scholarly journals Extracorporeal life support / membrane oxygenation following paediatric cardiac surgery

2012 ◽  
Vol 29 (2) ◽  
pp. 51
Author(s):  
Prasad Krishnan
Keyword(s):  
Cardiac Surgery ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Membrane Oxygenation ◽  
Paediatric Cardiac Surgery

scholarly journals What are the important morbidities associated with paediatric cardiac surgery? A mixed methods study

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e028533 ◽  
Author(s):  
Katherine L Brown ◽  
Christina Pagel ◽  
Deborah Ridout ◽  
Jo Wray ◽  
David Anderson ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Mixed Methods ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Early Mortality ◽  
Mixed Methods Study ◽  
Feeding Problems ◽  
Safety Outcome ◽  
Paediatric Cardiac Surgery ◽  
The Impact

ObjectivesGiven the current excellent early mortality rates for paediatric cardiac surgery, stakeholders believe that this important safety outcome should be supplemented by a wider range of measures. Our objectives were to prospectively measure the incidence of morbidities following paediatric cardiac surgery and to evaluate their clinical and health-economic impact over 6 months.DesignThe design was a prospective, multicentre, multidisciplinary mixed methods study.SettingThe setting was 5 of the 10 paediatric cardiac surgery centres in the UK with 21 months recruitment.ParticipantsIncluded were 3090 paediatric cardiac surgeries, of which 666 patients were recruited to an impact substudy.ResultsFamilies and clinicians prioritised:Acute neurological event, unplanned re-intervention, feeding problems, renal replacement therapy, major adverse events, extracorporeal life support, necrotising enterocolitis, postsurgical infection and prolonged pleural effusion or chylothorax.Among 3090 consecutive surgeries, there were 675 (21.8%) with at least one of these morbidities. Independent risk factors for morbidity included neonatal age, complex heart disease and prolonged cardiopulmonary bypass (p<0.001). Among patients with morbidity, 6-month survival was 88.2% (95% CI 85.4 to 90.6) compared with 99.3% (95% CI 98.9 to 99.6) with none of the morbidities (p<0.001). The impact substudy in 340 children with morbidity and 326 control children with no morbidity indicated that morbidity-related impairment in quality of life improved between 6 weeks and 6 months. When compared with children with no morbidities, those with morbidity experienced a median of 13 (95% CI 10.2 to 15.8, p<0.001) fewer days at home by 6 months, and an adjusted incremental cost of £21 292 (95% CI £17 694 to £32 423, p<0.001).ConclusionsEvaluation of postoperative morbidity is more complicated than measuring early mortality. However, tracking morbidity after paediatric cardiac surgery over 6 months offers stakeholders important data that are of value to parents and will be useful in driving future quality improvement.

scholarly journals Definition of important early morbidities related to paediatric cardiac surgery

2016 ◽  
Vol 27 (4) ◽  
pp. 747-756 ◽  
Author(s):  
Katherine L. Brown ◽  
Christina Pagel ◽  
Rhian Brimmell ◽  
Kate Bull ◽  
Peter Davis ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Life Support ◽  
Blood Stream Infection ◽  
Extracorporeal Life Support ◽  
Blood Stream ◽  
Feeding Problems ◽  
Cardiac Events ◽  
Multi Centre Study ◽  
Paediatric Cardiac Surgery ◽  
The Impact

AbstractBackgroundMorbidity is defined as a state of being unhealthy or of experiencing an aspect of health that is “generally bad for you”, and postoperative morbidity linked to paediatric cardiac surgery encompasses a range of conditions that may impact the patient and are potential targets for quality assurance.MethodsAs part of a wider study, a multi-disciplinary group of professionals aimed to define a list of morbidities linked to paediatric cardiac surgery that was prioritised by a panel reflecting the views of both professionals from a range of disciplines and settings as well as parents and patients.ResultsWe present a set of definitions of morbidity for use in routine audit after paediatric cardiac surgery. These morbidities are ranked in priority order as acute neurological event, unplanned re-operation, feeding problems, the need for renal support, major adverse cardiac events or never events, extracorporeal life support, necrotising enterocolitis, surgical site of blood stream infection, and prolonged pleural effusion or chylothorax. It is recognised that more than one such morbidity may arise in the same patient and these are referred to as multiple morbidities, except in the case of extracorporeal life support, which is a stand-alone constellation of morbidity.ConclusionsIt is feasible to define a range of paediatric cardiac surgical morbidities for use in routine audit that reflects the priorities of both professionals and parents. The impact of these morbidities on the patient and family will be explored prospectively as part of a wider ongoing, multi-centre study.

scholarly journals Initial experience with extracorporeal membrane oxygenation following cardiac surgery in children with congenital heart disease

2014 ◽  
Vol 11 (1) ◽  
pp. 39-44 ◽  
Author(s):  
Apurb Sharma ◽  
Jeju Nath Pokharel ◽  
Murari Raj Upreti ◽  
Bhagawan Koirala ◽  
Jyotindra Sharma ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Heart Surgery ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Open Heart Surgery ◽  
Life Support System ◽  
Extra Corporeal Membrane Oxygenation ◽  
Membrane Oxygenation ◽  
Congenital Cardiac Anomalies ◽  
Extracorporeal Support

Background and Aim: Cardiac extra-corporeal membrane oxygenation is a mechanical life support system initiated in patients with extreme cardiopulmonary failure. Extracorporeal circulation after cardiac surgery supports the heart and lungs recover from the acute injuries of the surgery. Aims of this study were to present our initial experience about complications and outcome with the use of extracorporeal membrane oxygenation following open-heart surgery for congenital cardiac anomalies. Methods: Medical records of all pediatric and neonatal patients requiring extracorporeal life support following cardiac surgery for congenital cardiac anomalies were retrospectively reviewed. Patient and extracorporeal system characteristics were evaluated. Results: Between 2009 and 2012, eight children were treated at our institution with mechanical extracorporeal life support system following open heart surgery. Median age was four months and mean weight was 7.24 kilograms. The indications for initiation of extracorporeal support were difficulty in weaning off cardiopulmonary bypass despite maximal inotropic support, refractory pulmonary oedema immediately after cardiopulmonary bypass and right ventricular dysfunction in postoperative period. Two patients were weaned from the extracorporeal support successfully. Conclusions: Initial results of our extra-corporeal membrane oxygenation programme do not meet the international standards. It can still be a valuable strategy for saving lives after paediatric cardiac surgery. DOI: http://dx.doi.org/10.3126/njh.v11i1.10980   Nepalese Heart Journal 2014;11(1): 39-44

Evaluation of a Multimodal Heparin Laboratory Monitoring Protocol in Adult Extracorporeal Membrane Oxygenation Patients

2021 ◽  
pp. 089719002110212
Author(s):  
Kalynn A. Northam ◽  
Bobbie Nguyen ◽  
Sheh-Li Chen ◽  
Edward Sredzienski ◽  
Anthony Charles
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Major Bleeding ◽  
Infusion Rate ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Factor Xa ◽  
Median Number ◽  
Multimodal Approach ◽  
Membrane Oxygenation ◽  
Monitoring Protocol

Background: Anticoagulation monitoring practices vary during extracorporeal membrane oxygenation (ECMO). The Extracorporeal Life Support Organization describes that a multimodal approach is needed to overcome assay limitations and minimize complications. Objective: Compare activated clotting time (ACT) versus multimodal approach (activated partial thromboplastin time (aPTT)/anti-factor Xa) for unfractionated heparin (UFH) monitoring in adult ECMO patients. Methods: We conducted a single-center retrospective pre- (ACT) versus post-implementation (multimodal approach) study. The incidence of major bleeding and thrombosis, blood product and antithrombin III (ATIII) administration, and UFH infusion rates were compared. Results: Incidence of major bleeding (69.2% versus 62.2%, p = 0.345) and thrombosis (23% versus 14.9%, p = 0.369) was similar between groups. Median number of ATIII doses was reduced in the multimodal group (1.0 [IQR 0.0-2.0] versus 0.0 [0.0 -1.0], p = 0.007). The median UFH infusion rate was higher in the ACT group, but not significant (16.9 [IQR 9.6-22.4] versus 13 [IQR 9.6-15.4] units/kg/hr, p = 0.063). Fewer UFH infusion rate changes occurred prior to steady state in the multimodal group (0.9 [IQR 0.3 -1.7] versus 0.1 [IQR 0.0-0.2], p < 0.001). Conclusion: The incidence of major bleeding and thrombosis was similar between groups. Our multimodal monitoring protocol standardized UFH infusion administration and reduced ATIII administration.

Extracorporeal membrane oxygenation outcomes in children with hemophagocytic lymphohistiocytosis

Perfusion ◽  
2016 ◽  
Vol 32 (2) ◽  
pp. 151-156 ◽  
Author(s):  
Katherine Cashen ◽  
Roland L Chu ◽  
Justin Klein ◽  
Peter T Rycus ◽  
John M Costello
Keyword(s):  
Risk Factors ◽  
Extracorporeal Membrane Oxygenation ◽  
Cardiac Failure ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Pediatric Patients ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Hemorrhagic Complication ◽  
Membrane Oxygenation ◽  
Va Ecmo

Introduction: Pediatric patients with hemophagocytic lymphohistiocytosis (HLH) may develop refractory respiratory or cardiac failure that warrants consideration for extracorporeal membrane oxygenation (ECMO) support. The purposes of this study were to describe the use and outcomes of ECMO in pediatric HLH patients, to identify risk factors for hospital mortality and to compare their ECMO use and outcomes to the ECMO population as a whole. Methods: Pediatric patients (⩽ 18 years) with a diagnosis of HLH in the Extracorporeal Life Support Organization (ELSO) Registry were included. Results: Between 1983 and 2014, data for 30 children with HLH were available in the ELSO registry and all were included in this study. All cases occurred in the last decade. Of the 30 HLH patients, 24 (80%) had a respiratory indication for ECMO and six (20%) had a cardiac indication (of which 4 were E-CPR and 2 cardiac failure). Of the 24 respiratory ECMO patients, 63% were placed on VA ECMO. Compared with all pediatric patients in the ELSO registry during the study period (n=17,007), HLH patients had worse hospital survival (non-HLH 59% vs HLH 30%, p=0.001). In pediatric HLH patients, no pre-ECMO risk factors for mortality were identified. The development of a hemorrhagic complication on ECMO was associated with decreased mortality (p=0.01). Comparing HLH patients with respiratory failure to patients with other immune compromised conditions, the overall survival rate is similar (HLH 38% vs. non-HLH immune compromised 31%, p=0.64). Conclusions: HLH is an uncommon indication for ECMO and these patients have increased mortality compared to the overall pediatric ECMO population. These data should be factored into decision-making when considering ECMO for pediatric HLH patients.

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.

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