Low cardiac output syndrome requiring extracorporeal membrane oxygenation following pericardiocentesis in an adolescent with Hodgkin Lymphoma: a case report

Perfusion ◽  
2020 ◽  
pp. 026765912095060
Author(s):  
Toni Matic ◽  
Matija Bakos ◽  
Dalibor Saric ◽  
Miran Cvitkovic ◽  
Zrinko Salek ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Pericardial Effusion ◽  
Extracorporeal Membrane Oxygenation ◽  
Hodgkin Lymphoma ◽  
Hemodynamic Instability ◽  
Low Cardiac Output Syndrome ◽  
Low Cardiac Output ◽  
Membrane Oxygenation ◽  
Drainage Rate ◽  
Large Pericardial Effusion

We present a case of a 16-year-old male with large pericardial effusion due to Hodgkin Lymphoma (HL). Shortly after drainage of pericardial effusion he developed a low cardiac output syndrome which had to be treated with extracorporeal membrane oxygenation (ECMO). This 9-day ECMO support helped the patient to recover his cardiac function, and thereafter a remission of his primary disease was successfully achieved with chemotherapy. It is a matter of discussion whether a large pericardial effusion with moderate symptoms in patients with HL should be evacuated or just observed since the effusion should ameliorate with chemotherapy. But based upon our experience in this case of hemodynamic instability due to a large effusion requiring evacuation, we propose that pericardiocentesis procedure should be performed with caution at a slow drainage rate of 0.5-1 ml/kg/hour with a maximum rate of 50 ml/hour, to help avoid the low cardiac output syndrome in patients with similar disease conditions.

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.

scholarly journals Preoperative Pericardial Effusion is Associated with Low Cardiac Output Syndrome After Pericardiectomy for Constrictive Pericarditis

2021 ◽  
Vol 24 (3) ◽  
pp. E427-E432
Author(s):  
Jing-bin Huang ◽  
Zhao-ke Wen ◽  
Wei-jun Lu ◽  
Chang-chao Lu ◽  
Xian-ming Tang
Keyword(s):  
Cardiac Output ◽  
Pericardial Effusion ◽  
Constrictive Pericarditis ◽  
Multivariate Analyses ◽  
Nyha Class ◽  
Low Cardiac Output Syndrome ◽  
Low Cardiac Output ◽  
Histopathologic Finding ◽  
Short Time

Background: Low cardiac output syndrome is the main cause of death after pericardiectomy. Methods: Patients who underwent pericardiectomy for constrictive pericarditis from January 2009 to October 2020 at our hospital were included in the study. Histopathologic studies of pericardium tissue from every patient were performed. All survivors were followed up. Results: Ninety-two consecutive patients underdoing pericardiectomy were included in the study. The incidence of postoperative low cardiac output syndrome was 10.7% (10/92). There were five operative deaths. Mortality and incidence of LCOS in the group with pericardial effusion were significantly higher than those in the group without pericardial effusion. Tuberculosis of the pericardium (60/92, 65.2%) was the most common histopathologic finding in this study. Both univariate and multivariate analyses showed that preoperative pericardial effusion is associated with increased rate of low cardiac output syndrome. Eighty-five survivors were in NYHA class I (85/87, 97.7%), and two were in class II (2/87, 2.3%) at the latest follow up. Conclusions: Preoperative pericardial effusion is associated with low cardiac output syndrome after pericardiectomy. Tuberculosis of the pericardium was the most common histopathologic finding in this study. For constrictive pericarditis caused by tuberculous bacteria, systematic antituberculosis drugs should be given. Preoperative pericardial effusion is associated with increased rate of low cardiac output syndrome. Perfect preoperative preparation is very important to reduce the incidence of postoperative low cardiac output syndrome and mortality. It is very important to use a large dose of diuretics with cardiotonic or vasopressor in a short time after the operation.

Extracorporeal Membrane Oxygenation in 108 Patients with Low Cardiac Output – a Single-Center Experience

2011 ◽  
Vol 34 (4) ◽  
pp. 365-373 ◽  
Author(s):  
Andres Beiras-Fernandez ◽  
Marcus-André Deutsch ◽  
Sandra Kainzinger ◽  
Ingo Kaczmarek ◽  
Ralf Sodian ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Extracorporeal Membrane Oxygenation ◽  
Single Center ◽  
Low Cardiac Output ◽  
Membrane Oxygenation ◽  
Single Center Experience

scholarly journals Preoperative and perioperative management of patients with pericardial diseases

2011 ◽  
Vol 58 (2) ◽  
pp. 45-53 ◽  
Author(s):  
Arsen Ristic ◽  
Dejan Simeunovic ◽  
Ivan Milinkovic ◽  
Jelena Seferovic-Mitrovic ◽  
Ruzica Maksimovic ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Pericardial Effusion ◽  
Surgical Procedure ◽  
Elective Surgery ◽  
Hemodynamic Instability ◽  
Systemic Resistance ◽  
Positive Pressure ◽  
Low Cardiac Output ◽  
Pericardial Diseases ◽  
Elective Surgical Procedure

Hemodynamic instability is the major concern in surgical patients with pericardial diseases, since general anesthesia and positive pressure ventilation may precipitate cardiac tamponade. In advanced constriction diastolic impairment and myocardial fibrosis/atrophy may cause low cardiac output during and after surgery. Elective surgery should be postponed in unstable patients with pericardial comorbidities. Pericardial effusion should be drained percutaneously (in local anesthesia) and pericardiectomy performed for constrictive pericarditis before any major surgical procedure. In emergencies, volume expansion, catecholamines, and anesthetics keeping cardiac output and systemic resistance should be applied. Etiology of pericardial diseases is an important issue is the preoperative management. Patients with neoplastic pericardial involvement have generally poor prognosis and any elective surgical procedure should be avoided. For patients with acute viral or bacterial infection or exacerbated metabolic, uremic, or autoimmune diseases causing significant pericardial effusion, surgery should be postponed until the causative disorder is stabilized and signs of pericarditis have resolved.

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