Key result
Higher PREDIC 3 T risk procedures linked to severe anesthesia adverse event rates reaching ~0.8%.
Why the study?
To explore the incidence of high severity anesthesia related adverse events and determine whether rates correlate with PREDIC 3 T case-type risk categories in congenital cardiac catheterization.
Does increasing PREDIC 3 T risk category correlate with a higher incidence of high severity anesthesia related adverse events in pediatric congenital cardiac catheterization?
Does increasing PREDIC 3 T risk category correlate with a higher incidence of high severity anesthesia related adverse events in pediatric congenital cardiac catheterization?
High severity anesthesia-related adverse events during pediatric congenital cardiac catheterization are rare (0.4%) but are significantly associated with lower patient weight, higher hemodynamic vulnerability, and higher procedural risk categories.
Supports anesthesia risk stratification by PREDIC 3T category; extends prior observational data but leaves open need for prospective validation.
Background Safe and effective anesthesia is critical for the care of pediatric patients with congenital heart disease undergoing cardiac catheterization. Over the past two decades, there has been a significant transition from primarily diagnostic procedures to complex interventional cases, accompanied by a shift from operator‐managed sedation to anesthesia administered by a trained anesthesiologist. Aims The aim of our study is to explore the incidence of high severity anesthesia related adverse events (ARAE) and whether these rates correlate with Procedural Risk in Congenital Cardiac Catheterization (PREDIC 3 T) case‐type risk categories. Higher risk categories have been shown to correlate with high severity procedural related adverse events. Methods A multicenter, retrospective cohort study utilized data collected prospectively in the Congenital Cardiac Catheterization Project on Outcomes (C3PO). This study, encompassing 18 contributing institutions, analyzed data from January 1, 2019 to December 31, 2023. Rates of 17 specific ARAE were stratified via PREDIC 3 T category. Results During the study period, 38, 021 cardiac catheterizations were included in this analysis. A total of 321 ARAE of any severity (level 1–5) were recorded, for an overall rate of 0.8% (CI, 0.7%–0.9%). Of these 321 ARAE, 160 were high severity (level 3bc/4/5), yielding a rate of 0.4%. Rates of high severity ARAE by PREDIC 3 T risk category (0,1, 2, 3, 4, 5) were found to be 0.2%. 0.4%, 0.5%, 0.3%. 0.8%, and 0.7%, respectively. Multivariable logistic regression analyses identified weight under 10 kg, hemodynamic vulnerability score (HVS) ≥ 1, and PREDIC 3 T risk category 5 procedures as factors associated with higher odds of experiencing a high severity ARAE. Conclusions The overall rate of ARAE, including high severity ARAE, was found to be increased in higher PREDIC 3 T risk category procedures. Both patient and procedural factors contribute to ARAE in the congenital cardiac catheterization laboratory. Clinical Trial Number and Registry Not applicable.
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Chenault et al. (2025) studied this question. Higher PREDIC 3 T risk category procedures were associated with increased rates of high severity anesthesia related adverse events, reaching up to 0.8%.
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