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Hord EC, Hager MP, Bolch CM, Bonugli K, Guo LJ, Tuzun E, Criscione JC. Preclinical Proof-of-Concept of a Minimally Invasive Direct Cardiac Compression Device for Pediatric Heart Support. Cardiovasc Eng Technol 2024; 15:147-158. [PMID: 38110762 PMCID: PMC11116177 DOI: 10.1007/s13239-023-00703-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 11/21/2023] [Indexed: 12/20/2023]
Abstract
PURPOSE For pediatric patients, extracorporeal membrane oxygenation (ECMO) remains the predominant mechanical circulatory support (MCS) modality for heart failure (HF) although survival to discharge rates remain between 50 and 60% for these patients. The device-blood interface and disruption of physiologic hemodynamics are significant contributors to poor outcomes. METHODS In this study, we evaluate the preclinical feasibility of a minimally invasive, non-blood-contacting pediatric DCC prototype for temporary MCS. Proof-of-concept is demonstrated in vivo in an animal model of HF. Hemodynamic pressures and flows were examined. RESULTS Minimally invasive deployment on the beating heart was successful without cardiopulmonary bypass or anticoagulation. During HF, device operation resulted in an immediate 43% increase in cardiac output while maintaining pulsatile hemodynamics. Compared to the pre-HF baseline, the device recovered up to 95% of ventricular stroke volume. At the conclusion of the study, the device was easily removed from the beating heart. CONCLUSIONS This preclinical proof-of-concept study demonstrated the feasibility of a DCC device on a pediatric scale that is minimally invasive and non-blood contacting, with promising hemodynamic support and durability for the initial intended duration of use. The ability of DCC to maintain pulsatile MCS without blood contact represents an opportunity to mitigate the mortality and morbidity observed in non-pulsatile, blood-contacting MCS.
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Affiliation(s)
- Erica C Hord
- CorInnova, Inc. JLABS @ TMC, 2450 Holcombe Blvd Suite J, Houston, TX, 77021, USA
| | - Melanie P Hager
- Department of Biomedical Engineering, Texas A&M University, 5045 Emerging Technologies Building 3120 TAMU, College Station, TX, 77843-3120, USA
- Texas A&M University College of Medicine, 3050 Health Professions Education Building 1359 TAMU, Bryan, TX, 77807-1359, USA
| | - Christina M Bolch
- CorInnova, Inc. JLABS @ TMC, 2450 Holcombe Blvd Suite J, Houston, TX, 77021, USA
| | - Katherine Bonugli
- Texas A&M University Institute for Preclinical Studies, 4478 TAMU, College Station, TX, 77843-4478, USA
| | - Lee-Jae Guo
- Texas A&M University Institute for Preclinical Studies, 4478 TAMU, College Station, TX, 77843-4478, USA
| | - Egemen Tuzun
- Texas A&M University Institute for Preclinical Studies, 4478 TAMU, College Station, TX, 77843-4478, USA
| | - John C Criscione
- CorInnova, Inc. JLABS @ TMC, 2450 Holcombe Blvd Suite J, Houston, TX, 77021, USA.
- Department of Biomedical Engineering, Texas A&M University, 5045 Emerging Technologies Building 3120 TAMU, College Station, TX, 77843-3120, USA.
- Texas A&M University College of Medicine, 3050 Health Professions Education Building 1359 TAMU, Bryan, TX, 77807-1359, USA.
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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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Hossain MS, Khan FA, Cass DL, Robertson JO. Discontinuation of the OriGen® Dual-lumen Right Atrial Cannula Decreased Venovenous ECMO Usage in Neonates and Older Children: A Survey of the American Pediatric Surgical Association. J Pediatr Surg 2023; 58:1185-1190. [PMID: 36914461 DOI: 10.1016/j.jpedsurg.2023.02.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 02/10/2023] [Indexed: 02/21/2023]
Abstract
INTRODUCTION Dual-lumen cannulas for venovenous (VV)-ECMO are widely used in pediatric patients. The popular OriGen® dual-lumen right atrial cannula was discontinued in 2019 without a comparable replacement. METHODS A survey covering VV-ECMO practice and opinions was distributed to attending members of the American Pediatric Surgical Association. RESULTS 137 pediatric surgeons responded (14%). Prior to discontinuation of the OriGen®, 82.5% offered VV-ECMO to neonates, and 79.6% cannulated with the OriGen®. Following its discontinuation, those that offered only venoarterial (VA)-ECMO to neonates increased to 37.6% from 17.5% (p = 0.0002). An additional 33.8% changed their practice to sometimes use VA-ECMO when VV-ECMO was indicated. Reasons for not incorporating dual-lumen bi-caval cannulation into practice included risk of cardiac injury (51.7%), inexperience with bi-caval cannulation in neonates (36.8%), difficulty with placement (31.0%), and recirculation and/or positioning problems (27.6%). For the pediatric/adolescent population, 95.5% of surgeons offered VV-ECMO prior to OriGen® discontinuation. Few switched to exclusive VA-ECMO (1.9%) when the OriGen® was discontinued, but 17.8% of surgeons began to incorporate selective use of VA-ECMO. CONCLUSION Discontinuation of the OriGen® cannula drove pediatric surgeons to alter their cannulation practices, dramatically increasing VA-ECMO use for neonatal and pediatric respiratory failure. These data may suggest a need for targeted education accompanying major technological shifts. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Mir Shanaz Hossain
- Department of Pediatric Surgery, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Faraz A Khan
- Department of Pediatric Surgery, Loma Linda Children's Hospital, Loma Linda, CA, USA
| | - Darrell L Cass
- Department of Pediatric Surgery, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Jason O Robertson
- Department of Pediatric Surgery, Cleveland Clinic Children's Hospital, Cleveland, OH, USA.
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4
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Tang W, Zhang WT, Zhang J, Jiang KH, Ge YW, Zheng AB, Wang QW, Xue P, Chen HL. Prevalence of hematologic complications on extracorporeal membranous oxygenation in critically ill pediatric patients: A systematic review and meta-analysis. Thromb Res 2023; 222:75-84. [PMID: 36603406 DOI: 10.1016/j.thromres.2022.12.014] [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: 10/18/2022] [Revised: 12/13/2022] [Accepted: 12/20/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Despite advances in Extracorporeal Membranous Oxygenation (ECMO) equipment, hematologic complications remain significant in critically ill children. The aim of this study is to summarize prevalence of hematologic complications for children and neonates. METHODS MEDLINE, PubMed and Scopus databases were searched focusing on the period from January 01, 2017 to October 01, 2022. The population included critically ill children and neonates with hematologic complications. The review included all aspects of related complications including hemorrhage, thrombosis, and hemolysis. We performed random effects meta-analyses. The primary outcome measure was overall hematologic complications. Secondary outcomes are changes in the prevalence of hemorrhagic complications. Risk of bias of included studies was assessed using the Joanna Briggs Institute checklist. RESULTS The systematic search identified 37 studies totaling 10,659 critically ill pediatric patients receiving ECMO. The pooled prevalence of hemorrhagic complications, thrombotic complications and hemolysis among pediatric patients requiring ECMO was 43.7 % (95 % CI: 28.6 % to 58.9 %, P < 0.001), 27.6 % (95 % CI: 20.4 % to 34.8 %, P < 0.001), 34.3 % (95 % CI: 22.9 % to 45.7 %, P < 0.001). The prevalence of hemorrhagic complications was represented in descending order: surgical site (21.6 %, 95 % CI: 10.3 % to 32.9 %); cannulation site (20.6 %, 95 % CI: 11.8 % to 29.3 %); intracranial (12.2 %, 95 % CI: 9.5 % to 15.0 %); pulmonary (7.7 %, 95 % CI: 5.9 % to 9.6 %); gastrointestinal (6.0 %, 3.7 % to 8.4 %). For the assessment of thrombotic complications, thrombosis in cannulation site had a higher prevalence (28.5 %, 95 % CI: 22.1 % to 34.9 %), followed by DIC (13.5 %, 95 % CI: 8.7 % to 18.3 %) and intracranial thrombosis (4.5 %, 95 % CI: 1.4 % to 7.6 %). Predictors of increased prevalence of hemorrhagic complications included age (P = 0.017) and VV-ECMO support mode (P = 0.029). CONCLUSIONS Among critically ill pediatric patients, there was a series of hematologic complications can occur during ECMO support. Physicians should pay special attention to the management and establish appropriate treatment programs to reduce the occurrence of hematologic complications.
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Affiliation(s)
- Wen Tang
- Medical School, Nantong University, Nantong, China
| | - Wen-Ting Zhang
- Affiliated Changzhou Children's Hospital of Nantong University, Changzhou Children's Hospital, Changzhou, China
| | - Jun Zhang
- Affiliated Changzhou Children's Hospital of Nantong University, Changzhou Children's Hospital, Changzhou, China
| | - Kai-Hua Jiang
- Affiliated Changzhou Children's Hospital of Nantong University, Changzhou Children's Hospital, Changzhou, China
| | - Ya-Wen Ge
- Affiliated Changzhou Children's Hospital of Nantong University, Changzhou Children's Hospital, Changzhou, China
| | - Ai-Bing Zheng
- Affiliated Changzhou Children's Hospital of Nantong University, Changzhou Children's Hospital, Changzhou, China
| | - Qiu-Wei Wang
- Affiliated Changzhou Children's Hospital of Nantong University, Changzhou Children's Hospital, Changzhou, China
| | - Peng Xue
- Affiliated Changzhou Children's Hospital of Nantong University, Changzhou Children's Hospital, Changzhou, China.
| | - Hong-Lin Chen
- School of Public Health, Nantong University, Nantong, China.
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Salas de Armas IA, Shirafkan A, Akay MH, Patel J, Patel MK, Marcano J, Al Rameni D, Zaki J, Gregoric ID. Transaortic Placement of Percutaneous Mechanical Support Device via Partial Sternotomy: Feasible Option for Unsuitable Axillary Artery Access. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:377-381. [DOI: 10.1177/15569845221123535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Acute decompensated refractory cardiogenic shock is an emergency in which the prompt instauration of mechanical circulatory support improves outcomes. The typical, initial approach for device delivery is via femoral vessels due to easy access and safety. If longer support is needed, the femoral access will severely impair the patient’s mobility and can also limit the amount of support given as the new-generation devices are too large for direct arterial insertion. Upper-body arterial conduits (UBACs) are used for the delivery of larger, percutaneous ventricular assist devices (pVADs). The Impella 5.5 (Abiomed, Danvers, MA, USA) is a pVAD that can be deployed through a UBAC by either axillary/subclavian access or a transaortic approach. The latter approach is typically used in cases of postcardiotomy shock, in which the ascending aorta is already exposed through a full sternotomy. However, in some cases, the axillary artery is not suitable due to size (<6 mm in diameter), and a smaller pVAD is delivered into the heart. To avoid providing suboptimal support, we present an alternative, minimally invasive approach in which the larger device is delivered through the ascending aorta. This article summarizes the details of this approach through a mini upper partial sternotomy and reviews the relevant technical considerations.
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Affiliation(s)
- Ismael A. Salas de Armas
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, TX, USA
| | - Ali Shirafkan
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, TX, USA
| | - Mehmet H. Akay
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, TX, USA
| | - Jayeshkumar Patel
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, TX, USA
| | - Manish K. Patel
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, TX, USA
| | - Juan Marcano
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, TX, USA
| | - Dina Al Rameni
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, TX, USA
| | - John Zaki
- Department of Anesthesiology, The University of Texas Health Science Center at Houston, TX, USA
| | - Igor D. Gregoric
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, TX, USA
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Yu SH, Mao DH, Ju R, Fu YY, Zhang LB, Yue G. ECMO in neonates: The association between cerebral hemodynamics with neurological function. Front Pediatr 2022; 10:908861. [PMID: 36147805 PMCID: PMC9485612 DOI: 10.3389/fped.2022.908861] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/25/2022] [Indexed: 11/20/2022] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) is a superior life support technology, commonly employed in critical patients with severe respiratory or hemodynamic failure to provide effective respiratory and circulatory support, which is especially recommended for the treatment of critical neonates. However, the vascular management of neonates with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is still under controversy. Reconstruction or ligation for the right common carotid artery (RCCA) after ECMO is inconclusive. This review summarized the existed studies on hemodynamics and neurological function after vascular ligation or reconstruction hoping to provide better strategies for vessel management in newborns after ECMO. After reconstruction, the right cerebral blood flow can increase immediately, and the normal blood supply can be restored rapidly. But the reconstructed vessel may be occluded and stenotic in long-term follow-ups. Ligation may cause lateralization damage, but there could be no significant effect owing to the establishment of collateral circulation. The completion of the circle of Willis, the congenital anomalies of cerebral or cervical vasculature, the duration of ECMO, and the vascular condition at the site of arterial catheterization should be assessed carefully before making the decision. It is also necessary to follow up on the reconstructed vessel sustainability, and the association between cerebral hemodynamics and neurological function requires further large-scale multi-center studies.
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Affiliation(s)
- Shu-Han Yu
- Department of Neonatology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Dan-Hua Mao
- Department of Neonatology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Rong Ju
- Department of Neonatology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yi-Yong Fu
- Department of Neonatology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Li-Bing Zhang
- Department of Pediatric Surgery, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Guang Yue
- Department of Neonatology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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de Oliveira FRC, de Araujo OR, Garros D, Colleti Junior J, de Carvalho WB, Lequier L. Extracorporeal membrane oxygenation for respiratory failure in children: the years before and after the 2009 H1N1 pandemic. Rev Bras Ter Intensiva 2021; 33:544-548. [PMID: 35081238 PMCID: PMC8889597 DOI: 10.5935/0103-507x.20210082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/01/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate whether there was any impact on the number of pediatric extracorporeal membrane oxygenation runs and survival rates in the years subsequent to the 2009 pandemic. METHODS We studied two different periods of extracorporeal membrane oxygenation support for respiratory failure in children by analyzing datasets from the Extracorporeal Life Support Organization. Autoregressive integrated moving average models were constructed to estimate the effect of the pandemic. The year 2009 was the year of intervention (the H1N1 epidemic) in an interrupted time series model. Data collected from 2001 - 2010 were considered preintervention, and data collected from 2010 - 2017 were considered postintervention. RESULTS There was an increase in survival rates in the period 2010 - 2017 compared to 2001 - 2010 (p < 0.0001), with a significant improvement in survival when extracorporeal membrane oxygenation was performed for acute respiratory failure due to viral pneumonia. The autoregressive integrated moving average model shows an increase of 23 extracorporeal membrane oxygenation runs per year, prior to the point of the level effect (2009). In terms of survival, the preslope shows that there was no significant increase in survival rates before 2009 (p = 0.41), but the level effect was nearly significant after two years (p = 0.05), with a 6% increase in survival. In four years, there was an 8% (p = 0.03) increase in survival, and six years after 2009, there was up to a 10% (p = 0.026) increase in survival. CONCLUSION In the years following 2009, there was a significant, global incremental increase in the extracorporeal membrane oxygenation survival rates for all runs, mainly due to improvements in the technology and treatment protocols for acute respiratory failure related to viral pneumonia and other respiratory conditions.
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Affiliation(s)
| | - Orlei Ribeiro de Araujo
- Pediatric Intensive Care Unit, Grupo de Apoio ao
Adolescente e à Criança com Câncer, Instituto de Oncologia Pediátrica, Universidade
Federal de São Paulo - São Paulo (SP), Brazil
| | - Daniel Garros
- Pediatric Intensive Care Unit, Stollery Children’s
Hospital - Edmonton, Alberta, Canada
| | - José Colleti Junior
- Pediatric Intensive Care Unit, Hospital Santa Catarina,
São Paulo, São Paulo (SP), Brazil
| | | | - Laurance Lequier
- Pediatric Intensive Care Unit, Stollery Children’s
Hospital - Edmonton, Alberta, Canada
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Tompkins LH, Gellman BN, Morello GF, Prina SR, Roussel T, Kopechek JA, Petit PC, Slaughter MS, Koenig SC, Dasse KA. Design and Computational Evaluation of a Pediatric MagLev Rotary Blood Pump. ASAIO J 2021; 67:1026-1035. [PMID: 33315663 PMCID: PMC8187468 DOI: 10.1097/mat.0000000000001323] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Pediatric heart failure (HF) patients have been a historically underserved population for mechanical circulatory support (MCS) therapy. To address this clinical need, we are developing a low cost, universal magnetically levitated extracorporeal system with interchangeable pump heads for pediatric support. Two impeller and pump designs (pump V1 and V2) for the pediatric pump were developed using dimensional analysis techniques and classic pump theory based on defined performance criteria (generated flow, pressure, and impeller diameter). The designs were virtually constructed using computer-aided design (CAD) software and 3D flow and pressure features were analyzed using computational fluid dynamics (CFD) analysis. Simulated pump designs (V1, V2) were operated at higher rotational speeds (~5,000 revolutions per minute [RPM]) than initially estimated (4,255 RPM) to achieve the desired operational point (3.5 L/min flow at 150 mm Hg). Pump V2 outperformed V1 by generating approximately 30% higher pressures at all simulated rotational speeds and at 5% lower priming volume. Simulated hydrodynamic performance (achieved flow and pressure, hydraulic efficiency) of our pediatric pump design, featuring reduced impeller size and priming volume, compares favorably to current commercially available MCS devices.
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Affiliation(s)
- Landon H. Tompkins
- Department of Bioengineering, University of Louisville, Louisville, KY 40202
| | | | | | | | - Thomas Roussel
- Department of Bioengineering, University of Louisville, Louisville, KY 40202
| | | | | | - Mark S. Slaughter
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, KY 40202
| | - Steven C. Koenig
- Department of Bioengineering, University of Louisville, Louisville, KY 40202
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, KY 40202
| | - Kurt A. Dasse
- Department of Bioengineering, University of Louisville, Louisville, KY 40202
- Inspired Therapeutics LLC, Merritt Island, FL 32925
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, KY 40202
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9
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Izquierdo-Blasco J, Riaza L, Pujol M, Gran F, Fernández-Doblas J, Pérez-Andreu J, Abella RF, Balcells J. Transient upper limb ischaemia during veno-arterial extracorporeal membrane oxygenation in a child. Interact Cardiovasc Thorac Surg 2021; 33:803-806. [PMID: 34000021 DOI: 10.1093/icvts/ivab153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/08/2021] [Accepted: 04/26/2021] [Indexed: 11/14/2022] Open
Abstract
Neck cannulation is the most common cannulation strategy performed to provide veno-arterial extracorporeal membrane oxygenation support in paediatric patients, especially in small children. Upper limb ischaemia is a rare complication of neck cannulation and is likely caused by arterial cannula malposition. We describe a case of right arm ischaemia caused by extrinsic compression of the right subclavian artery by the venous drainage cannula inserted through the right internal jugular vein. Upper limb hypoperfusion was resolved immediately after changing the venous drainage cannula from the right jugular vein to the right femoral vein.
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Affiliation(s)
- Jaume Izquierdo-Blasco
- Department of Pediatric Critical Care, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Lucía Riaza
- Department of Pediatric Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Montse Pujol
- Department of Pediatric Critical Care, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ferran Gran
- Department of Pediatric Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Joaquín Pérez-Andreu
- Department of Pediatric Cardiac Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Raul F Abella
- Department of Pediatric Cardiac Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Joan Balcells
- Department of Pediatric Critical Care, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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10
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Abstract
To review our experience with mobile extracorporeal membrane oxygenation (ECMO). Mobile ECMO team included: ECMO-trained surgeon and intensivist, specialist nurse, and perfusionist. Patients were cannulated for venous-arterial (V-A) or venous-venous (V-V) ECMO, depending on clinical indication. Mobile transfers were carried out utilizing a Levitronics Centrimag centrifugal pump and Hico Variotherm 555 heater cooler. From October 2009 to May 2019, 571 patients, 185 (32%) neonates, 95 (17%) pediatric, and 291 (51%) adults, underwent mobile ECMO transfer. Four hundred fifty-three (79%) transfers were completed by road, 76 (13%) by air, and 42 (8%) by road/air combination. Road was the travel mode of choice for journeys with expected duration up to 3 hours one way. Nevertheless, road transfers up to 6 hours duration were performed safely. Average duration of mobile ECMO transfer was 5.5 hours (2-18 hours). Two patients died before arrival of mobile ECMO team, four patients were cannulated during cardio-pulmonary resuscitation, and one of them died of uncontrollable hemorrhage in the right hemithorax. One patient had cardiac arrest after V-V cannulation and required conversion to V-A. Mobile ECMO is safe and reliable to transfer the sickest of patients. Fully trained team with all equipment and disposables is indispensable for reliable mobile ECMO service.
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Affiliation(s)
- Antonio F Corno
- East Midlands Congenital Heart Centre, University Hospitals of Leicester, Leicester, England, UK
- Cardiovascular Research Centre, University of Leicester, Leicester, United Kingdom
| | - Gail M Faulkner
- East Midlands Congenital Heart Centre, University Hospitals of Leicester, Leicester, England, UK
| | - Chris Harvey
- East Midlands Congenital Heart Centre, University Hospitals of Leicester, Leicester, England, UK
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11
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Das S, Gupta S, Das D, Dutta N. Basics of extra corporeal membrane oxygenation: a pediatric intensivist's perspective. Perfusion 2021; 37:439-455. [PMID: 33765881 DOI: 10.1177/02676591211005260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Extra Corporeal membrane oxygenation (ECMO) is one of the most advanced forms of life support therapy in the Intensive Care Unit. It relies on the principle where an external artificial circuit carries venous blood from the patient to a gas exchange device (oxygenator) within which blood becomes enriched with oxygen and has carbon dioxide removed. The blood is then returned to the patient via a central vein or an artery. The goal of ECMO is to provide a physiologic milieu for recovery in refractory cardiac/respiratory failure. The technology is not a definitive treatment for a disease, but provides valuable time for the body to recover. In that way it can be compared to a bridge, where patients are initiated on ECMO as a bridge to recovery, bridge to decision making, bridge to transplant or bridge to diagnosis. The use of this modality in children is not backed by a lot of randomized controlled trials, but the use has increased dramatically in our country in last 10 years. This article is not intended to provide an in-depth overview of ECMO, but outlines the basic principles that a pediatric intensive care physician should know in order to manage a kid on ECMO support.
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Affiliation(s)
- Shubhadeep Das
- Department of Pediatric Cardiac Intensive Care, NH Narayana Superspeciality Hospital, Howrah, West Bengal, India
| | - Sandip Gupta
- Department of Pediatric Intensive Care, Aster CMI Hospital, Bangalore, Karnataka, India
| | - Debasis Das
- Department of Cardiac Surgery, NH Narayana Superspeciality Hospital, Howrah, West Bengal, India
| | - Nilanjan Dutta
- Department of Cardiac Surgery, NH Narayana Superspeciality Hospital, Howrah, West Bengal, India
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12
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Pasek TA, Kitcho S, Fox S, Aspenleiter M, Mastrangelo B, Dolinich H, Butler G, Aneja R, Rohall J. Preventing Hospital-Acquired Pressure Injuries by Using a Tiered Protocol in Children Receiving ECMO in the Pediatric Intensive Care Unit. Crit Care Nurse 2021; 41:71-77. [PMID: 33560429 DOI: 10.4037/ccn2021558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Tracy Ann Pasek
- Tracy Ann Pasek is a systems analyst and clinical nurse specialist, Division of Health Informatics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sandra Kitcho
- Sandra Kitcho is a staff nurse, Pediatric Intensive Care, UPMC Children's Hospital of Pittsburgh, and doctor of nursing practice student, Robert Morris University, Pittsburgh
| | - Sarah Fox
- Sarah Fox is a senior wound care specialist II, Wound and Ostomy Nurse Department, UPMC Children's Hospital of Pittsburgh
| | - Marit Aspenleiter
- Marit Aspenleiter is a perfusionist, ECMO Department, UPMC Children's Hospital of Pittsburgh
| | - Beth Mastrangelo
- Beth Mastrangelo is the Quality Manager, Quality Services, UPMC Children's Hospital of Pittsburgh
| | - Heidilyn Dolinich
- Heidilyn Dolinich is Lead Informatics Nurse, Clinical Informatics, UPMC Children's Hospital of Pittsburgh
| | - Gabriella Butler
- Gabriella Butler is the Director, Division of Health Informatics, UPMC Children's Hospital of Pittsburgh
| | - Rajesh Aneja
- Rajesh Aneja is a professor, Department of Critical Care Medicine and Pediatrics, University of Pittsburgh School of Medicine
| | - Jennifer Rohall
- Jennifer Rohall is a senior wound care specialist II, Wound and Ostomy Nurse Department, UPMC Children's Hospital of Pittsburgh
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13
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Coagulopathy Characterized by Rotational Thromboelastometry in a Porcine Pediatric ECMO Model. THE JOURNAL OF EXTRA-CORPOREAL TECHNOLOGY 2020; 52:203-211. [PMID: 32981958 DOI: 10.1182/ject-2000011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/16/2020] [Indexed: 11/20/2022]
Abstract
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is used to support patients with reversible cardiopulmonary insufficiency. Although it is a lifesaving technology, bleeding, inflammation, and thrombosis are well-described complications of ECMO. Adult porcine models of ECMO have been used to recapitulate the physiology and hemostatic consequences of ECMO cannulation in adults. However, these models lack the unique physiology and persistence of fetal forms of coagulation factors and fibrinogen as in human infants. We aimed to describe physiologic and coagulation parameters of piglets cannulated and supported with VA-ECMO. Four healthy piglets (5.7-6.4 kg) were cannulated via jugular vein and carotid artery by cutdown and supported for a maximum of 20 hours. Heparin was used with a goal activated clotting time of 180-220 seconds. Arterial blood gas (ABG) was performed hourly, and blood was transfused from an adult donor to maintain hematocrit (Hct) > 24%. Rotational thromboelastometry (ROTEM) was performed at seven time points. All animals achieved adequate flow with a patent circuit throughout the run (pre- and post-oxygenator pressure gradient <10 mmHg). There was slow but significant hemorrhage at cannulation, arterial line, and bladder catheter sites. All animals required the maximum blood transfusion volume available. All animals became anemic after exhaustion of blood for transfusion. ABG showed progressively declining Hct and adequate oxygenation. ROTEM demonstrated decreasing fibrin-only ROTEM (FIBTEM) clot firmness. Histology was overall unremarkable. Pediatric swine are an important model for the study of pediatric ECMO. We have demonstrated the feasibility of such a model while providing descriptions of physiologic, hematologic, and coagulation parameters throughout. Weak whole-blood clot firmness by ROTEM suggested defects in fibrinogen, and there was a clinical bleeding tendency in all animals studied. This model serves as an important means to study the complex derangements in hemostasis during ECMO.
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14
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Pooboni SK, Gulla KM. Vascular access in ECMO. Indian J Thorac Cardiovasc Surg 2020; 37:221-231. [PMID: 33967445 DOI: 10.1007/s12055-020-00999-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/19/2020] [Accepted: 06/23/2020] [Indexed: 10/23/2022] Open
Abstract
In critically ill patients, deserving extracorporeal membrane oxygenation (ECMO), choosing the right pattern of cannulation such as veno-venous (VV), veno-arterial (VA), veno-veno-arterial (VVA), and central; selecting the appropriate size cannulae; and good cannulation techniques are all pre-requisites for the successful outcome of ECMO. We are describing the selection criteria for choosing appropriate size cannulae, cannulation configurations, available cannulae, and possible complications. A brief note on anticoagulation was added.
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Affiliation(s)
- Suneel Kumar Pooboni
- Department of Pediatric Critical Care Medicine, Mediclinic Hospital, Dubai Healthcare City, Dubai, UAE
| | - Krishna Mohan Gulla
- Division of Pediatric Emergency and Critical Care Department of Pediatrics PGIMER, Chandigarh-12, India
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15
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Straube T, Cheifetz IM, Jackson KW. Extracorporeal Membrane Oxygenation for Hemodynamic Support. Clin Perinatol 2020; 47:671-684. [PMID: 32713457 DOI: 10.1016/j.clp.2020.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Extracorporeal membrane oxygenation was first successfully achieved in 1975 in a neonate with meconium aspiration. Neonatal extracorporeal membrane oxygenation has expanded to include hemodynamic support in cardiovascular collapse before and after cardiac surgery, medical heart disease, and rescue therapy for cardiac arrest. Advances in pump technology, circuit biocompatibility, and oxygenators efficiency have allowed extracorporeal membrane oxygenation to support neonates with increasingly complex pathophysiology. Contraindications include extreme prematurity, extremely low birth weight, lethal chromosomal abnormalities, uncontrollable hemorrhage, uncontrollable disseminated intravascular coagulopathy, and severe irreversible brain injury. The future will involve collaboration to guide and evolve evidence-based practices for this life-sustaining therapy.
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Affiliation(s)
- Tobias Straube
- Pediatric Critical Care Medicine, Duke Children's, Durham, NC, USA
| | - Ira M Cheifetz
- Pediatric Critical Care Medicine, Duke Children's, Durham, NC, USA
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16
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Neurological Monitoring and Complications of Pediatric Extracorporeal Membrane Oxygenation Support. Pediatr Neurol 2020; 108:31-39. [PMID: 32299748 PMCID: PMC7698354 DOI: 10.1016/j.pediatrneurol.2020.03.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 12/17/2022]
Abstract
Extracorporeal membrane oxygenation is extracorporeal life support for life-threatening cardiopulmonary failure. Since its introduction, the use of extracorporeal membrane oxygenation has expanded to patients with more complex comorbidities without change in patient mortality rates. Although many patients survive, significant neurological complications like seizures, ischemic strokes, and intracranial hemorrhage can occur during extracorporeal membrane oxygenation care. The risks of these complications often add to the complexity of decision-making surrounding extracorporeal membrane oxygenation support. In this review, we discuss the pathophysiology and incidence of neurological complications in children supported on extracorporeal membrane oxygenation, factors influencing the incidence of these complications, commonly used neurological monitoring modalities, and outcomes for this complex patient population. We discuss the current literature on the use of electroencephalography for both seizure detection and monitoring of background electroencephalographic changes, in addition to the use of less commonly used imaging modalities like transcranial Doppler. We summarize the knowledge gaps and the lack of clinical consensus guidelines for managing these potentially life-changing neurological complications. Finally, we discuss future work to further understand the pathophysiology of extracorporeal membrane oxygenation-related neurological complications.
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Sniderman J, Monagle P, Annich GM, MacLaren G. Hematologic concerns in extracorporeal membrane oxygenation. Res Pract Thromb Haemost 2020; 4:455-468. [PMID: 32548547 PMCID: PMC7292669 DOI: 10.1002/rth2.12346] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/27/2020] [Accepted: 03/31/2020] [Indexed: 12/16/2022] Open
Abstract
This ISTH "State of the Art" review aims to critically evaluate the hematologic considerations and complications in extracorporeal membrane oxygenation (ECMO). ECMO is experiencing a rapid increase in clinical use, but many questions remain unanswered. The existing literature does not address or explicitly state many pertinent details that may influence hematologic complications and, ultimately, patient outcomes. This review aims to broadly introduce modern ECMO practices, circuit designs, circuit materials, hematologic complications, transfusion-related considerations, age- and size-related differences, and considerations for choosing outcome measures. Relevant studies from the 2019 ISTH Congress in Melbourne, which further advanced our understanding of these processes, will also be highlighted.
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Affiliation(s)
| | - Paul Monagle
- Department of PaediatricsDepartment of HaematologyUniversity of MelbourneThe Royal Children's HospitalHaematology Research Murdoch Children’s Research InstituteMelbourneVic.Australia
| | - Gail M. Annich
- Department of Critical Care MedicineThe Hospital for Sick ChildrenUniversity of TorontoTorontoOntarioCanada
| | - Graeme MacLaren
- Paediatric ICURoyal Children’s HospitalMelbourneVic.Australia
- Department of PaediatricsUniversity of MelbourneParkvilleVic.Australia
- Cardiothoracic ICUNational University Health SystemSingapore CitySingapore
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18
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Bazan VM, Taylor EM, Gunn TM, Zwischenberger JB. Overview of the bicaval dual lumen cannula. Indian J Thorac Cardiovasc Surg 2020; 37:232-240. [PMID: 33967446 DOI: 10.1007/s12055-020-00932-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/25/2020] [Accepted: 01/28/2020] [Indexed: 01/19/2023] Open
Abstract
Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is a form of extracorporeal life support that provides total gas exchange (CO2 and O2) within the central venous circulation. The bicaval dual lumen cannula (DLC) is an option for patients requiring respiratory support with VV-ECMO. The catheter is inserted via the internal jugular vein into the superior and inferior vena cava, drains blood into the ECMO circuit for gas exchange, and then returns arterialized blood to the right heart for circulation. The DLC facilitates physical therapy, ambulation, and early extubation. This chapter will review the uses, advantages, and unique complications of the DLC.
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Affiliation(s)
| | | | - Tyler Michael Gunn
- Graduate Medical Education, Division of Cardiothoracic Surgery, Lexington, KY USA
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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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20
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Corno AF, Faulkner GM, Harvey C. Extra-Corporeal Membrane Oxygenation for Neonatal Respiratory Support. Semin Thorac Cardiovasc Surg 2020; 32:553-559. [PMID: 32112973 DOI: 10.1053/j.semtcvs.2020.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 02/19/2020] [Indexed: 11/11/2022]
Abstract
To review our experience with Extra-Corporeal Membrane Oxygenation (ECMO) for respiratory support in neonates. From 1989 to 2018 2114 patients underwent respiratory ECMO support, with 764 (36%) neonates. Veno-Venous (V-V) cannulation was used in 428 (56%) neonates and Veno-Arterial (V-A) in 336 (44%). Historically V-V ECMO was our preferred modality, but due to lack of suitable cannula in the last 7 years V-A was used in 209/228 (92%) neonates. Mean and inter-quartile range of ECMO duration was 117 hours (inter-quartile range 90 to 164 hours). Overall 724 (95%) neonates survived to ECMO decannulation, with 640 (84%) hospital discharge. Survival varied with underlying diagnosis: meconium aspiration 98% (354/362), persistent pulmonary hypertension 80% (120/151), congenital diaphragmatic hernia 66% (82/124), sepsis 59% (35/59), pneumonia 86% (6/7), other 71% (43/61). Survival was 86% with V-V and 80% with V-A cannulation, better than ELSO Registry with 77% V-V and 63% V-A. Major complications: cerebral infarction/hemorrhage in 4.7% (31.1% survival to discharge), renal replacement therapy in 17.6% (58.1% survival to discharge), new infection in 2.9%, with negative impact on survival (30%). Following a circuit design modification and subsequent reduction in heparin requirement, intracerebral hemorrhage decreased to 9/299 (3.0%) radiologically proven cerebral infarction/hemorrhage. We concluded (1) outcomes from neonatal ECMO in our large case series were excellent, with better survival and lower complication rate than reported in ELSO registry. (2) These results highlight the benefits of ECMO service in high volume units. (3) The similar survival rate seen in neonates with V-A and V-V cannulation differs from the ELSO register; this may reflect the change in cannulation enforced by lack of suitable V-V cannula and all neonates undergoing V-A cannulation.
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Affiliation(s)
- Antonio F Corno
- East Midlands Congenital Heart Centre, University Hospitals of Leicester, Leicester, UK; Cardiovascular Research Centre, University of Leicester, Leicester, UK.
| | - Gail M Faulkner
- East Midlands Congenital Heart Centre, University Hospitals of Leicester, Leicester, UK
| | - Chris Harvey
- East Midlands Congenital Heart Centre, University Hospitals of Leicester, Leicester, UK
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21
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Staudt GE, Eagle SS. Anesthetic Considerations for Patients With Williams Syndrome. J Cardiothorac Vasc Anesth 2020; 35:176-186. [PMID: 32127269 DOI: 10.1053/j.jvca.2020.01.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 12/28/2019] [Accepted: 01/10/2020] [Indexed: 11/11/2022]
Abstract
Williams syndrome (WS) is a relatively rare congenital disorder which manifests across multiple organ systems with a wide spectrum of severity. Cardiovascular anomalies are the most common and concerning manifestations of WS, with supravalvar aortic stenosis present in up to 70% of patients with WS. Although a relatively rare disease, these patients frequently require sedation or anesthesia for a variety of medical procedures. The risk of sudden death in this population is 25 to 100 times that of the general population, with many documented deaths associated with sedation or anesthesia. This increased risk coupled with a disproportionately frequent need for anesthetic care renders it prudent for the anesthesiologist to have a firm understanding of the manifestations of WS. In the following review, the authors discuss pertinent clinical characteristics of WS along with particular anesthetic considerations for the anesthesiologist caring for patients with WS presenting for non-cardiac surgery.
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Affiliation(s)
- Genevieve E Staudt
- Division of Pediatric Cardiac Anesthesiology, Vanderbilt University Medical Center, Nashville, TN.
| | - Susan S Eagle
- Division of Cardiothoracic Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
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22
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ECMO Primer for the Pediatric Anesthesiologist. Int Anesthesiol Clin 2019; 57:72-83. [PMID: 31503097 DOI: 10.1097/aia.0000000000000249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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