Cardiopulmonary Bypass and Extracorporeal Life Support in Non-cardiac Surgery

2016 ◽  
Vol 25 (8) ◽  
pp. e107
Author(s):  
Jose Martinelli Nadal ◽  
Mohammad Azari ◽  
Robert Xu ◽  
Jason Varzaly ◽  
Tovi Vo ◽  
...  
Author(s):  
Zdenek Provaznik ◽  
Alois Philipp ◽  
Florian Zeman ◽  
Daniele Camboni ◽  
Christof Schmid ◽  
...  

Abstract Background Weaning failure from cardiopulmonary bypass, postoperative low cardiac output (LCO), and cardiopulmonary resuscitation (CPR) are common scenarios preceding extracorporeal life support (ECLS) implantation after cardiac surgery. The impact of these scenarios on short- and long-term outcome are not well described. Methods Between March 2006 and December 2018, 261 patients received ECLS support after cardiac surgery. Data of patients with weaning failure (NW), postoperative LCO, and CPR leading to ECLS implantation were retrospectively analyzed regarding outcome. Risk factors for outcome after postcardiotomy ECLS were assessed by uni- or multivariate regression analysis. Results Median duration of extracorporeal support was 5.5 ± 8.5 days. Overall mortality on ECLS was 39.1%. Scenario analysis revealed weaning failure from cardiopulmonary bypass in 40.6%, postoperative LCO in 24.5%, and postoperative CPR in 34.9% leading to initiation of ECLS. Most common cause of death was refractory LCO (25.3%). Overall follow-up survival was 23.7%. Survival after weaning and during follow-up in all subgroups was 9.2% (CPR), 5.0% (LCO), and 9.6% (NW), respectively. Uni- or multivariate regression analysis revealed age, aortic surgery, and vasopressor medication level on day 1 as risk for death on support, as well as postoperative renal failure, and body mass index (BMI) as risk factors for death during follow-up. Conclusion Mortality after postcardiotomy ECLS is high. Overall, outcome after CPR, NW, weaning failure and LCO is comparable. Postoperative resuscitation does not negatively affect outcome after postcardiotomy ECLS. Neurological status of ECLS survivors is good.


Author(s):  
Morgan L Brown ◽  
Luis G Quinonez ◽  
Steven J Staffa ◽  
James A DiNardo ◽  
Ari J Wassner

Abstract Context Thyroid function may be assessed in children before cardiac surgery because of concerns that hypothyroidism or thyrotoxicosis might adversely affect cardiac function perioperatively. However, the relationship between preoperative thyroid dysfunction and surgical outcomes is unknown. Objective Determine the relationship between preoperative thyroid dysfunction and outcomes of pediatric cardiac surgery. Methods Retrospective cohort study (January 2005 to July 2019). Setting Academic pediatric hospital. Patients All patients <19 years old who underwent cardiac surgery with cardiopulmonary bypass and had thyrotropin (TSH) measured within 14 days preoperatively. Exclusion criteria included neonates (≤30 days), preoperative extracorporeal life support, salvage operations, or transplantation procedures. Main Outcome Measures Subjects were stratified by preoperative TSH concentration (mIU/L): low (<0.5), normal (0.5-5), mildly high (5.01-10), or moderately high (>10). Outcomes were compared among subjects with normal TSH (control) and each group with abnormal TSH concentrations. The primary outcome was 30-day mortality. Secondary outcomes included time to extubation, intensive care unit and hospital length of stay, and operative complications. Results Among 592 patients analyzed, preoperative TSH was low in 15 (2.5%), normal in 347 (58.6%), mildly high in 177 (29.9%), and moderately high in 53 (9.0%). Free thyroxine was measured in 77.4% of patients and was low in 0 to 4.4% of subjects, with no differences among TSH groups. Thirty-day mortality was similar among TSH groups. There were no differences in any secondary outcome between patients with abnormal TSH and patients with normal TSH. Conclusion Preoperative mild to moderate subclinical hypothyroidism was not associated with adverse postoperative outcomes in children undergoing cardiopulmonary bypass procedures.


2009 ◽  
Vol 24 (3) ◽  
pp. 589-595 ◽  
Author(s):  
Rasheed Gbadegesin ◽  
Shuang Zhao ◽  
John Charpie ◽  
Patrick D. Brophy ◽  
William E. Smoyer ◽  
...  

2014 ◽  
Vol 24 (6) ◽  
pp. 981-1007 ◽  
Author(s):  
Jeffrey P. Jacobs

AbstractCardiology in the Youngis devoted to cardiovascular issues affecting the young, and older patients with congenital heart disease, or with other cardiac diseases acquired during childhood. The journal serves the interests of all professionals concerned with these topics. By design, the journal is international and multidisciplinary in its approach, and members of the editorial board take an active role in its mission, helping to make it an indispensable reference for paediatric and congenital cardiac care. All aspects of paediatric and congenital cardiac care are covered within the journal. The content includes original articles, brief reports, editorials, reviews, and papers devoted to continuing professional development. High-quality colour figures are published on a regular basis, and without charge to the authors. Regular supplements are published containing the abstracts of the annual meetings of the Association for European Paediatric and Congenital Cardiology, along with other occasional supplements. These supplements are supplied free to subscribers.The vision ofCardiology in the Youngis to use print and electronic media to improve paediatric and congenital cardiac care.The mission ofCardiology in the Youngis to be a premier global journal for paediatric and congenital cardiac care – an essential journal that spans the domains of patient care, research, education, and advocacy, and also spans geographical, temporal, and subspeciality boundaries.Cardiology in the Youngwas officially launched in December, 1990. The late Lucio Parenzan was Editor-in-Chief from 1990 through Volume 4, Number 1, January 1994. Professor Robert Anderson and Giancarlo Crupi then shared the Editor-in-Chief position until the end of 1995. Then, from 1995 through 2007, Professor Robert Anderson served as the sole Editor-in-Chief ofCardiology in the Young. Edward Baker, MD, FRCP, FRCPCH, served as Editor-in-Chief ofCardiology in the Youngfrom 2007 to 2013. In January, 2014, Jeffrey P. Jacobs, MD, FACS, FACC, FCCP, became Editor-in-Chief ofCardiology in the Young.Jeffrey P. Jacobs, MD, FACS, FACC, FCCP is Director of the Andrews/Daicoff Cardiovascular Program at Johns Hopkins All Children’s Heart Institute and Professor of Cardiac Surgery in the Division of Cardiac Surgery of the Department of Surgery at Johns Hopkins University. He is also Surgical Director of the Heart Transplantation Program and Director of the Extracorporeal Life Support Program at Johns Hopkins All Children’s Heart Institute. Dr Jacobs has been a cardiothoracic surgeon at All Children’s Hospital since 1998.


1999 ◽  
Vol 8 (1) ◽  
pp. 63
Author(s):  
C. Smith ◽  
J. Raman ◽  
R. Bellomo ◽  
G. Matalanis ◽  
B. Buxton

2020 ◽  
Vol 8 (30) ◽  
pp. 1-192
Author(s):  
Katherine L Brown ◽  
Christina Pagel ◽  
Deborah Ridout ◽  
Jo Wray ◽  
Victor T Tsang ◽  
...  

Background Over 5000 paediatric cardiac surgeries are performed in the UK each year and early survival has improved to > 98%. Objectives We aimed to identify the surgical morbidities that present the greatest burden for patients and health services and to develop and pilot routine monitoring and feedback. Design and setting Our multidisciplinary mixed-methods study took place over 52 months across five UK paediatric cardiac surgery centres. Participants The participants were children aged < 17 years. Methods We reviewed existing literature, ran three focus groups and undertook a family online discussion forum moderated by the Children’s Heart Federation. A multidisciplinary group, with patient and carer involvement, then ranked and selected nine key morbidities informed by clinical views on definitions and feasibility of routine monitoring. We validated a new, nurse-administered early warning tool for assessing preoperative and postoperative child development, called the brief developmental assessment, by testing this among 1200 children. We measured morbidity incidence in 3090 consecutive surgical admissions over 21 months and explored risk factors for morbidity. We measured the impact of morbidities on quality of life, clinical burden and costs to the NHS and families over 6 months in 666 children, 340 (51%) of whom had at least one morbidity. We developed and piloted methods suitable for routine monitoring of morbidity by centres and co-developed new patient information about morbidities with parents and user groups. Results Families and clinicians prioritised overlapping but also different morbidities, leading to a final list of acute neurological event, unplanned reoperation, feeding problems, renal replacement therapy, major adverse events, extracorporeal life support, necrotising enterocolitis, surgical infection and prolonged pleural effusion. The brief developmental assessment was valid in children aged between 4 months and 5 years, but not in the youngest babies or 5- to 17-year-olds. A total of 2415 (78.2%) procedures had no measured morbidity. There was a higher risk of morbidity in neonates, complex congenital heart disease, increased preoperative severity of illness and with prolonged bypass. Patients with any morbidity had a 6-month survival of 81.5% compared with 99.1% with no morbidity. Patients with any morbidity scored 5.2 points lower on their total quality of life score at 6 weeks, but this difference had narrowed by 6 months. Morbidity led to fewer days at home by 6 months and higher costs. Extracorporeal life support patients had the lowest days at home (median: 43 days out of 183 days) and highest costs (£71,051 higher than no morbidity). Limitations Monitoring of morbidity is more complex than mortality, and hence this requires resources and clinician buy-in. Conclusions Evaluation of postoperative morbidity provides important information over and above 30-day survival and should become the focus of audit and quality improvement. Future work National audit of morbidities has been initiated. Further research is needed to understand the implications of feeding problems and renal failure and to evaluate the brief developmental assessment. Funding This project was funded by the NIHR Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 30. See the NIHR Journals Library website for further project information.


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