Pediatric cardiac surgical ECMO: Multivariate analysis of risk factors for hospital death

Walters, Henry L.; Hakimi, Mehdi; Rice, Michael; Lyons, Juanita M.; Whittlesey, Grant C.; Klein, Michael D.

doi:10.1016/0003-4975(95)00410-m

Cited by 110 publications

(63 citation statements)

References 21 publications

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“…In our country, its development and clinical application are limited, being restricted to a few high-complexity centers 8 . Nevertheless, the use of the ECMO in the perioperative period of cardiovascular surgery is an effective method to control severe hemodynamic 9 or respiratory 10 alterations, allowing the recovery of targetorgans 11 or as bridge for transplant in selected cases [12][13][14] . The largest world experience with the method occurs in pediatric patients with respiratory failure.…”

Section: Discussionmentioning

confidence: 99%

Emprego do suporte cardiopulmonar com bomba centrífuga e oxigenador de membrana em cirurgia cardiovascular pediátrica

Atik¹,

Castro²,

Succi³

et al. 2008

Arq. Bras. Cardiol.

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Section: Discussionmentioning

confidence: 99%

Emprego do suporte cardiopulmonar com bomba centrífuga e oxigenador de membrana em cirurgia cardiovascular pediátrica

Atik¹,

Castro²,

Succi³

et al. 2008

Arq. Bras. Cardiol.

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“…There is controversy regarding whether there are any benefits of pulsatile flow in terms of cerebral hemodynamics or neurological outcome [79]. It has been suggested that the critical opening pressure of the capillary bed is lower with pulsatile than with nonpulsatile flow [201], which might be important in maintaining adequate tissue perfusion at the low pump flows used during CPB. In addition, there is a body of literature that suggests that CBF is higher during pulsatile pump flow over a wide range of mean arterial pressure at normothermia and drug recovery from DHCA in canine models [144].…”

Section: Pulsatile Vs Nonpulsatile Flowmentioning

confidence: 99%

“…The brain is vulnerable to secondary insults during the first few days postoperatively. An adequate cardiac output is essential for cerebral perfusion, and this may require the chest to be splinted open [72] or the use of ECMO [201]. Clinical and electroencephalographic seizures are common postoperatively [76] and appear to be associated with a poorer outcome [10].…”

Section: Postoperative Managementmentioning

confidence: 99%

Recognition and Prevention of Neurological Complications in Pediatric Cardiac Surgery

Kirkham¹

1998

Pediatr Cardiol

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Because of advances in surgical and cardiopulmonary bypass techniques it is now possible to definitively repair the vast majority of congenital heart disease in infancy or childhood. Although the majority of survivors do not have obvious cerebral sequelae, there is increasing disquiet about the high incidence of acute neurological events in the immediated postoperative period as well as evidence that at long-term follow-up there are subtle cognitive and motor deficits in many. Some children are more at risk of neurodevelopmental problems, either because of their cardiac (e.g. , extensive aortopulmonary collaterals) or cerebrovascular (e.g., the propensity to large vessel dissection) anatomy or because of genetic predisposition (e.g., to prothrombotic disorders). The incidence may vary with the surgery (e.g., the Fontan operation) and the cardiopulmonary bypass technique necessary to achieve an adequate technical repair (e.g., low or no flow at deep hypothermia). Recognition of the population at risk will lead to prevention of serious sequelae. Data collected in adults may be misleading, and many pediatric units have developed their own practice, but recent studies in animal models of child surgery and in children have produced some evidence to guide management to ensure the optimal cerebral as well as cardiac outcome. Pump flow should be maintained at least 30 ml/kg/min where possible, with inotropic support to maintain blood pressure if necessary. If pump flow must be lowered or circulatory arrest is essential, thorough cerebral cooling to deep hypothermic temperatures is mandatory; a pH-stat strategy may make this easier, but an alpha-stat strategy may be better in those operations that can be performed at moderate hypothermia. There is no evidence that the available pulsatile pumps offer an advantage. Tissue oxygenation may reach critical levels and a high hematocrit and oxygen tension may reduce the risk of significant hypoxia. There is a risk of embolization in children, which can be reduced with membrane oxygenators and careful monitoring; the role of arterial filtration remains controversial. The only protective agent that can currently be recommended is methylprednisolone to protect the spinal cord (e.g., in operations on the aortic arch). Further studies are needed in this important area.

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“…(1) Occasionally this complication may be refractory even to the most intensive pharmacologic therapy and the use of extracorporeal membrane oxygenator (ECMO) may be the only alternative. A significant body of literature exists regarding the use of ECMO in postoperative course after cardiac surgery in children, (2)(3)(4)(5) and more limited information exists regarding the use of intraoperative ECMO. In present study we report outcome in 35 pediatric patients who received ECMO intraoperatively after failing weaning from CPB following repair of complex heart malformations.…”

Section: Introductionmentioning

confidence: 99%

Pediatric surgical extracorporeal membrane oxygenation -a case series

Flick

Gleich

Hanson

et al. 2008

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Pediatric cardiac surgical ECMO: Multivariate analysis of risk factors for hospital death

Cited by 110 publications

References 21 publications

Emprego do suporte cardiopulmonar com bomba centrífuga e oxigenador de membrana em cirurgia cardiovascular pediátrica

Emprego do suporte cardiopulmonar com bomba centrífuga e oxigenador de membrana em cirurgia cardiovascular pediátrica

Recognition and Prevention of Neurological Complications in Pediatric Cardiac Surgery

Pediatric surgical extracorporeal membrane oxygenation -a case series

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