Citation

Bell JL, Saenz L, Domnina Y, Baust T, Panigrahy A, Bell MJ, Camprubí-Camprubí M, Sanchez-de-Toledo J. Ann. Thorac. Surg. 2019; 107(6): 1831-1837.

Affiliation

Department of Critical Care Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, US; Department of Cardiology, Hospital Sant Joan de Déu, Barcelona University, Spain. Electronic address: joansdt@gmail.com.

Copyright

(Copyright © 2019, Society of Thoracic Surgeons, Publisher Elsevier Publishing)

DOI

10.1016/j.athoracsur.2018.12.027

PMID

30682351

Abstract

BACKGROUND: Children with both acquired and congenital heart disease have low mortality but increased risk of neurologic morbidity which is multi-factorial. We hypothesize that acute neurologic injuries contributes to mortality in such children and are an important cause of death.

METHODS: Retrospective review of all admissions to the pediatric cardiac intensive care unit from January 2011 through January 2015. Patients were assessed for any acute neurologic events during admission (ANE) as defined by radiologic findings or electrographic seizures.

RESULTS: Of all 1,573 children admitted to the CICU, Incidence of ANE was 8.6%. Mortality of the ANE group was 16.3% compared to 1.5% who did not have ANE. Odds ratio for mortality with ANE was 8.55 (CI 4.56-16.03). Patients with ANE had a longer hospital length of stay compared to those without (41.4 ± 4 vs 14.2 ± 0.6 days (p<0.001)). Need for ECMO, previous cardiac arrest and prematurity were independently associated with presence of an acute neurologic event.

CONCLUSIONS: Neurologic injuries are common in pediatric cardiac intensive cares and are associated with an increase in mortality and hospital length of stay. Children admitted to the CICU are likely to benefit from improved surveillance and neuroprotective strategies to prevent neurological mortality.

Copyright © 2019. Published by Elsevier Inc.

Language: en

Keywords

Neurologic injury; brain injury; cardiac surgery; congenital heart disease; intensive care; pediatrics