David F. Vener, M.D.Database Coordinator

Congenital Cardiac Anesthesia SocietyAssoc. Professor of Pediatrics and Anesthesiology

Baylor College of Medicine/Texas Childrens HospitalHouston, TX

Disclaimer SlideI am not associated with any commercial

vendors, ventures or products associated with the creation or maintenance of the STS Congenital Heart Database or the CCAS and do not receive funds from any commercial vendors, the STS or the CCAS for my work. I have no known conflicts of interest to disclose in relationship to this talk.

CCAS Database Committee Nina Guzzetta, MD – Emory University/CHCAJumbo Williams, MB - StanfordLena Sun, MD – Columbia University, NYCMark Twite, MD – Denver Children’sAnshuman Sharma, MD – Washington Univ St LouisCourtney Hardy, MD – Children’s Memorial,

ChicagoDavid Jobes, MD – CHOPRoxann Barnes, MD – Mayo ClinicScott Schulman, MD – Duke

BackgroundAnesthesia-related complications are

relatively rare events and congenital cardiac surgery is a relatively rare procedure so the only way to contemporaneously and accurately capture anesthesia-related data is through a multi-site model.

Patients with congenital heart disease have up to 85x greater likelihood of having an adverse event intraoperatively than non-cardiac patients, regardless of the procedure being performed.

ParticipationData start date of January 1, 2010Current fee schedule: $3500 per year,

regardless of number of anesthesia providers or cases. This does not include any expenses associated with vendor fees and is in addition to any fees paid by the congenital heart surgeons.

Cases input into database may include not only cardiac surgical cases, but any procedures in which congenital cardiac anesthesiologists are involved: Cath Lab, Diagnostic and Interventional Radiology, General OR, ICU, etc.

ResultsOn August 1, 2011 we received back the first

report from the STS-CCAS data collection efforts

20 Programs paid the $3500 fee, of which 18 submitted at least some minimal data to DCRI during the Spring 2011 harvest for calendar year 2010

The results represent both full and partial calendar year submissions and many centers chose to enter only CV surgical cases at this time.

Who submitted?2010 Annual Volume Categories, CPB Cases

(Provided Groupings) 

Volume Number of ParticipantsSmall (< 125) 6Medium (125 – 250) 7

Large (251 – 500) 3Very Large (> 500) 2

Who submitted?Number of Participants by the 4 US

Census Regions

Region Number of Participants

Midwest 2Northeast 4South 8West 4

Case TypesTotal of 5,757 anesthesia cases submitted

Surgical CPB – 3,386 (58.8%) No CPB – 1,084 (18.8%)

Cardiology – 772 (13.4%) Diagnostic – 44 (0.8%) Interventional – 474 (8.2%) Electrophysiology Studies/Tx – 254 (4.4%)

Support Devices (VAD, ECMO) – 146 (2.5%) Other (Thoracic, Minor, etc.) – 369 (6.4%)

Age of Patients Submitted 2010

STS – EACTS Mortality/Complexity Categories

*Not Assigned includes all non-CV surgical cases.

Overall Adverse/Unexpected EventsNone/Missing – 5,589 (97.1%)

AirwayDental - 3 (0.1%)Respiratory Arrest – 2 (0.0%)Unexpected Difficult Intubation – 23

(0.4%)Stridor – 18 (0.3%)Unexpected Extubation – 3 (0.1%)Airway injury – 1 (0.0%)

Overall Adverse/Unexpected EventsVascular Injury/Line Related

Arrhythmia requiring Tx with CVL – 1 (0.0%)Myocardial Injury with CVL – 1 (0.0%)Vascular Injury w CVL (Bleeding) – 15 (0.3%)Vascular Access Issues (unable to obtain desired

access within one hour of induction) – 46 (0.8%)Hematoma – 3 (0.1%)Inadvertent Arterial Puncture – 32 (0.6%)

Regional Anesthesia-Related – 1 (0.0%) bleeding @ site

Overall Adverse/Unexpected EventsDrug-Related Events

Anaphylaxis/Anaphylactoid Reaction - 6 (0.1%)Medication Administration (Wrong Drug) – 1

(0.0%)Medication Dosage – 2 (0.0%)Suspected Malignant Hyperthermia – 1 (0.0%)Protamine Reaction req Tx – 3 (0.1%)

Cardiac Arrest Unrelated to Surgery – 10 (0.2%)(compared to Odegard et al: 11/5213 (0.2%))

Overall Adverse/Unexpected EventsTEE – Related

Esophageal Bleeding/Rupture – 3 (0.1%)Extubation – 1 (0.0%)Airway Compromise w TEE – 11 (0.2%)

Patient Transfer Events – 2 (0.0%)Neurologic Injury – 4 (0.1%)

Pre-Operative Medications (Surgical Cases Only)Anticoagulants – 382 (8.5%)Antiarrhythmics – 108 (2.4%)Prostaglandin – 383 (8.6%)Cardiac Medications

IV Inotropes – 368 (8.2%)IV Systemic Vasodilators – 30 (0.7%)IV Systemic Vasoconstrictors – 30 (0.4%)IV Pulmonary Vasodilators – 1 (0.0%)

Neurologic Monitoring (Surgical Cases Only)Yes - 2713 (60.7%) Of those monitored there is an analysis

problem with this in that it allowed single-choice only, where multi-modal monitoring is used frequently: NIRS 2449 (90.3%)TCD 5 (0.2%)BIS 233 (8.6%)Other 4 (0.1%) – other forms of EEG?

Areas for ImprovementReport Writing

There were multiple areas where the report produced did not really match up what we were trying to ascertain. This is largely a formatting issue that can be easily addressed.

New ItemsUpdated drug listingsUpdated complicationsBetter information about airway issues (preoperative

FiO2, in-situ airways, airway intubation mechanism (DL, FOB, etc.)

Areas for ImprovementUltrasound Guidance for CVL placementNew Dispositions

Discharge Home as plannedAdmit to Floor as plannedAdmit to ICU as plannedUnexpected admission to hospital or ICUPerioperative Demise (within 24 hours of last

anesthetic), regardless of cause

Contact InformationThe collection of anesthesia fields will be

associated with a number of questions. I am always available by email to answer any questions. Please do not hesitate to contact me:

vener@bcm.eduDavid Vener, MDDepartments of Pediatrics and AnesthesiologyBaylor College of MedicineHouston, TX