Application of the Modify Cardiac-Children's Hospital Early Warning Score for Prevention of Pulmonary Hypertensive Crisis in Pediatric Patients with Congenital Heart Disease after Open-Heart Surgery

Abstract

Pulmonary hypertensive crisis after congenital heart defect surgery is a life-threatening emergency that requires proper assessment and immediate treatment because it may lead to heart failure and death. This comparative retrospective and prospective study aimed to compare the prevalence of pulmonary hypertensive crisis occurrence and cardiopulmonary resuscitation after congenital heart defect surgery between an experimental group and a control group. The participants were 58 pediatric patients with non-cyanotic congenital heart defects of the left-to-right shunt type and preoperatively diagnosed with pulmonary hypertension, who were equally divided into each of the two groups. Regarding the control group, the researchers collected data retrospectively from the electronic medical records of the year 2019. The experimental group received assessment using the Modify Cardiac-Children's Hospital Early Warning Score (C-CHEWS) after their open-heart surgery and were managed based on the assessed scores. The research instrument included: 1) the data collection tools, including a general data form and pulmonary hypertensive crisis and cardiopulmonary resuscitation form; and 2) the intervention tool, the Modify C-CHEWS, with three dimensions: the behavioral assessment or neurological system; the cardiovascular system; and the respiratory system. Data were analyzed using descriptive statistics and the chi-square test.

The findings revealed that 24 patients (82.8%) in the control group had episodes of pulmonary hypertensive crisis, and one patient (3.40%) received cardiopulmonary resuscitation. The experimental group had episodes of neither pulmonary hypertensive crisis nor cardiopulmonary resuscitation. The prevalence of pulmonary hypertensive crisis between the two groups were statistically significantly different (p < .001); however, there was no statistically significant difference regarding the prevalence of cardiopulmonary resuscitation (p = .31).

The results of this study demonstrated that usage of the Modify C-CHEWS tool to assess signs and symptoms and manage deteriorated clinical conditions of congenital heart defect pediatric patients after their open-heart surgery helps prevent the occurrence of pulmonary hypertension crisis and decreases mortality rates. Therefore, it should be considered for use in the ward, for providing care to pediatric patients after heart surgery.