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Anaesthetic complications associated with the treatment of patients with congenital cardiac disease: consensus definitions from the Multi-Societal Database Committee for Pediatric and Congenital Heart Disease

Part of: The International Society for Nomenclature of Paediatric and Congenital Heart Disease (ISNPCHD)

Published online by Cambridge University Press:  01 December 2008

David F. Vener ,
Christopher F. Tirotta ,
Dean Andropoulos  and
Paul Barach
David F. Vener*
Affiliation:
Department of Pediatric Anesthesia, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, United States of America
Christopher F. Tirotta
Affiliation:
Congenital Heart Institute of Miami Children’s Hospital and Arnold Palmer Hospital for Children, Miami and Orlando, Florida, United States of America
Dean Andropoulos
Affiliation:
Department of Pediatric Anesthesia, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, United States of America
Paul Barach
Affiliation:
Department of Anesthesia, University of South Tampa, Florida, Florida, United States of America
*
Correspondence to: David F. Vener, MD, Associate Professor, Department of Pediatric Anesthesia, Pediatric Cardiac Anesthesia, Texas Children’s Hospital 6621 Fannin/WT17417B, Houston, Texas, 77030, United States of America. Tel: (832) 826-1711; Fax: (832) 825-1903; E-mail: dfvener@texaschildrens.org
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Abstract

Congenital heart defects are the most common cause of death in infants and young children in the developed world. As the mortality in this population has declined to less than 5%, more attention is being focused now on reducing post-procedural morbidities that may seriously impact the patient and their families. Because of multiple reasons, paediatric cardiac surgery and anaesthesia is a perfect model for studying human errors and their impact on patient safety. Congenital cardiac disease is a common lesion causing much morbidity, pain, and loss of life. Over 44,000 surgical procedures are performed yearly to repair congenital cardiac problems in the United States alone. The reduction or elimination of iatrogenic adverse outcomes, given the current mortality rates of 4.2%–4.5%, might lead to as many as 500 children achieving better outcomes or shorter hospitalizations.

Efforts to quantify the frequency of complications related to anaesthesia in patients undergoing congenital cardiac surgery have been difficult to date because of the low occurrence of this surgery compared to other surgeries on children and the relatively rare incidence of complications related to anaesthesia in this population. Anaesthesiologists play a crucial role in the reduction, recognition, and timely treatment of medical errors that impact this morbidity. Paediatric cardiac surgery encompasses many complex procedures that are highly dependent upon a sophisticated organizational structure, effective communication, coordinated efforts of multiple individuals working as a team, and high levels of cognitive and technical performance. Human factor error analysis in this patient population has shown how frequently both minor and major errors occur. The goal of this paper is to outline the frequency and sources of these errors and to suggest treatment strategies which may minimize their occurrence.

Keywords

Congenital heart diseasequality improvementpatient safetyoutcomesregistryoperative morbiditypaediatricsurgerycongenital abnormalitiescardiac surgical proceduresheartcatheteranaesthesiaNear Infrared Reflectance SpectroscopyNIRS
Type
Original Article
Information
Cardiology in the Young , Volume 18 , Issue S2: Databases and the assessment of complications associated with the treatment of patients with congenital cardiac disease , December 2008 , pp. 271 - 281
Copyright
Copyright © Cambridge University Press 2008

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