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Objectives: To determine whether shock index, coronary perfusion pressure, or rate pressure product in the first 24 hours after congenital heart surgery are independent predictors of subsequent clinically significant adverse outcomes., Design: A retrospective cohort study., Setting: A tertiary care center., Patients: All patients less than 18 years old who underwent cardiac surgery at Boston Children's Hospital between January 1, 2010, and December 31, 2018., Interventions: None., Measurements and Main Results: Shock index (heart rate/systolic blood pressure), coronary perfusion pressure (diastolic blood pressure-right atrial pressure), and rate pressure product (heart rate × systolic blood pressure) were calculated every 5 seconds, and the median value for the first 24 hours of cardiac ICU admission for each was used as a predictor. The composite, primary outcome was the occurrence of any of the following adverse events in the first 7 days following cardiac ICU admission: cardiopulmonary resuscitation, extracorporeal cardiopulmonary resuscitation, mechanical circulatory support, unplanned surgery, heart transplant, or death. The association of each variable of interest with this outcome was tested in a multivariate logistic regression model. Of the 4,161 patients included, 296 (7%) met the outcome within the specified timeframe. In a multivariate regression model adjusted for age, surgical complexity, inotropic and respiratory support, and organ dysfunction, shock index greater than 1.83 was significantly associated with the primary outcome (odds ratio, 6.6; 95% CI, 4.4-10.0), and coronary perfusion pressure greater than 35 mm Hg was protective against the outcome (odds ratio, 0.5; 0.4-0.7). Rate pressure product was not found to be associated with the outcome. However, the predictive ability of the shock index and coronary perfusion pressure models were not superior to their component hemodynamic variables alone., Conclusions: Both shock index and coronary perfusion pressure may offer predictive value for adverse outcomes following cardiac surgery in children, although they are not superior to the primary hemodynamic variables., Competing Interests: The authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2020 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.)

Objectives: We sought to assess quality of life of pediatric cardiac extracorporeal membrane oxygenation survivors. We hypothesized that these patients would have decreased quality of life when compared to that of a general U.S. population sample., Design: Cross-sectional study., Setting: Patient homes and Children's Hospital Boston., Patients: Cardiac extracorporeal membrane oxygenation survivors currently 5-18 yrs old., Interventions: None., Measurements and Main Results: Quality of life was assessed by parent proxy report using the Child Health Questionnaire Parent Form 50 and was compared to that of a general U.S. population sample and other cardiac populations. Factors associated with lower quality of life were sought. Physical summary scores for 41 cardiac extracorporeal membrane oxygenation survivors were lower than the mean of the general population sample (42.4 ± 16.4 vs. 53.0 ± 8.8; p < .001) but similar to those of children with Fontan physiology or an automatic implantable cardioverter defibrillator. Psychosocial summary scores in extracorporeal membrane oxygenation patients were not different from those of the general population (48.2 ± 11.8 vs. 51.2 ± 9.1; p = .11) or of other cardiac samples. Postcardiotomy extracorporeal membrane oxygenation, more noncardiac operations, total intensive care and hospital days, noncardiac medical conditions, medications, and the need for physical, occupational, or speech therapy were associated with low physical summary scores. More noncardiac operations, noncardiac medical conditions, and the need for special education, physical, occupational, or speech therapy were associated with low psychosocial summary scores., Conclusions: In pediatric cardiac extracorporeal membrane oxygenation survivors, the physical component of health-related quality of life is lower than that of the general population but similar to that of patients with complex cardiac disease, whereas psychosocial quality of life is similar to that of the general population and of other pediatric cardiac populations.