Early Enteral Nutrition in Postoperative Cardiac Surgery Patients with Severe Hemodynamic Failure and Venoarterial (VA) Extracorporeal Membrane Oxygenation (ECMO)

AbstractBackground:Extracorporeal membrane oxygenation has been widely used after paediatric cardiac surgery due to increasing complex surgical repairs in neonates and infants having complex CHDs.Materials and methods:We reviewed retrospectively the medical records of all patients with CHD requiring corrective or palliative cardiac surgery at King Abdulaziz University Hospital that needed extracorporeal membrane oxygenation support between November 2015 and November 2018.Results:The extracorporeal membrane oxygenation population was 30 patients, which represented 4% of 746 children who had cardiac surgery during this period. The patients’ age range was from 1 day to 20.33 years, with a median age of 6.5 months. Median weight was 5 kg (range from 2 to 53 kg). Twenty patients were successfully decannulated (66.67%), and 12 patients (40%) were survived to hospital discharge. Patients with biventricular repair tended to have better survival rate compared with those with single ventricle palliation (55.55 versus 16.66%, p-value 0.058). During the first 24 hours of extracorporeal membrane oxygenation support, the flow rate was significantly reduced after 4 hours of extracorporeal membrane oxygenation connection in successfully decannulated patients.Conclusion:Survival to hospital discharge in patients requiring extracorporeal membrane oxygenation support after paediatric cardiac surgery was better in those who underwent biventricular repair than in those who had univentricular palliation. Capillary leak on extracorporeal membrane oxygenation could be a risk of mortality in patients after paediatric cardiac surgery.

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Routine Enteral Nutrition in Neonates on Extracorporeal Membrane Oxygenation

Pediatric Critical Care Medicine ◽

10.1097/00130478-200505000-00053 ◽

2005 ◽

Vol 6 (3) ◽

pp. 387

Author(s):

M N. Hanekamp ◽

M Spoel ◽

M Sharman-Koendjbiharie ◽

J W.B. Peters ◽

M J.I.J. Albers ◽

...

Keyword(s):

Enteral Nutrition ◽

Extracorporeal Membrane Oxygenation ◽

Membrane Oxygenation

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Three consecutive cases of fatal intraoperative intracardiac thrombosis associated with the initiation of venoarterial extracorporeal membrane oxygenation in the presence of aprotinin

Perfusion ◽

10.1177/0267659119826822 ◽

2019 ◽

Vol 34 (5) ◽

pp. 417-421 ◽

Cited By ~ 1

Author(s):

Chris Oscier ◽

Chinmay Patvardhan ◽

Florian Falter ◽

Will Tosh ◽

John Dunning ◽

...

Keyword(s):

United States ◽

Cardiac Surgery ◽

Extracorporeal Membrane Oxygenation ◽

Hospital Mortality ◽

Cardiogenic Shock ◽

Bleeding Risk ◽

The United States ◽

Membrane Oxygenation ◽

Venoarterial Extracorporeal Membrane Oxygenation ◽

Intracardiac Thrombosis

Central venoarterial extracorporeal membrane oxygenation has been used since the 1970s to support patients with cardiogenic shock following cardiac surgery. Despite this, in-hospital mortality is still high, and although rare, thrombus within the cardiac chambers or within the extracorporeal membrane oxygenation circuit is often fatal. Aprotinin is an antifibrinolytic available in Europe and Canada, though not currently in the United States. Due to historical safety concerns, use of aprotinin is generally limited and is commonly reserved for patients with the highest bleeding risk. Given the limited availability of aprotinin over the last decade, it is not surprising to find a complete absence of literature describing the use of venoarterial extracorporeal membrane oxygenation in the presence of aprotinin. We present three consecutive cases of rapid fatal intraoperative intracardiac thrombosis associated with post-cardiotomy central venoarterial extracorporeal membrane oxygenation in patients receiving aprotinin.

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