisation has consistently improved in recent decades, with often highly successful outcomes. However, progress is still required in terms of the information delivered to parents and how parental anxiety is managed. To investigate the impact of cardiac printed models on improving parental understanding and alleviating anxiety before interventional catheterisation. The parents of children undergoing interventional cardiac catheterisation were prospectively enrolled in the study. A questionnaire highlighting knowledge and understanding of the condition and cardiac catheterisation per se was scored on a scale of 1-30. The State-Trait Anxiety Inventory (STAI), which generates current anxiety scores, was also used before and after the pre-catheterisation meeting. The "printing group" received an explanation of catheterisation using the device and a three-dimensional (3D) model, while the "control group" received an explanation using only the device and a manual drawing. In total, 76 parents of 50 children were randomly assigned to a "control group" (n = 38) or "printing group" (n = 38). The groups were comparable at baseline. The level of understanding and knowledge improved after the "control group" and "printing group" meetings (+5.5±0.8 and +10.2±0.8; p < 0.0001 and p < 0.0001, respectively). A greater improvement was documented in the "printing group" compared to the "control group" (p < 0.0001). The STAI score also improved after the explanation was given to both groups (-1.8±0.6 and -5.6±1.0; p < 0.0001 and p < 0.0001). The greatest improvement was noted in the "printing group" (p = 0.0025). Most of the parents (35/38 from the "printing group") found the models to be extremely useful. 3D-printed models improve parental knowledge and understanding of paediatric cardiac catheterisation, thereby reducing anxiety levels.

Clinical hypnosis associated with local anesthesia for cardiac catheterization in pediatric population

Hypnosis is a promising non-pharmacological adjunct treatment for improving pain and interventional anxiety management in pediatric interventions. Its efficiency and impacts in pediatric cardiac catheterization (CC) are unknown. Evaluate hypnosis efficiency and impacts in pediatric cardiac catheterization. This a prospective monocentric study, all patients aged < 16 years who had CC under hypnosis with local anesthesia from January to December 2021 were included. Pain and anxiety were evaluated by the ANI (Analgesia Nociception Index) measured during the intervention, and the Visual Analogue Scale (VAS) assessed by the patients after the intervention. Sixteen patients were included, mean age was 10.5 years |range 4–16 years], mean weight was 37 kg [range 15–69 kg]. Catheterizations were interventional in 10 patients (62.5%) and for diagnostic purposes in 6 patients (37.5%). Hypnosis indications were general anesthesia (GA) contraindication in 4 patients (25.0%), the need of accurate pressures measurements without GA interference in 3 patients (18.7%) and interventions/patients preferences in 9 patients (56.3%). In one patient of 4 years old, the hypnotic status was not achieved and the procedure was aborted before the installation. CC was accomplished successfully in 15 patients (93.7%) even in complicated cases; large atrial septal defect (ASD) closed with 39 mm Occlutech device in 16 years old patient, and a large ASD 26 mm/m2 closed by 18 mm Amplazer device in 7 years old patient. Mean procedures and fluoroscopy times were 67.5 and 5.3 min, respectively. In one case, pulmonary artery pressures were normalized comparing to previous catheterization under local anesthesia alone leading to the cancellation of cardiac surgery on mitral stenosis. No additional medication was necessary in all patients. VAS score was under 5/10 in all patients. The ANI remained above 50 (non-painful zone) in all but one patient. There is no significative decrease of the ANI during the intervention comparing to the baseline (P = 0.62). One patient with language difficulties had short and transient decrease of the ANI (49) during one minute after the puncture (Table 1). Pediatric CC are feasible under hypnosis even in complicated cases. Hypnosis was efficient to manage pain and stress in all cases. It ensures more reliable pressure measurements.

Ultrasound-guided femoral vascular access in pediatric cardiac catheterization.

In pediatric catheterization, the palpation and landmark (PL) technique is widely used for femoral arterial and venous (FAV) cannulation. Over the past decade, the ultrasound-guided (US) technique has replaced the PL technique. This study aimed to assess the clinical impact of application of the US technique on the success rate and completion time of FAV cannulation during cardiac catheterization in children. This is a retrospective observational study of consecutive pediatric patients who underwent cardiac catheterization in a tertiary care children's hospital from April 2016 to March 2022. The association between FAV cannulation success rate and the US technique was analyzed using multiple logistic regression analysis by adjusting for potential confounders, including patient and operator characteristics and procedural details. A total of 749 patients (PL, 378; US, 371) were analyzed. The odds ratio (OR) of the US technique success rate for FAV cannulation was 2.03, 95% confidence interval (CI), 1.10-3.73; p=0.02. The OR of the cannulation success rate of children aged <1 year was 0.16 (95% CI, 0.03-0.97; p=0.046). The US-guided technique was associated with an increased success rate of FAV cannulation, compared with the PL technique. Moreover, age < 1 year was an independent factor associated with a lower success rate of FAV cannulation. The US-guided technique might be an effective procedure in FAV cannulation during cardiac catheterization in children.

Effects of General Anesthesia on the Results of Cardiac Catheterization in Pediatric Patients with Ventricular Septal Defect

<b>Background:</b> There is no gold standard sedation method for pediatric cardiac catheterization. In congenital heart diseases with intracardiac shunts, hemodynamic parameters are prone to change depending on the ventilation conditions and anesthetics, although few studies have examined these effects. The purpose of this study was to investigate the effects of two different sedation methods on the hemodynamic parameters. <b>Methods:</b> This study retrospectively evaluated consecutive patients with ventricular septal defect (VSD) below 1 year of age who underwent cardiac catheterization at Aichi Children’s Health and Medical Center, who were divided into age- and VSD diameter-matched general anesthesia (GA) and monitored anesthesia care (MAC) under the natural airway groups (<i></i>n = 40 each), for comparison of hemodynamic parameters. <b>Results:</b> In the GA group, arterial blood pH and arterial partial pressure of oxygen were significantly higher (<i>p</i> < 0.01), whereas arterial partial pressure of carbon dioxide was significantly lower than in the MAC group (<i>p</i> < 0.01). Mean pulmonary artery pressure (<i>p</i> < 0.05) and systemic blood pressure (<i>p</i> < 0.01) were lower in the GA group. Pulmonary vascular resistance index (<i>p</i> < 0.01) and systemic vascular resistance index (<i>p</i> < 0.01) were also significantly lower in the GA group than the MAC group. There were no significant differences in pulmonary blood flow index, systemic blood flow index, and pulmonary/systemic blood flow ratio between the two groups. <b>Conclusions:</b> Cardiac catheterization under GA in VSD patients results in different hemodynamic parameters compared to that under MAC. In particular, when using pulmonary artery pressure and pulmonary vascular resistance measured under GA for judgment regarding the surgical indications or perioperative management, consideration should be given to the fact that these parameters might be lower compared to those measured under MAC.

The effect of fluids flushed in pediatric cardiac catheterization procedures on lung ultrasound score

ABSTRACT Background Intravascular catheters used during cardiac catheterization require frequent flushing with heparinized solutions. Fluid overload is more common in pediatric patients with congenital heart diseases. This study aimed to determine the safe volume of fluids that can be used without congestion using the lung ultrasound score. Methodology A total of 42 patients aged from 1 month to 6 years undergoing diagnostic cardiac procedures were included in this study. The total volume of infused fluids, the volume of fluids used for flushing intravascular sheaths and catheters, the lung ultrasound score, and PaCO2 and PaO2 /FiO2 ratio were documented. Results There was a very strong positive relationship between the total fluid volume infused in ml/kg and the difference in the lung ultrasound score before and after fluid infusion (r = 0.841, P < 0.001). There was a very weak positive relationship between the total fluid volume infused in ml/kg and the difference in PaCO2 before and after fluid infusion (r = 0.217, P = 0.167). There was a weak negative relationship between the total fluid volume infused in ml/kg and the change in the PaO2 /FiO2 ratio (r = −0.21, P = 0.182). Conclusion A fluid flush volume of >11.3 ml/kg has a high probability of inducing volume load in pediatric patients undergoing cardiac catheterization. A flushing volume of 3.478 ml/kg affects the lung ultrasound score. Hence, we recommend reducing the volume of intravenous fluids if higher volumes are required for flushing.

Comparative Assessment of Propofol and Ketamine on Hemodynamic Indices and Cerebral Oximetry of Pediatric Patients Undergoing Cardiac Catheterization.

Propofol and ketamine are widely used in the induction and maintenance of anesthesia and sedation with different cardiovascular and respiratory effects. In cardiac anesthesia (including pediatric cardiac catheterization), due to the high risk of neurologic complications, cerebral oximetry can effectively monitor cerebral blood oxygen saturation to prevent neurological and respiratory complications. This study aimed to compare the effect of propofol and ketamine on hemodynamic indices and cerebral oxygenation results in children undergoing cardiac catheterization. This clinical trial study was performed on 48 patients who were candidates for cardiac catheterization by easy and continuous sampling. Patients were randomly divided into 2 groups: ketamine and propofol. In the ketamine group, ketamine was injected at a dose of 1 - 2 mg/kg, and in the propofol group, propofol was injected at a dose of 0.5 - 1.5 mg/kg. In both groups, incremental doses were repeated as needed. The hemodynamic indices, including blood pressure, heart rate, and peripheral SpO2, were recorded. Cerebral regional oxygen saturation (RSO2) was recorded using infrared spectroscopic sensors. Data were analyzed using chi-square, independent t-test, paired t-test, and 1-way analysis of variance (ANOVA). The results showed that all demographic characteristics of patients and also the mean duration of catheterization were homogeneous between the 2 groups. Hemodynamic indices (such as systolic, diastolic, and mean arterial blood pressure) did not show a significant difference between the 2 groups; however, in the ketamine group compared to the propofol group, the heart rate was significantly higher, and mean RSO2 was lower (P = 0.023). Propofol has fewer complications than ketamine and is a good drug for sedating children undergoing cardiac catheterization.

Adverse Events in the Pediatric Cardiac Catheterization Suite: Does Having Pediatric Cardiac Anesthesiologists Make a Difference?

It has been suggested that anesthesiologists with subspecialty expertise in pediatric cardiac anesthesia are best qualified to care for patients with complex congenital cardiac anomalies and manage the complex physiology frequently encountered in the pediatric cardiac catheterization lab. We evaluated the incidence of adverse events in our pediatric cardiac catheterization lab, comparing care provided by cardiac and noncardiac pediatric attending anesthesiologists. Data were collected on each anesthetic in the pediatric cardiac catheterization lab from January 1, 2016 to December 31, 2019. A generalized linear mixed effect model was used to identify associations between pediatric cardiac and noncardiac anesthesiologists and the presence of adverse events adjusting for age, American Society of Anesthesiologists physical status, emergency status, and interventional versus diagnostic procedures. A total of 3,761 procedures involving 1,729 patients were included in the study. There was no significant difference between noncardiac and cardiac anesthesia attendings for overall adverse events (odds ratio [OR], 1.2; 95% confidence interval [CI], 0.82 to 1.75 P=0.349). Specific respiratory adverse events (OR, 1.22; 95%, CI 0.73 to 2.03 P=0.443) or cardiac adverse events (OR, 1.26; 95% CI, 0.64 to 2.48 P=0.502) were also not significantly different with respect to noncardiac compared with cardiac attending anesthesiologists. In our analysis, the incidence of adverse events in the pediatric cardiac catheterization lab during the study period was not statistically different, whether anesthesia care was provided by a cardiac or a noncardiac anesthesiologist.

Abstract 15657: Risk Based Scheduling for Pediatric Cardiac Catheterization

Introduction: Machine learning techniques can predict operational capacity needs and improve understanding of procedural risk in heterogeneous patient populations. Our goal is to combine machine learning and computer simulation to design scheduling formats for pediatric cardiac catheterization maximizing patient safety and system efficiency. Methods: Data for 13,115 pediatric cardiac catheterizations from 2010-19 were used to develop a simulation model including 3 catheterization interventional laboratories. Data on case time, patient and procedural complexity, and adverse events were used to determine statistical distributions on patient, procedure, and system factors for key components of the catheterization lab process. The simulation model was used to evaluate scheduling plans implemented for historical and synthetic populations of patients, comparing both system efficiency and total lab time spent where the system risk of an adverse event is high. Results: A simple scheduling heuristic model was developed where one lab worked cases from lowest to highest risk and another lab worked from highest to lowest risk. This scheduling heuristic was applied to all cases in 2018 and compared against the original schedule. Using thresholds of 10% and 20% probability of an adverse event to separate low, medium- and high-risk times. Implementing the sorting schedule resulted in the reduction of minutes spent at high-risk equivalent to 11.57 days per year. Conclusions: This study demonstrates that predictive analytics and simulation using simple scheduling heuristics results in reduced time at increased risk. Future work includes improving the fidelity of the model to include specific providers, case cancellations, and other system complexities.