Taylor D, et al. - Children with congenital heart disease develop perioperative cardiac arrest with increased frequency, as suggested in database analysis, and subgroups at the highest risk have been identified in several case series and large datasets from ACS NSQIP. Increased risk for adverse events has been consistently reported in patients with single ventricle physiology (especially prior to cavopulmonary anastomosis), severe/supra-systemic pulmonary hypertension, complex lesions, and cardiomyopathy with significantly decreased ventricular function. Algorithms for risk evaluation have been introduced, considering these findings as a basis. The employment of modern quality improvement techniques is needed for the application of these guidelines by hospitals and health care systems to offer safe care for these challenging patient groups. A system which reflects local expertise and resources should be developed by each institution.