Factors affecting the outcome of extracorporeal membrane oxygenation following paediatric cardiac surgery

2019 ◽  
Vol 29 (12) ◽  
pp. 1501-1509 ◽  
Author(s):  
Ahmed M. Dohain ◽  
Gaser Abdelmohsen ◽  
Ahmed A. Elassal ◽  
Ahmed F. ElMahrouk ◽  
Osman O. Al-Radi
Keyword(s):  
Cardiac Surgery ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Discharge ◽  
University Hospital ◽  
P Value ◽  
Biventricular Repair ◽  
Factors Affecting ◽  
Membrane Oxygenation ◽  
Paediatric Cardiac Surgery ◽  
Neonates And Infants

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.

Extended survival and re-hospitalisation among paediatric patients requiring extracorporeal membrane oxygenation for primary cardiac dysfunction

2012 ◽  
Vol 23 (2) ◽  
pp. 258-264 ◽  
Author(s):  
Nicole Erwin ◽  
Jeannie Zuk ◽  
Jon Kaufman ◽  
Zhaoxing Pan ◽  
Esther Carpenter ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Discharge ◽  
Cardiac Dysfunction ◽  
Survival Rates ◽  
Paediatric Hospital ◽  
Membrane Oxygenation ◽  
Paediatric Patients ◽  
Extended Survival

AbstractBackgroundAlthough survival to hospital discharge among children requiring extracorporeal membrane oxygenation support for medical and surgical cardio-circulatory failure has been reported in international registries, extended survival and re-hospitalisation rates have not been well described in the literature.Material and methodsThis is a single-institution, retrospective review of all paediatric patients receiving extracorporeal membrane oxygenation for primary cardiac dysfunction over a 5-year period.ResultsA total of 74 extracorporeal membrane oxygenation runs in 68 patients were identified, with a median follow-up of 5.4 years from hospital discharge. Overall, 66% of patients were decannulated alive and 25 patients (37%) survived to discharge. There were three late deaths at 5 months, 20 months, and 6.8 years from discharge. Of the hospital survivors, 88% required re-hospitalisation, with 63% of re-admissions for cardiac indications. The median number of hospitalisations per patient per year was 0.62, with the first re-admission occurring at a mean time of 9 months after discharge from the index hospitalisation. In all, 38% of patients required further cardiac surgery.ConclusionsExtended survival rates for paediatric hospital survivors of cardiac extracorporeal membrane oxygenation support for medical and post-surgical indications are encouraging. However, re-hospitalisation within the first year following hospital discharge is common, and many patients require further cardiac surgery. Although re-admission hospital mortality is low, longer-term follow-up of quality-of-life indicators is required.

Global leadership in paediatric and congenital cardiac care: “Humility in Leadership – an interview with Katarina Hanséus, MD, PhD, President of the Association for European Paediatric and Congenital Cardiology (AEPC)”

2021 ◽  
Vol 31 (5) ◽  
pp. 689-695
Author(s):  
Justin T. Tretter ◽  
Jeffrey P. Jacobs
Keyword(s):  
Cardiac Surgery ◽  
Global Leadership ◽  
University Hospital ◽  
Cardiac Care ◽  
Paediatric Surgery ◽  
Cross Sectional ◽  
Paediatric Cardiology ◽  
Pediatric Society ◽  
European Paediatric ◽  
Paediatric Cardiac Surgery

AbstractDr. Katarina Hanséus is the focus of our fourth in a series of interviews in Cardiology in the Young entitled, “Global Leadership in Paediatric and Congenital Cardiac Care”. Dr. Hanséus was born in Malmö, Sweden. She attended undergraduate school in her home town in Malmö, Sweden, graduating in 1974. Dr. Hanséus then went on to complete medical school at University of Lund in Lund, Sweden, graduating in 1980, where additionally she completed a Doctoral Dissertation in the evaluation of cardiac function and chamber size in children using Doppler and cross-sectional echocardiography. Under the Swedish Board of National Welfare, Dr. Hanséus completed her authorisation as a paediatrician in 1986, followed by her authorisation as a paediatric cardiologist in 1988, at University of Lund. She was appointed head of Paediatric Cardiology in 2000 at the Children’s Heart Center, Skane University Hospital, Lund, Sweden. The programme at Lund serves as one of the two national referral centres for comprehensive paediatric and congenital cardiac care, including paediatric cardiac surgery, in Sweden. From 2006 to 2013, she served as the clinical and administrative head of the Department of Neonatology, Paediatric Surgery, Paediatric Intensive Care, Paediatric Cardiology, and Paediatric Cardiac Surgery, returning as the head of Paediatric Cardiology in 2013, for which she currently holds the position.Dr. Hanséus is a recognised leader in the field of Paediatric Cardiology and has been involved in leadership within the Swedish Pediatric Society, the Swedish Association for Pediatric Cardiology, and the Association for European Paediatric and Congenital Cardiology throughout her career. Within the Association for European Paediatric and Congenital Cardiology, she served as the Secretary General from 2011 to 2016, the President Elect in 2018, and is the current President serving from 2019 until 2022. This article presents our interview with Dr. Hanséus, an interview that covers her experience as a leader in the field of Paediatric Cardiology, including the history and goals of the Association for European Paediatric and Congenital Cardiology, and her role and vision as their current President.

scholarly journals Effects of Extracorporeal Membrane Oxygenation Initiation on Oxygenation and Pulmonary Opacities

2021 ◽  
Vol 7 (1) ◽  
pp. 6-13
Author(s):  
Kiran Batra ◽  
Manish Mohanka ◽  
Srinivas Bollineni ◽  
Vaidehi Kaza ◽  
Prabhakar Rajiah ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
P Value ◽  
Limited Data ◽  
Hospital Survival ◽  
Membrane Oxygenation ◽  
Pulmonary Physiology ◽  
Before And After ◽  
Laboratory Variables ◽  
The Difference ◽  
The Impact

Abstract Introduction There is limited data on the impact of extracorporeal membrane oxygenation (ECMO) on pulmonary physiology and imaging in adult patients. The current study sought to evaluate the serial changes in oxygenation and pulmonary opacities after ECMO initiation. Methods Records of patients started on veno-venous, or veno-arterial ECMO were reviewed (n=33; mean (SD): age 50(16) years; Male: Female 20:13). Clinical and laboratory variables before and after ECMO, including daily PaO2 to FiO2 ratio (PFR), were recorded. Daily chest radiographs (CXR) were prospectively appraised in a blinded fashion and scored for the extent and severity of opacities using an objective scoring system. Results ECMO was associated with impaired oxygenation as reflected by the drop in median PFR from 101 (interquartile range, IQR: 63-151) at the initiation of ECMO to a post-ECMO trough of 74 (IQR: 56-98) on post-ECMO day 5. However, the difference was not statistically significant. The appraisal of daily CXR revealed progressively worsening opacities, as reflected by a significant increase in the opacity score (Wilk’s Lambda statistic 7.59, p=0.001). During the post-ECMO period, a >10% increase in the opacity score was recorded in 93.9% of patients. There was a negative association between PFR and opacity scores, with an average one-unit decrease in the PFR corresponding to a +0.010 increase in the opacity score (95% confidence interval: 0.002 to 0.019, p-value=0.0162). The median opacity score on each day after ECMO initiation remained significantly higher than the pre-ECMO score. The most significant increase in the opacity score (9, IQR: -8 to 16) was noted on radiographs between pre-ECMO and forty-eight hours post-ECMO. The severity of deteriorating oxygenation or pulmonary opacities was not associated with hospital survival. Conclusions The use of ECMO is associated with an increase in bilateral opacities and a deterioration in oxygenation that starts early and peaks around 48 hours after ECMO initiation.

Abstract 67: Cardiac Arrest and Surgical Case Volume, Household Income and Availability of Trauma and Cardiac Surgery Are Associated with Higher Risk-Standardized Survival After Cardiac Arrest Among University Hospital Consortium Institutions in 2012

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Michael C Kurz ◽  
John P Donnelly ◽  
Henry E Wang
Keyword(s):  
Cardiac Arrest ◽  
Cardiac Surgery ◽  
Household Income ◽  
University Hospital ◽  
Individual Risk ◽  
P Value ◽  
Case Volume ◽  
Surgical Case ◽  
Catchment Areas ◽  
Cardiac Arrest Survival

Objective: Wide variation exists in cardiac arrest survival. Historically cardiac arrest research has focused upon clinical pre-arrest and intra-arrest factors to explain this variation in outcomes. In-hospital post-arrest care is increasingly recognized as an important aspect of survival. We sought to identify hospital characteristics associated with improved cardiac arrest survival. Methods: We examined all participating hospitals in the University Hospital Consortium (UHC) clinical database with more than 25 adult cardiac arrests in 2012. Cases were identified using International Classification of Diseases, 9th Edition, code 427.5 (cardiac arrest) or 99.60 (CPR), excluding prisoners, pregnant patients, transfers, and hospice patients. We estimated hospital-specific risk-standardized survival rates (RSSRs) using hierarchical logistic regression, adjusting for individual risk of mortality. Institutions in the highest RSSR quartile were compared with those in the lowest three quartiles using Pearson chi-square tests of association. Results: UHC institutions admitted 3,686,296 patients in 2012, of which 33,700 patients experienced cardiac arrest. Overall survival was 42.3% (95% CI 41.8-42.9) with median RSSR of 42.7% (IQR 35.5-50.8). Hospitals in the highest quartile of RSSR had higher cardiac arrest volume (median 193 vs. 150, p-value 0.019), higher annual surgical operation volume (21,177 vs. 14,122, 0.007), cared for patients from catchment areas with higher household income ($60,753 vs. $56,424, 0.027), and were more likely to be a trauma (79% vs 59%, 0.024) or cardiac surgery center (91% vs 70%, 0.007). In addition, hospital size (477 vs 415 beds, 0.060) and teaching status (77% vs. 62%, 0.067) demonstrated a trend toward association with higher RSSR. Conclusion: Among hospitals in the UHC, those with higher cardiac arrest and surgical case volume, patient household income, and availability of trauma and cardiac surgery were associated with improved RSSR.

scholarly journals Safety and Putative Benefits of Tracheostomy Tube Placement in Patients on Extracorporeal Membrane Oxygenation: A Single-Center Experience

2019 ◽  
Vol 35 (11) ◽  
pp. 1153-1161 ◽  
Author(s):  
Jatinder Grewal ◽  
Anna-Liisa Sutt ◽  
George Cornmell ◽  
Kiran Shekar ◽  
John Fraser
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Patient Comfort ◽  
Tube Placement ◽  
P Value ◽  
Assessment Scores ◽  
Membrane Oxygenation ◽  
Single Center Experience ◽  
Significant Difference ◽  
Failure Assessment ◽  
Vasopressor Use

Purpose: Patients supported with extracorporeal membrane oxygenation (ECMO) have been reported to have increased sedation requirements. Tracheostomies are performed in intensive care to facilitate longer term mechanical ventilation, reduce sedation, improve patient comfort, secretion clearance, and ability to speak and swallow. We aimed to investigate the safety of tracheostomy (TT) placement on ECMO, its impact on fluid intake, and the use of sedative, analgesic, and vasoactive drugs. Methods: Prospective data were collated for all ECMO patients over a 5.5-year period. Data included the cumulative dose of sedatives and analgesics, fluid balance, inotrope and vasopressor requirements, and number of packed red cell (PRC) units transfused. Data were analyzed to determine the differences in the aforementioned between 5 days pre-TT and post-TT insertion. Results: Thirty-one (22.1%) of 140 patients underwent TT while on ECMO in the study period. Inotrope and vasopressor use was significantly less in the post-TT period compared to pre-TT dose ( P value = .01). This was in the setting of Sequential Organ Failure Assessment scores the day before TT placement being significantly greater than those on days 2, 3, and 4. There was a trend toward reduction in analgesic usage in the post-TT period. No major complications of TT were reported. There was no significant difference ( P value = .46) in the amount of PRC used post-TT. Conclusions: These data indicate that TT may result in a reduction in vasopressor and inotropic requirement. Data do not suggest increased major bleeding with placement of TT in patients on ECMO. The potential risk and benefits of inserting a TT in ECMO patients need further validation in prospective clinical studies.

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

Perfusion ◽  
2019 ◽  
Vol 34 (5) ◽  
pp. 417-421 ◽  
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.

Use of extracorporeal membrane oxygenation in postcardiotomy pediatric patients: parameters affecting survival

Perfusion ◽  
2020 ◽  
Vol 35 (7) ◽  
pp. 608-620 ◽  
Author(s):  
Servet Ergün ◽  
Okan Yildiz ◽  
Mustafa Güneş ◽  
Halil Sencer Akdeniz ◽  
Erkut Öztürk ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Extracorporeal Membrane Oxygenation ◽  
Odds Ratio ◽  
Survival Rates ◽  
Low Cardiac Output Syndrome ◽  
Low Cardiac Output ◽  
Factors Affecting ◽  
Membrane Oxygenation ◽  
Successful Weaning

Aim: We aimed to investigate the risk factors affecting survival after extracorporeal membrane oxygenation use in pediatric postcardiotomy patients. Methods: One hundred thirty-three consecutive patients who underwent surgery for congenital heart disease who needed extracorporeal membrane oxygenation support were retrospectively analyzed. Results: In all, 3,082 patients were operated, of which 140 patients (4.54% of the total number of operations) needed extracorporeal membrane oxygenation. Eighty (60.1%) patients were successfully weaned and 51 (38.3%) patients were discharged. Of the 50 patients discharged during the mean follow-up period of 34.8 (0-192.4) months, 6 (12%) patients died. The extracorporeal membrane oxygenation support was instituted in 29 (21.8%) patients for extracorporeal membrane oxygenation cardiopulmonary resuscitation, in 44 (33.1%) patients due to the inability to be separated from cardiopulmonary bypass, in 19 (14.3%) patients due to respiratory failure, and in 41 patients due to low cardiac output syndrome. Eighty patients (60.2%) were successfully weaned from extracorporeal membrane oxygenation support. The remaining 53 (39.8%) patients died on extracorporeal membrane oxygenation. Mortality was observed in 29 (21.8%) of the 80 patients in the successful weaning group, while the remaining 51 (38.3%) patients were discharged from the hospital. Multivariate analysis showed that double-ventricular physiology increased the rate of successful weaning (odds ratio: 3.4, 95% confidence interval lower: 1.5 and upper: 8, p = 0.004) and prolonged extracorporeal membrane oxygenation durations were a risk factor in successful weaning (odds ratio: 0.9, 95% confidence interval lower: 0.8 and upper: 0.9, p = 0.007). The parameters affecting mortality were the presence of syndrome (odds ratio: 3.8, 95% confidence interval lower: 1.0 and upper: 14.9, p = 0.05), single-ventricular physiology (odds ratio: 5.3, 95% confidence interval lower: 1.8 and upper: 15.3, p = 0.002), and the need for a second extracorporeal membrane oxygenation (odds ratio: 12.9, 95% confidence interval lower: 1.6 and upper: 104.2, p = 0.02). While 1-year survival was 15.2% and 3-year survival was 12.1% in patients with single-ventricular physiology, the respective survival rates were 43.9% and 40.8%. Conclusion: Parameters affecting mortality after extracorporeal membrane oxygenation support in pediatric postcardiotomy patient group were the presence of a syndrome, multiple runs of extracorporeal membrane oxygenation, and single-ventricular physiology. Timing of extracorporeal membrane oxygenation initiation, appropriate patient selection, appropriate reintervention or reoperation for patients with correctable pathology, the use of an appropriate cannulation strategy in single-ventricle patients, management of shunt flow, and appropriate interventions to reduce the incidence of complications play key roles in improving survival.

Cost-effectiveness of Argatroban Versus Heparin Anticoagulation in Adult Extracorporeal Membrane Oxygenation Patients

2019 ◽  
pp. 001857871989009
Author(s):  
Angelina E. Cho ◽  
Kathleen Jerguson ◽  
Joy Peterson ◽  
Deepa V. Patel ◽  
Asif A. Saberi
Keyword(s):  
Cost Effectiveness ◽  
Extracorporeal Membrane Oxygenation ◽  
Average Cost ◽  
P Value ◽  
Bleeding Events ◽  
Membrane Oxygenation ◽  
Increased Risk ◽  
Heparin Anticoagulation ◽  
Ischemic Events ◽  
Ecmo Therapy

Purpose: The purpose of this study was to evaluate the cost effectiveness of argatroban compared to heparin during extracorporeal membrane oxygenation (ECMO) therapy. Methods: This was a retrospective study of patients who received argatroban or heparin infusions with ECMO therapy at a community hospital between January 1, 2017 and June 30, 2018. Adult patients who received heparin or argatroban for at least 48 hours while on venovenous (VV) or venoarterial (VA) ECMO were included. Patients with temporary mechanical circulatory assist devices were excluded. Each continuous course of anticoagulant exposure that met the inclusion criteria was evaluated. The primary endpoint was the total cost of anticoagulant therapy for heparin versus argatroban, including all administered study drugs, blood or factor products, and associated laboratory tests. Secondary endpoints included safety and efficacy of anticoagulation with each agent during ECMO. Documentation of bleeding events, circuit clotting, and ischemic events were noted. Partial thromboplastin time (PTT) values were evaluated for time to therapeutic range and percentage of therapeutic PTTs. Results: A total of 11 courses of argatroban and 24 courses of heparin anticoagulation were included in the study. The average cost per course of argatroban was less than the average cost per course of heparin ($7,091.98 vs $15,323.49, respectively; P value = 0.15). Furthermore, argatroban was not associated with an increased incidence of bleeding, thrombotic, or ischemic events. Conclusion: Argatroban may be more cost-effective during ECMO therapy in patients with low antithrombin III levels without increased risk of adverse events.

Sign in / Sign up

Export Citation Format

Share Document