Predicting Pediatric ICU Needs: Key Factors After Elective Cardiac Catheterization

The Challenge of Post-Cardiac Catheterization Care

As pediatric cardiac catheterization procedures become more advanced, the need to anticipate which children will require intensive care unit (ICU) support grows ever more critical. Unplanned ICU admissions can strain limited resources, disrupt workflow, and affect patient outcomes. A new study published in the Annals of Cardiac Anaesthesia delves into the preoperative factors that can help clinicians better predict—and plan for—ICU admissions following elective cardiac catheterizations in children.

Study Overview: Who, What, and How

This prospective cohort study included 169 children (out of 193 initially enrolled) undergoing elective cardiac catheterization at a single tertiary care center. Excluding those with recent surgeries or major illnesses, researchers examined whether specific patient demographics (age, weight), the American Society of Anesthesiologists (ASA) physical grade, and the Catheterization Risk Score for Pediatrics (CRISP) model categories could predict post-procedure ICU admissions.

Major Findings: Four Key Predictors

1. Lower Weight Increases ICU Admission Risk

Children with lower body weight were significantly more likely to require ICU care after elective catheterization. Each 1 kg decrease in weight raised the odds of ICU admission by 18.4%.

2. ASA Physical Grade 4 Signals Higher Risk

Patients classified as ASA grade 4—indicating severe systemic disease—had almost three times the odds of ICU admission compared to those with lower ASA grades, making this a crucial pre-procedural consideration.

3. CRISP Diagnosis Category 3 Is a Strong Predictor

CRISP-based pre-catheterization diagnosis category 3 (the highest risk group within the model) was independently associated with ICU admission, with an odds ratio of 28.3. This underlines the importance of detailed pre-catheterization risk stratification.

4. CRISP Physiologic Category 3 Is Also Significant

Similarly, patients falling into CRISP physiologic risk category 3 (indicating the most compromised physiological status) were over six times more likely to require ICU care post-procedure.

Clinical Impact: Sharpening ICU Resource Planning

The study’s results empower clinicians and hospital administrators to make more objective, evidence-based decisions regarding ICU bed reservations. By focusing on easily measurable factors—weight, ASA status, and detailed CRISP categories—health teams can optimize resource use, reduce unnecessary ICU requests, and ensure high-risk children get the specialized care they need.

Citation:

Maddali MM, Patel MH, Al Aamri I, Sathiya PM. Factors associated with intensive care unit admission following elective cardiac catheterization in children without a recent history of cardiac surgery or major noncardiac comorbidities. Ann Card Anaesth 2026;29:49-55.