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Bulescu NC, Mitchell J, Metton O, El Jonhy N, Amaz C, Perouse de Montclos T, Lilot M, Mewton N, Henaine R. Celsior® vs. St Thomas® cardioplegia: analysis of myocardial protection and clinical safety in neonates. Front Pediatr 2024; 12:1430832. [PMID: 39040670 PMCID: PMC11260699 DOI: 10.3389/fped.2024.1430832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 06/20/2024] [Indexed: 07/24/2024] Open
Abstract
Objective To compare the effectiveness and safety of Celsior® crystalloid solution to St Thomas® solution as cardioplegia in pediatric arterial switch surgery. Methods A retrospective study was conducted on 180 patients who underwent arterial switch operation (ASO) between 2005 and 2019. The patients were divided into two groups: the St Thomas group receiving St Thomas solution and the Celsior® group receiving Celsior® solution. The study aimed to assess myocardial protection while evaluating clinical outcomes of patients between groups. Results Baseline characteristics not different between groups. The postoperative troponin release trends and blood lactate levels were not different between groups. However, the Celsior® group had a significant lower incidence of delayed sternal closure (9.7% vs. 19.5%; p = 0.09) and mechanical circulatory support (ECMO) (4.9% vs. 24.7%; p < 0.001) compared to the St Thomas group. The length of stay in the intensive care unit (ICU) was significantly shorter in the Celsior® group (4.6 ± 3.36 days vs. 8.72 ± 5.08 days, respectively; p < 0.001). There was no significant difference in 30-day mortality between the two groups (2.9% vs. 2.6%; p = 0.147). Conclusion The study suggests that Celsior® solution is effective and safe for myocardial protection in pediatric arterial switch surgery. It may offer potential benefits such as reduced need for delayed sternal closure and ECMO support, as well as shorter ICU stay. However, the study has limitations including its retrospective design and the use of different cardioplegic solutions during different time periods. Further prospective randomized trials are needed for confirmation. Clinical Registration Number ClinicalTrials.gov, ID: NCT04616222.
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Affiliation(s)
| | - Julia Mitchell
- Congenital Cardiac Surgery, Louis Pradel Hospital, Lyon, France
| | - Olivier Metton
- Congenital Cardiac Surgery, Louis Pradel Hospital, Lyon, France
| | - Naoual El Jonhy
- Center for Clinical Investigation, Louis Pradel Hospital, Lyon, France
| | - Camille Amaz
- Center for Clinical Investigation, Louis Pradel Hospital, Lyon, France
| | | | - Marc Lilot
- Pediatric Cardiac, Thoracic and Vascular Anesthesia and Intensive Care Unit, Louis Pradel Hospital, Lyon, France
| | - Nathan Mewton
- Center for Clinical Investigation, Louis Pradel Hospital, Lyon, France
| | - Roland Henaine
- Congenital Cardiac Surgery, Louis Pradel Hospital, Lyon, France
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Kumar A, Raj S, Singh S, Ghotra GS, Tiwari N. Empowering Little Fighters: Post-Cardiotomy Pediatric ECMO and the Journey to Recovery. Ann Card Anaesth 2024; 27:128-135. [PMID: 38607876 PMCID: PMC11095788 DOI: 10.4103/aca.aca_184_23] [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: 11/18/2023] [Revised: 01/16/2024] [Accepted: 01/29/2024] [Indexed: 04/14/2024] Open
Abstract
INTRODUCTION Extra Corporeal Membrane Oxygenation (ECMO) has long been used for cardiorespiratory support in the immediate post-paediatric cardiac surgery period with a 2-3% success as per the ELSO registry. Success in recovery depends upon the optimal delivery of critical care to paediatric patients and a comprehensive healthcare team. METHODOLOGY The survival benefit of children placed on central veno arterial (VA) ECMO following elective cardiac surgeries for congenital heart disease (n = 672) was studied in a cohort of 29 (4.3%) cases from the period of Jan 2018 to Dec 2022 in our cardiac surgical centre. Indications for placing these patients on central VA ECMO included inability to wean from cardiopulmonary bypass (CPB), low cardiac output syndrome, severe pulmonary arterial hypertension, significant bleeding, anaphylaxis, respiratory failure and severe pulmonary edema. RESULTS The mean time to initiation of ECMO was less than 5 h and the mean duration of ECMO support was 56 h with a survival rate of 58.3%. Amongst perioperative complications, sepsis and arrhythmia on ECMO were found to be negatively associated with survival. Improvements in the pH, PaO2 levels and serum lactate levels after initiation of ECMO were associated with survival benefits. CONCLUSION The early initiation of ECMO for paediatric cardiotomies could be a beacon of hope for families and medical teams confronting these challenging situations. Improvement in indicators of adequate perfusion and ventricular recoveries like pH and serum lactate and absence of arrhythmia and sepsis are associated with good outcomes.
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Affiliation(s)
- Alok Kumar
- Department of Anaesthesia and Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
| | - Sangeeth Raj
- Department of Anaesthesia, Army Hospital (Research and Referral), Delhi Cantt, New Delhi, Delhi, India
| | - Saurabh Singh
- Department of Cardiothoracic Surgery, Army Institute of Cardiothoracic Sciences, Pune, Maharashtra, India
| | - Gurpinder S. Ghotra
- Department of Anaesthesia and Critical Care, Army Hospital (Research and Referral), Delhi Cantt, New Delhi, Delhi, India
| | - Nikhil Tiwari
- Department of Cardiothoracic Surgery, Army Institute of Cardiothoracic Sciences, Pune, Maharashtra, India
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Deng MX, Haller C, Moss K, Saha S, Runeckles K, Fan CPS, Langanecha B, Floh A, Guerguerian AM, Honjo O. Early outcomes of moderate-to-high-risk pediatric congenital cardiac surgery and predictors of extracorporeal circulatory life support requirement. Front Pediatr 2024; 12:1282275. [PMID: 38523837 PMCID: PMC10957634 DOI: 10.3389/fped.2024.1282275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/23/2024] [Indexed: 03/26/2024] Open
Abstract
Background Cardiopulmonary failure refractory to medical management after moderate-to-high-risk congenital cardiac surgery may necessitate mechanical support with veno-arterial extracorporeal membrane oxygenation (ECMO). On the extreme, ECMO can also be initiated in the setting of cardiac arrest (extracorporeal cardiopulmonary resuscitation, ECPR) unresponsive to conventional resuscitative measures. Methods This was a single-center retrospective cohort study of patients (n = 510) aged <3 years old who underwent cardiac surgery with cardiopulmonary bypass with a RACHS-1 score ≥3 between 2011 and 2014. Perioperative factors were reviewed to identify predictors of ECMO initiation and mortality in the operating room (OR) and the intensive care unit (ICU). Results A total of 510 patients with a mean surgical age of 10.0 ± 13.4 months were included. Among them, 21 (4%) patients received postoperative ECMO-12 were initiated in the OR and 9 in the ICU. ECMO cannulation was associated with cardiopulmonary bypass duration, aortopulmonary shunt, residual severe mitral regurgitation, vaso-inotropic score, and postprocedural lactate (p < 0.001). Of the 32 (6%) total deaths, 7 (22%) were ECMO patients-4 were elective OR cannulations and 3 were ICU ECPR. Prematurity [hazard ratio (HR): 2.61, p < 0.01), Norwood or Damus-Kaye-Stansel procedure (HR: 4.29, p < 0.001), postoperative left ventricular dysfunction (HR: 5.10, p = 0.01), residual severe tricuspid regurgitation (HR: 6.06, p < 0.001), and postoperative ECMO (ECPR: HR: 15.42, p < 0.001 vs. elective: HR: 5.26, p = 0.01) were associated with mortality. The two patients who were electively cannulated in the ICU survived. Discussion Although uncommon, postoperative ECMO in children after congenital cardiac surgery is associated with high mortality, especially in cases of ECPR. Patients with long cardiopulmonary bypass time, residual cardiac lesions, or increased vaso-inotropic requirement are at higher risk of receiving ECMO. Pre-emptive or early ECMO initiation before deterioration into cardiac arrest may improve survival.
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Affiliation(s)
- Mimi Xiaoming Deng
- Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Christoph Haller
- Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Kasey Moss
- Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada
- Faculty of Internal Medicine, McMaster University, Hamilton, ON, Canada
| | - Sudipta Saha
- Rogers Computational Program, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Kyle Runeckles
- Rogers Computational Program, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Chun-Po Steve Fan
- Rogers Computational Program, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | | | - Alejandro Floh
- Department of Critical Care Medicine, Labatt Family Heart Centre, Toronto, ON, Canada
| | | | - Osami Honjo
- Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
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Bezuska L, O'Doherty JP, Ali B, Harvey C, Omeje I, Mimic B. Extracorporeal membrane oxygenation in paediatric cardiac surgery: 5-year single centre experience. J Cardiothorac Surg 2023; 18:314. [PMID: 37950258 PMCID: PMC10638805 DOI: 10.1186/s13019-023-02440-w] [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: 12/31/2022] [Accepted: 11/04/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) has become an integral part of paediatric cardiac surgery. We report the experience of a well-established ECMO service over 5 years. METHODS This retrospective study analysed all paediatric patients who required ECMO support following cardiac surgery from April 2015 to March 2020. Inclusion criteria were age less than 18 years and post-operative ECMO support. Patients were analysed dividing into groups according to the urgency for ECMO support (extracorporeal cardiopulmonary resuscitation (ECPR) and cardiac ECMO) and according to age (neonatal and paediatric ECMO groups). They were followed for 30-day, 6-month mortality, long-term survival, postoperative morbidity and the need for reintervention. RESULTS Forty-six patients were included who had a total of venoarterial (VA) 8 ECMO runs. The 5-year incidence of the need for VA ECMO after cardiac surgery was 3.3% (48 of the overall 1441 cases recorded). The median follow-up period was 3.5 (interquartile ranges, 0.8-4.7) years. Thirty-day, 6-month and follow-up survival rate was 85%, 65% and 52% respectively. At the 6-month follow-up, the ECPR group showed a trend towards worse survival compared with the cardiac ECMO group (47% vs. 55%) but with no statistical significance (p = 0.35). Furthermore, the survival rates between paediatric (60%) and neonatal (46%) ECMO groups were similar, with no statistical significance (p = 0.45). The rate of acute neurological events was 27% (13/48). CONCLUSION ECPR and neonatal ECMO groups had higher mortality. VA ECMO 30-day and 6-month survival rates were 85% and 65% respectively. Major neurological injury resulting in ECMO termination occurred in 3 patients. Accumulated experiences and protocols in ECMO management can improve mortality and morbidity.
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Affiliation(s)
- Laurynas Bezuska
- East Midlands Congenital Heart Centre, University Hospitals of Leicester NHS Trust, Leicester, UK.
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariskiu 2, Vilnius, LT-08661, Lithuania.
| | - Jonathan P O'Doherty
- East Midlands Congenital Heart Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Bilal Ali
- East Midlands Congenital Heart Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Chris Harvey
- East Midlands Congenital Heart Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Ikenna Omeje
- East Midlands Congenital Heart Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Branko Mimic
- East Midlands Congenital Heart Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
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Elizalde PS, Chaud GJ, Gundelach J, Gaete B, Durand M, Cuadra I, Provoste S, Yanten E, Tiznado M, Alvarado C. Extracorporeal Membrane Oxygenation Uses in Refractory Cardiogenic Shock After Open-Heart Surgery. Braz J Cardiovasc Surg 2023; 39:e20220344. [PMID: 37889232 PMCID: PMC10611424 DOI: 10.21470/1678-9741-2022-0344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 04/18/2023] [Indexed: 10/28/2023] Open
Abstract
INTRODUCTION Extracorporeal membrane oxygenation (ECMO) is the first-line therapy for temporary mechanical circulatory support allowing cardiac and pulmonary recovery or as a bridge to further therapeutic alternatives. The aim of this study was to report clinical outcomes in adult patients with refractory cardiac failure after open-heart surgery undergoing ECMO in a single center with an ECMO unit in Chile. METHODS We retrospectively analyzed adults with refractory cardiac failure after open-heart surgery who required a venoarterial (VA) ECMO between 2016 and 2021. RESULTS Of 16 patients with VA ECMO, 60% were men (n=10), 90% had hypertension (n=14), 69% had < 30% of left ventricular ejection fraction (n=11), and the mean European System for Cardiac Operative Risk Evaluation II score was 12 ± 11%. ECMO support with central cannulation accounts for 81% (n=13), and an intra-aortic balloon pump was used in nine patients (56%). The mean time of support was 4.7 ± 2.6 days (1.5 - 12 days). ECMO weaning was achieved in 88% of patients, and in-hospital mortality was 44% (n=7) after discharge. The freedom from all-cause mortality at one year of follow-up of the entire cohort was 38% (n=6). CONCLUSION VA ECMO is now a well-known life-saving therapeutic option, but mortality and morbidity remain high. Implementation of an ECMO program with educational training is mandatory in order to find the proper balance between patient benefits, ethical considerations, and public health financial input in South America.
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Affiliation(s)
| | - German J. Chaud
- Cardiac Surgery Department and ECMO Unit, Las Higueras Hospital,
Talcahuano, Chile
| | - Joaquín Gundelach
- Cardiac Surgery Department and ECMO Unit, Las Higueras Hospital,
Talcahuano, Chile
- Basic Sciences Department, School of Medicine, Universidad
Católica de la Santísima Concepción, Concepción, Chile
| | - Barbara Gaete
- Cardiac Surgery Department and ECMO Unit, Las Higueras Hospital,
Talcahuano, Chile
| | - Marcos Durand
- Cardiac Surgery Department and ECMO Unit, Las Higueras Hospital,
Talcahuano, Chile
| | - Ignacio Cuadra
- Cardiac Surgery Department and ECMO Unit, Las Higueras Hospital,
Talcahuano, Chile
| | - Sinthya Provoste
- Cardiac Surgery Department and ECMO Unit, Las Higueras Hospital,
Talcahuano, Chile
| | - Enrique Yanten
- Cardiac Surgery Department and ECMO Unit, Las Higueras Hospital,
Talcahuano, Chile
| | - Marcelo Tiznado
- Cardiac Surgery Department and ECMO Unit, Las Higueras Hospital,
Talcahuano, Chile
| | - Cristóbal Alvarado
- Biomedical Research Unit, Las Higueras Hospital, Talcahuano, Chile
- Basic Sciences Department, School of Medicine, Universidad
Católica de la Santísima Concepción, Concepción, Chile
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Agha HM, Fathalla A, Isgro G, Cotza M. Predictors of Neurological Complications of Pediatric Post-Cardiotomy Extracorporeal Life Support. J Saudi Heart Assoc 2023; 34:249-256. [PMID: 36816795 PMCID: PMC9930983 DOI: 10.37616/2212-5043.1324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 01/23/2023] Open
Abstract
Background Post-cardiotomy extracorporeal membrane oxygenation (ECMO) was associated with significant neurological complications affecting the overall outcome. The aim of the work is to determine the incidence and the predictors of neurological events during pediatric extracorporeal life support after cardiac surgery. Patients & Methods This is a retrospective study that encompassed all neonates, infants, and children (<18 years of age) who need extracorporeal life support following cardiac surgery between January 2015 and December 2018 at San Donato Hospital, Italy. Data as regards surgical procedure of congenital heart disease, in-hospital mortality, length of ECMO, hospital stay durations, short-term neurological ECMO complications and outcome were analyzed. Results The sixty-three patients who received post-cardiotomy ECMO, Neurological complications were evident in 31.7% in the form of ischemic stroke in 17.5% and hemorrhagic stroke in 11.1%. By multivariable analysis, the older age of cyanotic cases, the need for a venting cannula, and the rapid CO2 drop in the first 24 h were the most independent risk factors for neurological complications. Prolonged ECMO support and hospital stay duration were associated with neurological sequelae. Conclusion Neurological complications either ischemic or hemorrhagic strokes were common during pediatric post-cardiotomy ECMO and were significantly related to prolonged ECMO support and hospital stay. Predictors of these neurological sequelae are the older cyanotic cases, the need for a venting cannula, the oxygenator thrombosis, and the rapid CO2 drop in the first 24 h of ECMO.
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Affiliation(s)
- Hala M. Agha
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, Cairo University,
Egypt,Corresponding author at: Pediatric Department, Pediatric Cardiology Division, Specialized Pediatric Hospital, Faculty of Medicine, Cairo University. Kasr Al Aini Street, Cairo, 11562, Egypt. E-mail address: (H.M. Agha)
| | - Amr Fathalla
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, Cairo University,
Egypt
| | - Giuseppe Isgro
- Anaesthesia and Intensive Care Department, IRCCS, Policlinico San Donato, Milan,
Italy
| | - Mauro Cotza
- ECMO/ECLS Unit, IRCCS, Policlinico San Donato, Milan,
Italy
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Bezerra RF, Pacheco JT, Volpatto VH, Franchi SM, Fitaroni R, da Cruz DV, Castro RM, da Silva LDF, da Silva JP. Extracorporeal Membrane Oxygenation After Norwood Surgery in Patients With Hypoplastic Left Heart Syndrome: A Retrospective Single-Center Cohort Study From Brazil. Front Pediatr 2022; 10:813528. [PMID: 35311057 PMCID: PMC8926323 DOI: 10.3389/fped.2022.813528] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/11/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) is increasingly being used to support patients after the repair of congenital heart disease. OBJECTIVE We report our experience with patients with a single functional ventricle who were supported by ECMO after the Norwood procedure, reviewing the outcomes and identifying risk factors for mortality in these patients. METHODS In this single-center retrospective cohort study, we enrolled 33 patients with hypoplastic left heart syndrome (HLHS) who received ECMO support after the Norwood procedure between January 2015 and December 2019. The independent variables evaluated in this study were demographic, anatomical, and those directly related to ECMO support (ECMO indication, local of initiation, time under support, and urinary output while on ECMO). The dependent variable was survival. A p < 0.05 was considered statistically significant. RESULTS The ECMO support was applied in 33 patients in a group of 120 patients submitted to Norwood procedure (28%). Aortic atresia was present in 72.7% of patients and mitral atresia in 51.5%. For 15% of patients, ECMO was initiated in the operating room; for all other patients, ECMO was initiated in the intensive care unit. The indications for ECMO in the cardiac intensive care unit were cardiac arrest in 22 (79%) of patients, low cardiac output state in 10 (18%), and arrhythmia in 1 patient (3%). The median time under support was 5 (2-25) days. The median follow-up time was 59 (4-150) days. Global survival to Norwood procedure was 90.9% during the 30-day follow-up, being 33.3% for those submitted to ECMO. Longer ECMO support (p = 0.004) was associated with a higher risk of death in the group submitted to ECMO. CONCLUSIONS The mortality of patients with HLHS who received ECMO support after stage 1 palliation was high. Patients with low urine output were related to worse survival rates, and longer periods under ECMO support (more than 9 days of ECMO) were associated with 100% mortality. Earlier ECMO initiation before multiorgan damage may improve results.
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Affiliation(s)
- Rodrigo Freire Bezerra
- Division of Congenital Heart Surgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - Juliana Torres Pacheco
- Cardiac Intensive Care Unit, Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - Victor Hugo Volpatto
- Division of Congenital Heart Surgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - Sônia Meiken Franchi
- Division of Congenital Heart Surgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - Rosangela Fitaroni
- Division of Congenital Heart Surgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - Denilson Vieira da Cruz
- Division of Congenital Heart Surgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - Rodrigo Moreira Castro
- Division of Congenital Heart Surgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - Luciana da Fonseca da Silva
- Division of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - José Pedro da Silva
- Division of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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Surti J, Jain I, Mishra A, Gajjar T, Solanki A, Patel J, Shah J, Shah S. Venoarterial extra corporeal membrane oxygenation and blood component usage in pediatric patients undergoing cardiac surgery: Single centre experience. Ann Card Anaesth 2021; 24:203-208. [PMID: 33884977 PMCID: PMC8253037 DOI: 10.4103/aca.aca_112_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Extra Corporeal Membrane Oxygenation (ECMO) is a well-known tool for providing life-saving support in patients developing post cardiotomy cardiogenic shock in post cardiac surgeries. The current study was designed to evaluate blood transfusion requirements and its relation to mortality in neonate and pediatric cardiac patients requiring venoarterial cardiac ECMO during post-operative period following cardiac surgery. Materials and Methods Overall 24 pediatric patients (including neonates) who underwent VA ECMO in post cardiac surgery at our institute from January 2016 to October 2017 were included in the study. The details of demographics, blood transfusion, ECMO, and morbidity and mortality were collected for all the patients. Objective of the Study The primary objective of our study was to assess the outcome of patients on ECMO in post pediatric cardiac surgery. The secondary objective of the study was to assess the effect of blood transfusion on the outcome of the patients. Results Overall mortality rate was 50% (n = 12). The overall transfusion rate of packed red blood cells was higher in patients who did not survive even after institution of VA ECMO. The transfusion of other blood products like platelets, cryoprecipitate, and fresh frozen plasma were also higher in this group of patients though it was statistically non-significant except for packed red cell transfusion. Though statistically non-significant, the patients who didn't survive even after institution of VA ECMO post-surgery had relatively higher mean age (703.88 ± 998.94 days) as compared to their counterparts (510.63 ± 384.36 days). Conclusion The use of ECMO is associated with considerable morbidity and mortality. Packed red cell transfusion is definitely higher in expired patients, indicative of deteriorated status of the patient. However, considering non-significant association of other blood components, except packed red cell it is recommended that patients' overall clinical condition should be taken into consideration for transfusion of blood products and not only targeting the transfusion triggers.
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Affiliation(s)
- Jigar Surti
- Department of Cardiac Anesthesia, U.N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India
| | - Imelda Jain
- Department of Cardiac Anesthesia, U.N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India
| | - Amit Mishra
- Department of Pediatric Cardiac Surgery, U.N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India
| | - Trushar Gajjar
- Department of Pediatric Cardiac Surgery, U.N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India
| | - Atul Solanki
- Department of Perfusion, U.N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India
| | - Jigar Patel
- Department of Perfusion, U.N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India
| | - Jatin Shah
- Department of Pediatrics, U.N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India
| | - Sapna Shah
- Department of Cardiology, U.N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India
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Mechanical circulatory support in paediatric population. Cardiol Young 2021; 31:31-37. [PMID: 33423709 DOI: 10.1017/s1047951120004849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Extra-corporeal membrane oxygenation is a life-saving modality to support the cardiac and/or pulmonary system as a form of life support in resuscitation, post-cardiotomy, as a bridge to cardiac transplantation and in respiratory failure. Its use in the paediatric and neonatal population has proven incredibly useful. However, extra-corporeal membrane oxygenation is also associated with a greater rate of mortality and complications, particularly in those with co-morbidities. As a result, interventions such as ventricular assist devices have been trialled in these patients. In this review, we provide a comprehensive analysis of the current literature on extra-corporeal membrane oxygenation for cardiac support in the paediatric and neonatal population. We evaluate its effectiveness in comparison to other forms of mechanical circulatory support and focus on areas for future development.
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Abstract
Worldwide, the use of Extracorporeal Membrane Oxygenation (ECMO) for cardiac failure has been steadily increasing in the neonatal population and has become a widely accepted modality. Especially in centers caring for children with (congenital) heart disease, ECMO is now an essential part of care available for those with severe heart failure as a bridge to recovery, long term mechanical support, or transplantation. Short-term outcomes depend very much on indication. Hospital survival is ~40% for all neonatal cardiac ECMO patients combined. ECMO is being used for pre- and/or post-operative stabilization in neonates with congenital heart disease and in neonates with medical heart disease such as myocarditis, cardiomyopathy or refractory arrhythmias. ECMO use during resuscitation (ECPR) or for sepsis is summarized elsewhere in this special edition of Frontiers in Pediatrics. In this review article, we will discuss the indications for neonatal cardiac ECMO, the difficult process of patients' selection and identifying the right timing to initiate ECMO, as well as outline pros and cons for peripheral vs. central cannulation. We will present predictors of mortality and, very importantly, predictors of survival: what can be done to improve the outcomes for your patients. Furthermore, an overview of current insights regarding supportive care in neonatal cardiac ECMO is given. Additionally, we will address issues specific to neonates with single ventricle physiology on ECMO, for example cannulation strategies and the influence of shunt type (Blalock-Taussig shunt vs. "right ventricle to pulmonary artery" shunt). We will not only focus on short term outcomes, such as hospital survival, but also on the importance of long-term neuro-developmental outcomes, and we will end this review with suggestions for future research.
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Affiliation(s)
| | - Malaika Mendonca
- Pediatric Intensive Care Unit, Children's Hospital, Inselspital, Bern University Hospital, Bern, Switzerland
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