Factors Associated with Intensive Care Unit Admission Following Elective Cardiac Catheterization in Children without a Recent History of Cardiac Surgery or Major Noncardiac Comorbidities

BACKGROUND As pediatric cardiac catheterization procedures become more complex, critically ill children increasingly require postprocedure intensive care unit (ICU) admissions.

AIMS PRIMARY The primary aim was to evaluate the association between patient demographics and ICU admission after elective cardiac catheterization in children without recent surgery or pre-existing systemic illness (acute renal failure, hepatic failure, active infection).

SECONDARY The secondary aim was to analyze associations between ICU admission and American Society of Anesthesiologists (ASA) physical grade, and Catheterization Risk Score for Pediatrics (CRISP) online model-based precatheterization diagnosis, physiological category, and procedure risk category.

SETTINGS AND DESIGN A prospective cohort study conducted at a single tertiary cardiac care center.

MATERIALS AND METHODS The study included 193 pediatric patients undergoing elective cardiac catheterization from June 2023 to May 2024 under general anesthesia. Postprocedure, patients were admitted to ICU or transferred to wards. Demographic data, ASA physical status, and CRISP-based categories were analyzed for ICU admission predictors using univariate and multivariate analyses.

RESULTS Of 193 participants, 169 met eligibility criteria, and 27 required ICU admission. Univariate analysis showed that age (P < 0.001), weight (P < 0.01), ASA Grade 4 physical status (P = 0.001), CRISP-based category 2 and 3 of precatheterization diagnosis, and physiology were factors associated with children admitted to the ICU. Multivariate analysis showed weight [odds ratio (OR): 0.816, 95% CI: 0.679-0.980, P = 0.029], ASA physical grade 4 [OR: 2.966, 95% CI: 1.155 - 7.612, P = 0.024], CRISP-based pre-catheterization diagnosis category 3 [OR: 28.304, 95% CI: 1.025 - 781.835, P = 0.048], and physiologic risk category 3 [OR: 6.816, 95% CI: 1.275 - 36.439, P = 0.025] were independently associated with ICU admissions after elective cardiac catheterization.

CONCLUSIONS The results showed that the child's weight, ASA physical grade, and the diagnosis and physiologic categories by the CRISP model may predict the possibility of a pediatric patient requiring an ICU admission after cardiac catheterization procedures.