Incidence of High Severity Anesthesia Related Adverse Events With Increasing PREDIC3T Risk Category in Congenital Cardiac Catheterization: A Review of the C3PO Database. Paediatr Anaesth 2025 Dec 31
Date
01/01/2026Pubmed ID
41476376DOI
10.1002/pan.70110Scopus ID
2-s2.0-105026491952 (requires institutional sign-in at Scopus site)Abstract
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 (PREDIC3T) 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 PREDIC3T 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 PREDIC3T 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 PREDIC3T 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 PREDIC3T risk category procedures. Both patient and procedural factors contribute to ARAE in the congenital cardiac catheterization laboratory.
CLINICAL TRIAL NUMBER AND REGISTRY: Not applicable.
