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Salha A, Chowdhury T, Singh S, Luyt J, Harky A. Optimizing Outcomes in Extracorporeal Membrane Oxygenation Postcardiotomy in Pediatric Population. J Pediatr Intensive Care 2023; 12:245-255. [PMID: 37970139 PMCID: PMC10631840 DOI: 10.1055/s-0041-1731682] [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: 03/16/2021] [Accepted: 05/29/2021] [Indexed: 10/20/2022] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) is a rapidly emerging advanced life support technique used in cardiorespiratory failure refractory to other treatments. There has been an influx in the number of studies relating to ECMO in recent years, as the technique becomes more popular. However, there are still significant gaps in the literature including complications and their impacts and methods to predict their development. This review evaluates the available literature on the complications of ECMO postcardiotomy in the pediatric population. Areas explored include renal, cardiovascular, hematological, infection, neurological, and hepatic complications. Incidence, risk factors and potential predictors, and scoring systems for the development of these complications have been evaluated.
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Affiliation(s)
- Ahmad Salha
- Department of Medicine, St George's Hospital Medical School, London, United Kingdom
| | - Tasnim Chowdhury
- Department of Medicine, St George's Hospital Medical School, London, United Kingdom
| | - Saloni Singh
- School of Medicine, University of Central Lancashire, Preston, United Kingdom
| | - Jessica Luyt
- Department of Paediatric Intensive Care, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Amer Harky
- Department of Cardiac Surgery, Alder Hey Children Hospital, Liverpool, United Kingdom
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
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2
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Cannulation approach and mortality in neonatal ECMO. J Perinatol 2023; 43:196-202. [PMID: 36076033 DOI: 10.1038/s41372-022-01503-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 08/17/2022] [Accepted: 08/26/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Identify associations between cannulation approach and mortality in neonates who received ECMO support for respiratory failure. STUDY DESIGN A retrospective analysis of neonates receiving ECMO for respiratory indications at a single quaternary-referral NICU. Associations between cannulation approach and mortality were assessed after adjustment for Neo-RESCUERS score. Cox Proportional Hazards (CPH) model was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for each variable and outcome. RESULTS Among 244 neonates, overall survival was 88%, with 71% undergoing VV cannulation. After adjusting for Neo-RESCUERS score, VA cannulation was associated with higher mortality during ECMO when compared with VV cannulation (HR 4.189, 95% CI 1.480-11.851, P = 0.0069). Disease-specific comparisons revealed no statistical difference in Neo-RESCUERS score between VA and VV cohorts; however, VA cannulation was associated with higher ECMO mortality for neonates with congenital diaphragmatic hernia (50% vs. 5.5%, Χ2 = 8.5965, P = 0.0034) and PPHN (20% vs. 1.8%, Χ2 = 9.1047, P = 0.0025) when compared with VV cannulation. CONCLUSION VA cannulation was associated with increased mortality in neonates while on ECMO for respiratory failure, which was independent of illness severity.
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Amodeo A, Stojanovic M, Dave H, Cesnjevar R, Konetzka A, Erdil T, Kretschmar O, Schweiger M. Bridging with Veno-Arterial Extracorporeal Membrane Oxygenation in Children: A 10-Year Single-Center Experience. Life (Basel) 2022; 12:life12091398. [PMID: 36143434 PMCID: PMC9503544 DOI: 10.3390/life12091398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 08/30/2022] [Accepted: 09/05/2022] [Indexed: 11/16/2022] Open
Abstract
Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is frequently used in children with and without congenital heart disease (CHD). This study, of a single-center and retrospective design, evaluated the use and timing of V-A ECMO in a pediatric cohort who underwent V-A ECMO implantation between January 2009 and December 2019. The patients were divided into a pre-/non-surgical group and a post-surgical group. Among the investigated variables were age, gender, weight, duration of ECMO, ECMO indication, and ventricular physiology, with only the latter being statistically relevant between the two groups. A total of 111 children (58 male/53 female), with a median age of 87 days (IQR: 7–623) were supported using V-A ECMO. The pre-/non-surgical group consisted of 59 patients and the post-surgical group of 52 patients. Survival at discharge was 49% for the pre-/non-surgical group and 21% for the surgical group (p = 0.04). Single-ventricle physiology was significant for a worse outcome (p = 0.0193). Heart anatomy still has the biggest role in the outcomes of children on ECMO. Nevertheless, children with CHD can be successfully bridged with ECMO to cardiac operation.
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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
- Correspondence:
| | - 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
| | - 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
| | - Alexander Konetzka
- 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
- 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, Department of Surgery, 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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Kurniawati ER, van Kuijk SMJ, Vranken NPA, Maessen JG, Weerwind PW. Efficacy of Veno-Arterial Extracorporeal Life Support in Adult Patients with Refractory Cardiogenic Shock. CLINICAL MEDICINE INSIGHTS: CIRCULATORY, RESPIRATORY AND PULMONARY MEDICINE 2022; 16:11795484221113988. [PMID: 35899243 PMCID: PMC9309772 DOI: 10.1177/11795484221113988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/29/2022] [Indexed: 11/16/2022] Open
Abstract
Background This study aimed to describe the efficacy of veno-arterial extracorporeal
life support (VA-ECLS) through early lactate clearance and pH restoration
and assess the potential association with 30-day survival following hospital
discharge. Methods Data of patients receiving VA-ECLS for at least 24 h were retrospectively
compiled. Blood lactate levels, liver enzymes, and kidney parameters prior
to VA-ECLS initiation and at 2, 8, 14, 20, and 26 h of support had been
recorded as part of clinical care. The primary outcome was 30-day
survival. Results Of 77 patients who underwent VA-ECLS for refractory cardiogenic shock, 44.2%
survived. For all non-survivors, ECLS was initiated after eight hours
(p = .008). Blood pH was significantly higher in
survivors compared to non-survivors at all time points except for pre-ECLS.
Lactate levels were significantly lower in survivors (median range 1.95-4.70
vs 2.90-6.70 mmol/L for survivors vs non-survivors, respectively).
Univariate and multivariate analyses indicated that blood pH at 24 h (OR
0.045, 95% CI: 0.005-0.448 for pH <7.35, p = .045) and
lactate concentration pre-ECLS (OR 0.743, 95% CI: 0.590-0.936,
p = .012) were reliable predictors for 30-day survival.
Further, ischemic cardiogenic shock as ECLS indication showed 36.2% less
lactate clearance compared to patients with other indications such as
arrhythmia, postcardiotomy, and ECPR. Conclusion ECLS showed to be an effective treatment in reducing blood lactate levels in
patients suffering from refractory cardiogenic shock in which the outcome is
influenced by the initial lactate level and pH in the early phase of the
intervention.
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Affiliation(s)
- ER Kurniawati
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - SMJ van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - NPA Vranken
- Department of Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - JG Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - PW Weerwind
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
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Cho HJ, Choi I, Kwak Y, Kim DW, Habimana R, Jeong IS. The Outcome of Post-cardiotomy Extracorporeal Membrane Oxygenation in Neonates and Pediatric Patients: A Systematic Review and Meta-Analysis. Front Pediatr 2022; 10:869283. [PMID: 35547551 PMCID: PMC9083359 DOI: 10.3389/fped.2022.869283] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Post-cardiotomy extracorporeal membrane oxygenation (PC-ECMO) is a known rescue therapy for neonates and pediatric patients who failed to wean from cardiopulmonary bypass (CPB) or who deteriorate in intensive care unit (ICU) due to various reasons such as low cardiac output syndrome (LCOS), cardiac arrest and respiratory failure. We conducted a systematic review and meta-analysis to assess the survival in neonates and pediatric patients who require PC-ECMO and sought the difference in survivals by each indication for PC-ECMO. DESIGN Systematic review and meta-analysis. SETTING Multi-institutional analysis. PARTICIPANTS Neonates and pediatric patients who requires PC- ECMO. INTERVENTIONS ECMO after open-heart surgery. RESULTS Twenty-six studies were included in the analysis with a total of 186,648 patients and the proportion of the population who underwent PC-ECMO was 2.5% (2,683 patients). The overall pooled proportion of survival in this population was 43.3% [95% Confidence interval (CI): 41.3-45.3%; I 2: 1%]. The survival by indications of PC-ECMO were 44.6% (95% CI: 42.6-46.6; I 2: 0%) for CPB weaning failure, 47.3% (95% CI: 39.9-54.7%; I 2: 5%) for LCOS, 37.6% (95% CI: 31.0-44.3%; I 2: 32%) for cardiac arrest and 47.7% (95% CI: 32.5-63.1%; I 2: 0%) for respiratory failure. Survival from PC-ECMO for single ventricle or biventricular physiology, was reported by 12 studies. The risk ratio (RR) was 0.74 for survival in patients with single ventricle physiology (95% CI: 0.63-0.86; I 2: 40%, P < 0.001). Eight studies reported on the survival after PC-ECMO for genetic conditions. The RR was 0.93 for survival in patients with genetic condition (95% CI: 0.52-1.65; I 2: 65%, P = 0.812). CONCLUSIONS PC-ECMO is an effective modality to support neonates and pediatric patients in case of failed CPB weaning and deterioration in ICU. Even though ECMO seems to improve survival, mortality and morbidity remain high, especially in neonates and pediatric patients with single ventricle physiology. Most genetic conditions alone should not be considered a contraindication to ECMO support, further studies are needed to determine which genetic abnormalities are associated with favorable outcome.
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Affiliation(s)
- Hwa Jin Cho
- Division of Pediatric Cardiology and Cardiac Critical Care, Department of Pediatrics, Chonnam National University Children's Hospital and Medical School, Gwangju, South Korea.,Cardiovascular and Respiratory Research Team, Chonnam National University Hospital, Gwangju, South Korea
| | - Insu Choi
- Division of Pediatric Cardiology and Cardiac Critical Care, Department of Pediatrics, Chonnam National University Children's Hospital and Medical School, Gwangju, South Korea
| | - Yujin Kwak
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital and Medical School, Gwangju, South Korea
| | - Do Wan Kim
- Cardiovascular and Respiratory Research Team, Chonnam National University Hospital, Gwangju, South Korea.,Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital and Medical School, Gwangju, South Korea
| | - Reverien Habimana
- Cardiovascular and Respiratory Research Team, Chonnam National University Hospital, Gwangju, South Korea.,Department of Biomedical Sciences, College of Medicine, Chonnam National University Graduate School, Gwangju, South Korea
| | - In-Seok Jeong
- Cardiovascular and Respiratory Research Team, Chonnam National University Hospital, Gwangju, South Korea.,Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital and Medical School, Gwangju, South Korea
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Yu X, Yang Y, Zhang W, Guo Z, Shen J, Xu Z, Zhang H, Wang W. Postcardiotomy Extracorporeal Membrane Oxygenation in Neonates. Thorac Cardiovasc Surg 2021; 69:e41-e47. [PMID: 34327689 PMCID: PMC8324001 DOI: 10.1055/s-0041-1730034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/07/2021] [Indexed: 10/26/2022]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) provides circulatory support in children with congenital heart disease, particularly in the setting of cardiopulmonary failure and inability to wean from cardiopulmonary bypass. This study summarized the clinical application of ECMO in the treatment of heart failure after cardiac surgery in neonates. MATERIALS AND METHODS Clinical data of 23 neonates who received ECMO support in our center from January 2017 to June 2019 were retrospectively analyzed. RESULTS Twenty-three neonates, aged from 0 to 25 days and weight between 2,300 and 4,500 g, with heart failure postcardiotomy were supported with ECMO. The successful weaning rate was 78.26% and discharge rate was 52.17%. Bleeding and residual malformation were the most common complications. The univariate analysis showed that nonsurvivors were related to the factors such as higher lactate value of ECMO 12 and 24 hours (p = 0.008 and 0.001, respectively), longer time to lactate normalization (p = 0.001), lactate > 10 mmol/L before ECMO (p = 0.01), lower weight (p = 0.01), longer ECMO duration (p = 0.005), lower platelet count (p = 0.001), more surgical site bleeding (p = 0.001), and surgical residual malformation (p = 0.04). Further logistic regression analysis revealed that higher lactate value of ECMO 24 hours (p = 0.003), longer ECMO duration (p = 0.015), and surgical site bleeding (p = 0.025) were independent risk factors. CONCLUSION ECMO was an effective technology to support the neonates with cardiopulmonary failure after open heart surgery. Control the lactate acidosis and surgical site bleeding event may be helpful for patients' recovery.
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Affiliation(s)
- Xindi Yu
- Department of Pediatric Thoracic and Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yinyu Yang
- Department of Pediatric Thoracic and Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wei Zhang
- Department of Pediatric Thoracic and Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zheng Guo
- Department of Pediatric Thoracic and Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jia Shen
- Department of Pediatric Thoracic and Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhuoming Xu
- Department of Pediatric Thoracic and Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Haibo Zhang
- Department of Pediatric Thoracic and Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wei Wang
- Department of Pediatric Thoracic and Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Meenaghan SM, Nugent GM, Dee EC, Smith HA, McMahon CJ, Nolke L. Health-Related Quality of Life in Pediatric Cardiac Patients After Extracorporeal Life Support. Pediatr Cardiol 2021; 42:1433-1441. [PMID: 33928419 DOI: 10.1007/s00246-021-02629-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/22/2021] [Indexed: 11/25/2022]
Abstract
Extracorporeal Life Support (ECLS) is often considered successful if the child leaves intensive care alive. For the child and family, a major concern is quality of life. Aim of this study is to compare health-related quality of life scores of children following cardiac ECLS to a healthy control group. Cross-sectional prospective study using Pediatric Quality of Life Inventory 4.0 Generic Core Scale questionnaire. Population included consecutive children between two and sixteen years of age who underwent cardiac ECLS from 2005 to 2016 and their parents. Each age groups' mean and standard deviation was analyzed individually with minimal clinically important difference calculated. We then compared the scores to a healthy population group. Cronbach's alpha for reliability was calculated and linear regression assessed for relationships between demographics and quality of life scores. Forty-one (60%) families responded. The ECLS had significantly (statistically and clinically) lower health-related quality of life scores in every domain when compared to the healthy cohort. The lowest mean total score was school functioning for both children (59.79 vs 81.31, p < 0.01) and parents (59.01 vs 78.27, p < 0.01). Parents had excellent reliability (α = 0.93, 0.95 & 0.90) compared to children with reliability improving with increasing age in children. Improvements in the management of pediatric patients following ECLS are required to improve their health-related quality of life. Further research is warranted to explore the physical and psychological effects of cardiac ECLS on pediatric survivors to establish individual healthcare needs and optimize health-related quality of life.
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Affiliation(s)
- Samantha M Meenaghan
- Physiotherapy Department, Children's Health Ireland at Crumlin, Dublin, Ireland.
| | - Gillian M Nugent
- Physiotherapy Department, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Eithne C Dee
- Physiotherapy Department, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Hazel A Smith
- Pediatrics, Trinity College Dublin, Dublin, Ireland
- Pediatric Intensive Care Unit, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Colin J McMahon
- Department of Pediatric Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Lars Nolke
- Department of Cardiothoracic Surgery, Children's Health Ireland at Crumlin, Dublin, Ireland
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Shah N, Said AS. Extracorporeal Support Prognostication-Time to Move the Goal Posts? MEMBRANES 2021; 11:537. [PMID: 34357187 PMCID: PMC8304743 DOI: 10.3390/membranes11070537] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/12/2021] [Accepted: 07/12/2021] [Indexed: 12/21/2022]
Abstract
Advances in extracorporeal membrane oxygenation (ECMO) technology are associated with expanded indications, increased utilization and improved outcome. There is growing interest in developing ECMO prognostication scores to aid in bedside decision making. To date, the majority of available scores have been limited to mostly registry-based data and with mortality as the main outcome of interest. There continues to be a gap in clinically applicable decision support tools to aid in the timing of ECMO cannulation to improve patients' long-term outcomes. We present a brief review of the commonly available adult and pediatric ECMO prognostication tools, their limitations, and future directions.
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Affiliation(s)
- Neel Shah
- Division of Pediatric Critical Care, Department of Pediatrics, School of Medicine, Washington University in St. Louis, St. Louis, MO 63130, USA;
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Blalock-Taussig Shunt versus Ductal Stent in the Palliation of Duct Dependent Pulmonary Circulation; A Systematic Review and Metanalysis. Curr Probl Cardiol 2021; 47:100885. [PMID: 34175152 DOI: 10.1016/j.cpcardiol.2021.100885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/02/2021] [Indexed: 11/22/2022]
Abstract
In infants with ductal dependent pulmonary blood flow, Blalock-Taussig (BT) shunt and Patent Ductus Arteriosus (PDA) stent, are two palliative procedures aimed to restore circulation. A systematic review and metanalysis was performed on studies comparing PDA stents and BT shunts, in accordance with PRISMA guidelines. Meta-analysis revealed the following; (1) a reduced risk of mortality [RR = 0.585 [0.399-0.859], (P = 0.006)], (2) a reduced risk of complications [RR = 0.523 [0.318-0.860], (P = 0.011), and (3) a reduced risk of ECMO use [R = 0.267 [0.101-0.706] (P = 0.008)], all in the stent group. Additionally, stent group showed higher post procedure oxygen saturation [SMD = 1.307 [95% CI 1.065-1.550], (P < 0.001)], and Nakata index [SMD = 0.679 95% CI [0.513 to 0.845], (P < 0.001)]. PDA stenting presents a viable alternative to BT shunt procedure with better post procedure stability.
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Risk factors for in-hospital mortality and acute kidney injury in neonatal-pediatric patients receiving extracorporeal membrane oxygenation. J Formos Med Assoc 2021; 120:1758-1767. [PMID: 33810928 DOI: 10.1016/j.jfma.2021.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/03/2021] [Accepted: 03/04/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is the most frequent complication in critically ill neonatal and pediatric patients receiving extracorporeal membrane oxygenation (ECMO) support. This study analyzed risk factors for in-hospital mortality and the incidence of AKI in neonatal and pediatric patients received ECMO support. METHODS We reviewed the medical records of 105 neonatal and 171 pediatric patients who received ECMO support at the intensive care unit (ICU) of a tertiary care university hospital between January 2008 and December 2015. Demographic, clinical, and laboratory data were retrospectively collected as survival and AKI predictors, utilizing the Kidney Disease Improving Global Outcome (KDIGO) consensus definition for AKI. RESULTS In the 105 neonatal and 171 pediatric patients, the overall in-hospital mortality rate were 58% and 55% respectively. The incidence of AKI at post-ECMO 24 h were 64.8% and 61.4%. A greater KDIGO24-h severity was associated with a higher in-hospital mortality rate (chi-square test; p < 0.01) and decreased survival rate (log-rank tests, p < 0.01). In univariate logistic regression analysis of in-hospital mortality, the CVP level at post ECOMO 24-h increased odds ratio (OR) (OR = 1.27 [1.10-1.46], p = 0.001) of in-hospital mortality in neonatal group; as for pediatric group, elevated lactate (OR = 1.12 [1.03-1.20], p = 0.005) and PT (OR = 1.86 [1.17-2.96], p = 0.009) increased OR of in-hospital mortality. And the KDIGO24h stage 3 had the strongest association with in-hospital mortality in both neonatal (p = 0.005) and pediatric (p = 0.001) groups. In multivariate OR of neonatal and pediatric groups were 4.38 [1.46-13.16] (p = 0.009) and 3.76 [1.70-8.33] (p = 0.001), respectively. CONCLUSIONS AKI was a significant risk factor for in-hospital mortality in the neonatal and pediatric patients who received ECMO support. A greater KDIGO24-h severity was associated with higher mortality rates and decreased survival rate in both neonatal and pediatric groups. Of note, KDIGO24h can be an easy and early tool for the prognosis of AKI in the neonatal and pediatric patients.
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11
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Merkle-Storms J, Djordjevic I, Weber C, Avgeridou S, Krasivskyi I, Gaisendrees C, Mader N, Kuhn-Régnier F, Kröner A, Bennink G, Sabashnikov A, Trieschmann U, Wahlers T, Menzel C. Impact of Lactate Clearance on Early Outcomes in Pediatric ECMO Patients. ACTA ACUST UNITED AC 2021; 57:medicina57030284. [PMID: 33803807 PMCID: PMC8003148 DOI: 10.3390/medicina57030284] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/07/2021] [Accepted: 03/15/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Pediatric extracorporeal membrane oxygenation (ECMO) support is often the ultimate therapy for neonatal and pediatric patients with congenital heart defects after cardiac surgery. The impact of lactate clearance in pediatric patients during ECMO therapy on outcomes has been analyzed. Materials andMethods: We retrospectively analyzed data from 41 pediatric vaECMO patients between January 2006 and December 2016. Blood lactate and lactate clearance have been recorded prior to ECMO implantation and 3, 6, 9 and 12 h after ECMO start. Receiver operating characteristic (ROC) analysis was used to identify cut-off levels for lactate clearance. Results: Lactate levels prior to ECMO therapy (9.8 mmol/L vs. 13.5 mmol/L; p = 0.07) and peak lactate levels during ECMO support (10.4 mmol/L vs. 14.7 mmol/L; p = 0.07) were similar between survivors and nonsurvivors. Areas under the curve (AUC) of lactate clearance at 3, 9 h and 12 h after ECMO start were significantly predictive for mortality (p = 0.017, p = 0.049 and p = 0.006, respectively). Cut-off values of lactate clearance were 3.8%, 51% and 56%. Duration of ECMO support and respiratory ventilation was significantly longer in survivors than in nonsurvivors (p = 0.01 and p < 0.001, respectively). Conclusions: Dynamic recording of lactate clearance after ECMO start is a valuable tool to assess outcomes and effectiveness of ECMO application. Poor lactate clearance during ECMO therapy in pediatric patients is a significant marker for higher mortality.
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Affiliation(s)
- Julia Merkle-Storms
- Heart Centre, Department of Cardiothoracic Surgery, University of Cologne, 50924 Cologne, Germany; (C.W.); (S.A.); (I.K.); (C.G.); (N.M.); (F.K.-R.); (A.K.); (G.B.); (A.S.); (T.W.)
- Correspondence: (J.M.-S.); (I.D.)
| | - Ilija Djordjevic
- Heart Centre, Department of Cardiothoracic Surgery, University of Cologne, 50924 Cologne, Germany; (C.W.); (S.A.); (I.K.); (C.G.); (N.M.); (F.K.-R.); (A.K.); (G.B.); (A.S.); (T.W.)
- Correspondence: (J.M.-S.); (I.D.)
| | - Carolyn Weber
- Heart Centre, Department of Cardiothoracic Surgery, University of Cologne, 50924 Cologne, Germany; (C.W.); (S.A.); (I.K.); (C.G.); (N.M.); (F.K.-R.); (A.K.); (G.B.); (A.S.); (T.W.)
| | - Soi Avgeridou
- Heart Centre, Department of Cardiothoracic Surgery, University of Cologne, 50924 Cologne, Germany; (C.W.); (S.A.); (I.K.); (C.G.); (N.M.); (F.K.-R.); (A.K.); (G.B.); (A.S.); (T.W.)
| | - Ihor Krasivskyi
- Heart Centre, Department of Cardiothoracic Surgery, University of Cologne, 50924 Cologne, Germany; (C.W.); (S.A.); (I.K.); (C.G.); (N.M.); (F.K.-R.); (A.K.); (G.B.); (A.S.); (T.W.)
| | - Christopher Gaisendrees
- Heart Centre, Department of Cardiothoracic Surgery, University of Cologne, 50924 Cologne, Germany; (C.W.); (S.A.); (I.K.); (C.G.); (N.M.); (F.K.-R.); (A.K.); (G.B.); (A.S.); (T.W.)
| | - Navid Mader
- Heart Centre, Department of Cardiothoracic Surgery, University of Cologne, 50924 Cologne, Germany; (C.W.); (S.A.); (I.K.); (C.G.); (N.M.); (F.K.-R.); (A.K.); (G.B.); (A.S.); (T.W.)
| | - Ferdinand Kuhn-Régnier
- Heart Centre, Department of Cardiothoracic Surgery, University of Cologne, 50924 Cologne, Germany; (C.W.); (S.A.); (I.K.); (C.G.); (N.M.); (F.K.-R.); (A.K.); (G.B.); (A.S.); (T.W.)
| | - Axel Kröner
- Heart Centre, Department of Cardiothoracic Surgery, University of Cologne, 50924 Cologne, Germany; (C.W.); (S.A.); (I.K.); (C.G.); (N.M.); (F.K.-R.); (A.K.); (G.B.); (A.S.); (T.W.)
| | - Gerardus Bennink
- Heart Centre, Department of Cardiothoracic Surgery, University of Cologne, 50924 Cologne, Germany; (C.W.); (S.A.); (I.K.); (C.G.); (N.M.); (F.K.-R.); (A.K.); (G.B.); (A.S.); (T.W.)
| | - Anton Sabashnikov
- Heart Centre, Department of Cardiothoracic Surgery, University of Cologne, 50924 Cologne, Germany; (C.W.); (S.A.); (I.K.); (C.G.); (N.M.); (F.K.-R.); (A.K.); (G.B.); (A.S.); (T.W.)
| | - Uwe Trieschmann
- Anaesthesiology and Intensive Care Medicine, University of Cologne, 50924 Cologne, Germany; (U.T.); (C.M.)
| | - Thorsten Wahlers
- Heart Centre, Department of Cardiothoracic Surgery, University of Cologne, 50924 Cologne, Germany; (C.W.); (S.A.); (I.K.); (C.G.); (N.M.); (F.K.-R.); (A.K.); (G.B.); (A.S.); (T.W.)
| | - Christoph Menzel
- Anaesthesiology and Intensive Care Medicine, University of Cologne, 50924 Cologne, Germany; (U.T.); (C.M.)
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Vargas-Camacho G, Contreras-Cepeda V, Gómez-Gutierrez R, Quezada-Valenzuela G, Nieto-Sanjuanero A, Santos-Guzmán J, González-Salazar F. Venoarterial extracorporeal membrane oxygenation in heart surgery post-operative pediatric patients: A retrospective study at Christus Muguerza Hospital, Monterrey, Mexico. SAGE Open Med 2020; 8:2050312120910353. [PMID: 32166028 PMCID: PMC7052455 DOI: 10.1177/2050312120910353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 02/04/2020] [Indexed: 01/13/2023] Open
Abstract
Objectives Extracorporeal membrane oxygenation is a life support procedure developed to offer cardiorespiratory support when conventional therapies have failed. The purpose of this study is to describe the findings during the first years using venoarterial extracorporeal membrane oxygenation in pediatric patients after cardiovascular surgery at Christus Muguerza High Specialty Hospital in Monterrey, Mexico. Methods This is a retrospective, observational, and descriptive study. The files of congenital heart surgery post-operative pediatric patients, who were treated with venoarterial extracorporeal membrane oxygenation from January 2013 to December 2015, were reviewed. Results A total of 11 patients were reviewed, of which 7 (63.8%) were neonates and 4 (36.7%) were in pediatric age. The most common diagnoses were transposition of great vessels, pulmonary stenosis, and tetralogy of Fallot. Survival rate was 54.5% and average life span was 6.3 days; the main complications were sepsis (36.3%), acute renal failure (36.3%), and severe cerebral hemorrhage (9.1%). The main causes of death were multi-organ dysfunction syndrome (27.3%) and cerebral hemorrhage (18.2%). Conclusion The mortality rates found are very similar to those found in a meta-analysis report published in 2013 and the main complication and causes of death are also very similar to the majority of extracorporeal membrane oxygenation reports for these kinds of patients. Although the results are encouraging, early sepsis detection, prevention of cerebral hemorrhage, and renal function monitoring must be improved.
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Affiliation(s)
- Gerardo Vargas-Camacho
- Pediatric Intensive Care Unit, Christus Muguerza High Specialty Hospital, Monterrey, Mexico
| | | | - Rene Gómez-Gutierrez
- Pediatric Intensive Care Unit, Christus Muguerza High Specialty Hospital, Monterrey, Mexico
| | | | | | | | - Francisco González-Salazar
- Northeastern Biomedical Investigation Center, Mexican Social Security Institute, Monterrey, Mexico.,Department of Basic Sciences, University of Monterrey, San Pedro Garza García, Mexico
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Jouffroy R, Vivien B. Epinephrine, inodilator, or no inotrope in venoarterial extracorporeal membrane oxygenation implantation: a single-center experience-an RCT would be desirable. Crit Care 2020; 24:21. [PMID: 31969189 PMCID: PMC6977294 DOI: 10.1186/s13054-019-2712-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 12/17/2019] [Indexed: 11/11/2022] Open
Affiliation(s)
- Romain Jouffroy
- SAMU de Paris, Service d'Anesthésie Réanimation, Hôpital Universitaire Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, and Université Paris Descartes - Paris 5, Paris, France.
| | - Benoit Vivien
- SAMU de Paris, Service d'Anesthésie Réanimation, Hôpital Universitaire Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, and Université Paris Descartes - Paris 5, Paris, France
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