Beyond daylight: emergent cardiac catheterization in congenital heart disease during evenings and nights: clinical demand and logistical realities

Background: Emergency cardiac catheterizations (ECC) during off-hours are high risk due to limited staffing and resources. To date, no systematic data are available on the outcomes of such emergent procedures for congenital heart disease (CHD). Objectives: To the best of our knowledge, this study is among the first to systematically evaluate outcomes, procedural characteristics, and multidisciplinary involvement in off-hours ECC among patients with CHD. Methods: We retrospectively analyzed all ECC performed during evenings and nights over two and half years at a single tertiary center. Data included demographics, indications, interventions, staffing, and outcomes. Results: Between January 2023 and November 2025, a total of 2,050 procedures were performed; of these, 37 (1.8%) were emergent off-hours cases. Median age was 25 days (range: 1 day-14 years); median weight was 3.9 kg (range: 2-50 kg). Indications included critical cyanosis (40.5%), cardiogenic shock (19%), postoperative instability (37.8%), and interventional complications (2.7%). Interventions included Rashkind atrioseptostomy, pulmonary/aortic balloon angioplasty, shunt, pulmonary and coarctation stenting, and postoperative rescue procedures, accounting for 89% of cases. All ECCs were performed by a single interventionalist. Nursing staff support was required in 48% of performed interventions, primarily those involving stenting and dilation. Rashkind-guided echocardiography was performed by anesthesiology (n = 7). The surgical team was on-site in 40% of cases. All patients who underwent intervention showed clinical improvement; ECMO was avoided in four cases and weaned in two. No early complications were observed. One late femoral arteriovenous fistula required surgical revision. Conclusions: Emergent off-hours catheterizations in CHD can achieve favorable outcomes when performed by a skilled multidisciplinary team. Success depends not only on physician expertise but also on institutional readiness, effective organization, and seamless team coordination.