Database analysis has proved that peri‐operative cardiac arrest occurs with increased frequency in children with congenital heart disease. Several case series and bigger data from ACS NSQIP, have elucidated subgroups at the highest risk. Consistently patients with single ventricle physiology (especially prior to cavo‐pulmonary anastomosis), severe/supra‐systemic pulmonary hypertension, complex lesions and cardiomyopathy with significantly reduced ventricular function have been shown to be of the greatest concern. Subsequently risk assessment algorithms have been proposed, some based on the national databases. How hospitals and health care systems apply these guidelines to provide safe care to this challenging patient groups requires application of modern quality improvement techniques. Each institution needs to develop a system which reflects local expertise and resources.
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