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Sperotto F, Daverio M, Amigoni A, Gregori D, Dorste A, Kobayashi RL, Thiagarajan RR, Maschietto N, Alexander PM. Extracorporeal Cardiopulmonary Resuscitation Use Among Children With Cardiac Disease in the ICU: A Meta-Analysis and Meta-Regression of Data Through March 2024. Pediatr Crit Care Med 2024:00130478-990000000-00378. [PMID: 39177428 DOI: 10.1097/pcc.0000000000003594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
OBJECTIVE Epidemiologic data on extracorporeal cardiopulmonary resuscitation (ECPR) use in children with cardiac disease after in-hospital cardiac arrest (IHCA) are lacking. We aimed to investigate trends in ECPR use over time in critically ill children with cardiac disease. DATA SOURCES We performed a secondary analysis of a recent systematic review (PROSPERO CRD42020156247) to investigate trends in ECPR use in children with cardiac disease. PubMed, Web of Science, Embase, and Cumulative Index to Nursing and Allied Health Literature were screened (inception to September 2021). For completeness of this secondary analysis, PubMed was also rescreened (September 2021 to March 2024). STUDY SELECTION Observational studies including epidemiologic data on ECPR use in children with cardiac disease admitted to an ICU. DATA EXTRACTION Data were extracted by two independent investigators. The risk of bias was assessed using the National Heart Lung and Blood Institutes Quality Assessment Tools. Random-effects meta-analysis was used to compute a pooled proportion of subjects undergoing ECPR; meta-regression was used to assess trends in ECPR use over time. DATA SYNTHESIS Of the 2664 studies identified, 9 (17,669 patients) included data on ECPR use in children with cardiac disease. Eight were cohort studies, 1 was a case-control, 8 were retrospective, 1 was prospective, 6 were single-center, and 3 were multicenter. Seven studies were included in the meta-analysis; all were judged of good quality. By meta-analysis, we found that a pooled proportion of 21% (95% CI, 15-29%) of pediatric patients with cardiac disease experiencing IHCA were supported with ECPR. By meta-regression adjusted for category of patients (surgical vs. general cardiac), we found that the use of ECPR in critically ill children with cardiac disease significantly increased over time (p = 0.026). CONCLUSIONS About one-fifth of critically ill pediatric cardiac patients experiencing IHCA were supported with ECPR, and its use significantly increased over time. This may partially explain the increased trends in survival demonstrated for this population.
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Affiliation(s)
- Francesca Sperotto
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Marco Daverio
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Angela Amigoni
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Dario Gregori
- Laboratories of Epidemiological Methods and Biostatistics, Department of Environmental Medicine and Public Health, University of Padova, Padova, Italy
| | - Anna Dorste
- Boston Children's Hospital Library, Boston Children's Hospital, Boston, MA
| | - Ryan L Kobayashi
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Ravi R Thiagarajan
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Nicola Maschietto
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Peta M Alexander
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
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Kobayashi RL, Sperotto F, Alexander PMA. Targeting Hemodynamics of Cardiopulmonary Resuscitation to Cardiac Physiology-The Next Frontier for Resuscitation Science? Pediatr Crit Care Med 2024; 25:380-382. [PMID: 38573041 PMCID: PMC10997157 DOI: 10.1097/pcc.0000000000003466] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Affiliation(s)
- Ryan L Kobayashi
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Francesca Sperotto
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Peta M A Alexander
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
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Thiagarajan RR. Quality of Cardiopulmonary Resuscitation in Children With Cardiac and Noncardiac Disease: Comparing Apples and Oranges? Pediatr Crit Care Med 2024; 25:72-73. [PMID: 38169337 DOI: 10.1097/pcc.0000000000003399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Affiliation(s)
- Ravi R Thiagarajan
- Division of Cardiovascular Critical Care, Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
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Zea-Vera R, Sperotto F, Eghtesady P, Maschietto N. From Surgical to Total Transcatheter Stage I Palliation: Exploring Evidence and Perspectives. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2023; 27:3-10. [PMID: 38522869 DOI: 10.1053/j.pcsu.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/01/2023] [Accepted: 12/06/2023] [Indexed: 03/26/2024]
Abstract
Neonates with single ventricle physiology and ductal-dependent systemic circulation, such as those with hypoplastic left heart syndrome, undergo palliation in the first days of life. Over the past decades, variations on the traditional Stage 1 palliation, also known as Norwood operation, have emerged. These include the hybrid palliation and the total transcatheter approach. Here, we review the current evidence and data on different Stage 1 approaches, with a focus on their advantages, challenges, and future perspectives. Overall, although controversy remains regarding the superiority or inferiority of one approach to another, outcomes after the Norwood and the hybrid palliation have improved over time. However, both procedures still represent high-risk approaches that entail exposure to sternotomy, surgery, and potential cardiopulmonary bypass. The total transcatheter Stage 1 palliation spares patients the surgical and cardiopulmonary bypass insults and has proven to be an effective strategy to bridge even high-risk infants to a later palliative surgery, complete repair, or transplant. As the most recently proposed approach, data are still limited but promising. Future studies will be needed to better define the advantages, challenges, outcomes, and overall potential of this novel approach.
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Affiliation(s)
- Rodrigo Zea-Vera
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Washington University, Saint Louis, Missouri
| | - Francesca Sperotto
- Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Pirooz Eghtesady
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Washington University, Saint Louis, Missouri.
| | - Nicola Maschietto
- Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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K SSNSP, Taksande A, Meshram RJ. Reviving Hope: A Comprehensive Review of Post-resuscitation Care in Pediatric ICUs After Cardiac Arrest. Cureus 2023; 15:e50565. [PMID: 38226102 PMCID: PMC10788704 DOI: 10.7759/cureus.50565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/15/2023] [Indexed: 01/17/2024] Open
Abstract
This comprehensive review thoroughly examines post-resuscitation care in pediatric ICUs (PICUs) following cardiac arrest. The analysis encompasses adherence to resuscitation guidelines, advances in therapeutic interventions, and the nuanced management of neurological, cardiovascular, and respiratory considerations during the immediate post-resuscitation phase. Delving into the complexities of long-term outcomes, cognitive and developmental considerations, and rehabilitation strategies, the review emphasizes the importance of family-centered care for pediatric survivors. A call to action is presented, urging continuous education, research initiatives, and quality improvement efforts alongside strengthened multidisciplinary collaboration and advocacy for public awareness. Through implementing these principles, healthcare providers and systems can collectively contribute to ongoing advancements in pediatric post-resuscitation care, ultimately improving outcomes and fostering a culture of excellence in pediatric critical care.
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Affiliation(s)
- Sri Sita Naga Sai Priya K
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Amar Taksande
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Revat J Meshram
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Sperotto F, Lang N, Nathan M, Kaza A, Hoganson DM, Valencia E, Odegard K, Allan CK, da Cruz EM, Del Nido PJ, Emani SM, Baird C, Maschietto N. Transcatheter Palliation With Pulmonary Artery Flow Restrictors in Neonates With Congenital Heart Disease: Feasibility, Outcomes, and Comparison With a Historical Hybrid Stage 1 Cohort. Circ Cardiovasc Interv 2023; 16:e013383. [PMID: 38113289 DOI: 10.1161/circinterventions.123.013383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 08/31/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Neonates with complex congenital heart disease and pulmonary overcirculation have been historically treated surgically. However, subcohorts may benefit from less invasive procedures. Data on transcatheter palliation are limited. METHODS We present our experience with pulmonary flow restrictors (PFRs) for palliation of neonates with congenital heart disease, including procedural feasibility, technical details, and outcomes. We then compared our subcohort of high-risk single ventricle neonates palliated with PFRs with a similar historical cohort who underwent a hybrid Stage 1. Cox regression was used to evaluate the association between palliation strategy and 6-month mortality. RESULTS From 2021 to 2023, 17 patients (median age, 4 days; interquartile range [IQR], 2-8; median weight, 2.5 kilograms [IQR, 2.1-3.3]) underwent a PFR procedure; 15 (88%) had single ventricle physiology; 15 (88%) were high-risk surgical candidates. All procedures were technically successful. At a median follow-up of 6.2 months (IQR, 4.0-10.8), 13 patients (76%) were successfully bridged to surgery (median time since PFR procedure, 2.6 months [IQR, 1.1-4.4]; median weight, 4.9 kilograms [IQR, 3.4-5.8]). Pulmonary arteries grew adequately for age, and devices were easily removed without complications. The all-cause mortality rate before target surgery was 24% (n=4). Compared with the historical hybrid stage 1 cohort (n=23), after adjustment for main confounding (age, weight, intact/severely restrictive atrial septum or left ventricle to coronary fistulae), the PFR procedure was associated with a significantly lower all-cause 6-month mortality risk (adjusted hazard ratio, 0.26 [95% CI, 0.08-0.82]). CONCLUSIONS Transcatheter palliation with PFR is feasible, safe, and represents an effective strategy for bridging high-risk neonates with congenital heart disease to surgical palliation, complete repair, or transplant while allowing for clinical stabilization and somatic growth.
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Affiliation(s)
- Francesca Sperotto
- Department of Cardiology (F.S., N.L., E.V., C.K.A., E.M.d.C., N.M.), Boston Children's Hospital, Harvard Medical School, MA
| | - Nora Lang
- Department of Cardiology (F.S., N.L., E.V., C.K.A., E.M.d.C., N.M.), Boston Children's Hospital, Harvard Medical School, MA
- Department of Pediatric Cardiology, University Heart & Vascular Center Hamburg, Germany (N.L.)
| | - Meena Nathan
- Department of Cardiac Surgery (M.N., A.K., D.M.H., P.J.D.N., S.M.E., C.B.), Boston Children's Hospital, Harvard Medical School, MA
| | - Aditya Kaza
- Department of Cardiac Surgery (M.N., A.K., D.M.H., P.J.D.N., S.M.E., C.B.), Boston Children's Hospital, Harvard Medical School, MA
| | - David M Hoganson
- Department of Cardiac Surgery (M.N., A.K., D.M.H., P.J.D.N., S.M.E., C.B.), Boston Children's Hospital, Harvard Medical School, MA
| | - Eleonore Valencia
- Department of Cardiology (F.S., N.L., E.V., C.K.A., E.M.d.C., N.M.), Boston Children's Hospital, Harvard Medical School, MA
| | - Kirsten Odegard
- Department of Cardiac Anesthesia (K.O.), Boston Children's Hospital, Harvard Medical School, MA
| | - Catherine K Allan
- Department of Cardiology (F.S., N.L., E.V., C.K.A., E.M.d.C., N.M.), Boston Children's Hospital, Harvard Medical School, MA
| | - Eduardo M da Cruz
- Department of Cardiology (F.S., N.L., E.V., C.K.A., E.M.d.C., N.M.), Boston Children's Hospital, Harvard Medical School, MA
| | - Pedro J Del Nido
- Department of Cardiac Surgery (M.N., A.K., D.M.H., P.J.D.N., S.M.E., C.B.), Boston Children's Hospital, Harvard Medical School, MA
| | - Sitaram M Emani
- Department of Cardiac Surgery (M.N., A.K., D.M.H., P.J.D.N., S.M.E., C.B.), Boston Children's Hospital, Harvard Medical School, MA
| | - Christopher Baird
- Department of Cardiac Surgery (M.N., A.K., D.M.H., P.J.D.N., S.M.E., C.B.), Boston Children's Hospital, Harvard Medical School, MA
| | - Nicola Maschietto
- Department of Cardiology (F.S., N.L., E.V., C.K.A., E.M.d.C., N.M.), Boston Children's Hospital, Harvard Medical School, MA
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Amodeo A, Stojanovic M, Erdil T, Dave H, Cesnjevar R, Paal S, Kretschmar O, Schweiger M. Risk Factors and Outcomes of Children with Congenital Heart Disease on Extracorporeal Membrane Oxygenation-A Ten-Year Single-Center Report. Life (Basel) 2023; 13:1582. [PMID: 37511957 PMCID: PMC10381661 DOI: 10.3390/life13071582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
For children born with congenital heart defects (CHDs), extracorporeal life support may be necessary. This retrospective single-center study aimed to investigate the outcomes of children with CHDs on extracorporeal membrane oxygenation (ECMO), focusing on various risk factors. Among the 88 patients, 36 (41%) had a single-ventricle heart defect, while 52 (59%) had a biventricular defect. In total, 25 (28%) survived, with 7 (8%) in the first group and 18 (20%) in the latter. A p-value of 0.19 indicated no significant difference in survival rates. Children with biventricular hearts had shorter ECMO durations but longer stays in the intensive care unit. The overall rate of complications on ECMO was higher in children with a single ventricle (odds ratio [OR] 1.57, 95% confidence interval [CI] 0.67-3.7); bleeding was the most common complication in both groups. The occurrence of a second ECMO run was more frequent in patients with a single ventricle (22% vs. 9.6%). ECMO can be effective for children with congenital heart defects, including single-ventricle patients. Bleeding remains a serious complication associated with worse outcomes. Patients requiring a second ECMO run within 30 days have lower survival rates.
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Affiliation(s)
- Antonio Amodeo
- Pediatric Cardiovascular Surgery, Pediatric Heart Center, Department of Surgery, University Children's Hospital Zurich, 8032 Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, 8032 Zurich, Switzerland
| | - Milena Stojanovic
- Pediatric Cardiovascular Surgery, Pediatric Heart Center, Department of Surgery, University Children's Hospital Zurich, 8032 Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, 8032 Zurich, Switzerland
| | - Tugba Erdil
- Division of General Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Hitendu Dave
- Pediatric Cardiovascular Surgery, Pediatric Heart Center, Department of Surgery, University Children's Hospital Zurich, 8032 Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, 8032 Zurich, Switzerland
| | - Robert Cesnjevar
- Pediatric Cardiovascular Surgery, Pediatric Heart Center, Department of Surgery, University Children's Hospital Zurich, 8032 Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, 8032 Zurich, Switzerland
| | - Sebastian Paal
- Pediatric Cardiovascular Surgery, Pediatric Heart Center, Department of Surgery, University Children's Hospital Zurich, 8032 Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, 8032 Zurich, Switzerland
| | - Oliver Kretschmar
- Children's Research Center, University Children's Hospital Zurich, 8032 Zurich, Switzerland
- Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, 8032 Zurich, Switzerland
| | - Martin Schweiger
- Pediatric Cardiovascular Surgery, Pediatric Heart Center, Department of Surgery, University Children's Hospital Zurich, 8032 Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, 8032 Zurich, Switzerland
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