Recent innovations in perfusion and cardiopulmonary bypass for neonatal and infant cardiac surgery

Sturmer, David L.; Beaty, Claude A.; Clingan, Sean; Jenkins, Eric; Peters, Whitney; Si, Ming‐Sing

doi:10.21037/tp.2018.03.05

Cited by 26 publications

(17 citation statements)

References 96 publications

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“…Although the use of PB has been reported, its effect as FB therapy was unknown. The use of PB is one of many strategies to optimize hematocrit and reduce exposure to blood transfusions following cardiopulmonary bypass (13). Trials investigating optimal intraoperative hematocrit have measured the effects on short-term oxygen delivery, cardiac output, cerebral oxygenation, and fluid balance as well as medium-term neurodevelopmental outcomes (14,15).…”

Section: Relationship To Previous Studiesmentioning

confidence: 99%

Hemodynamic Response to Fluid Boluses for Hypotension in Children in a Cardiac ICU

Gelbart

Harrois

Gardiner

et al. 2020

Pediatric Critical Care Medicine

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To describe the hemodynamic response to fluid boluses for hypotension in children in a cardiac ICU. DESIGN: A prospective, observational study. SETTING: Single-centered cardiac ICU. PATIENTS: Children in a cardiac ICU with hypotension. INTERVENTIONS: Clinician prescribed fluid bolus. MEASUREMENTS AND MAIN RESULTS: Sixty-four fluid boluses were administered to 52 children. Fluid composition was 4% albumin in 36/64 (56%), 0.9% saline in 18/64 (28%), and cardiopulmonary bypass pump blood in 10/64 (16%). The median volume and duration were 5.0 mL/kg (interquartile range, 4.8-5.4) and 8 minutes (interquartile range, 4-19), respectively. Hypovolemia/low filling pressures was the most common additional indication (25/102 [25%]). Mean arterial pressure response, defined as a 10% increase from baseline, occurred in 42/64 (66%) of all fluid boluses at a median time of 6 minutes (interquartile range, 4-11). Mean arterial pressure responders had a median peak increase in the mean arterial pressure of 15 mm Hg (43 mm Hg [interquartile range, 29-50 mm Hg] to 58 mm Hg [interquartile range, 49-65 mm Hg]) at 17 minutes (interquartile range, 14-24 min) compared with 4 mm Hg (48 mm Hg [interquartile range, 40-51 mm Hg] to 52 mm Hg [interquartile range, 45-56 mm Hg]) at 10 minutes (interquartile range, 3-18 min) in nonresponders. Dissipation of mean arterial pressure response, when defined as a subsequent decrement in mean arterial pressure below 10%, 5%, and 2% increases from baseline, occurred in 28/42 (67%), 18/42 (43%), and 13/42 (31%) of mean arterial pressure responders, respectively. Cardiopulmonary bypass pump blood was strongly associated with peak change in mean arterial pressure from baseline (coefficient 11.0 [95% CI, 4.3-17.7]; p = 0.02). Fifty out of 64 (78%) were receiving a vasoactive agent. However, change in vasoactive inotrope score was not associated with change in mean arterial pressure (coefficient 2.3 [95% CI,-2.5 to-7.2]; p = 0.35). Timing from admission, nor fluid bolus duration, influenced mean arterial pressure response. CONCLUSIONS: In children with hypotension in a cardiac ICU, the median dose and duration of fluid boluses were 5 mL/kg and 8 minutes. Peak response occurred shortly following administration and commonly returned to baseline.

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Section: Relationship To Previous Studiesmentioning

confidence: 99%

Hemodynamic Response to Fluid Boluses for Hypotension in Children in a Cardiac ICU

Gelbart

Harrois

Gardiner

et al. 2020

Pediatric Critical Care Medicine

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“…Multiple studies have proved a longer period of mechanical ventilation posthypothermic CPB in parallel to our results which demonstrated a significant increase in intubation period in hypothermic group of patients. [ 6 19 20 ]…”

Section: Discussionmentioning

confidence: 99%

Normothermia versus hypothermia during cardiopulmonary bypass in cases of repair of atrioventricular septal defect

et al. 2020

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Background: Cardiopulmonary bypass (CPB) used for cardiac surgery is now uniformly carried out under normothermic conditions in adult patients; however, the temperature applied in pediatric CPB vary significantly, ranging from deep hypothermia to normothermia due to the lack of a consistent approach to CPB temperature in pediatric cardiac surgery, which is related to a lack of supportive evidence. Organs protection aim to decrease metabolic requirement and provide energy and oxygen, hypothermia has reached these goals by arresting and cooling the heart, delivering oxygen, and modifying reperfusion. Recently, a large number of studies investigated effect of hypothermia to decrease the negative impact of hypothermia. It has been suggested that the degree of hypothermia affects the inflammatory responses triggered by CPB. However, the use of normothermia during CPB had been introduced and resulted in acceptable results. We hypothesized that the use of normothermia during corrective surgery of AV septal defects improves the outcome of the CPB. Objective: The study aimed to compare the outcome of normothermic technique and mild hypothermic technique during (CPB) in pediatric cardiac patients undergoing repair of atrioventricular (AV) septal defect and their effect on tissue perfusion, serum lactate level, duration of patient intubation, and postoperative hospital stay. Patients and Methods: Forty patients presented for repair of AV defect aged from 1 month to 36 months were divided randomly into two equal groups (20 patients in each): Group I (Normothermic group) of body temperature more than 35°C up to 37°C and Group II (mild Hypothermic group) body temperature between (32°C–35°C). Basal data include complete blood count, electrolytes, arterial blood gases (ABGs), coagulation profile, and liver function tests were collected. Hemodynamic variables, ABG, serum lactate, and activated clotting time (ACT) measured in different time intervals related to CPB. With the termination of CPB, aortic cross-clamping time (minutes), CPB time (minutes), spontaneous regaining of the heart function, need for inotropic administration, and/or vasopressor requirements to wean the heart from CPB were reported in all patients. Results: This study showed statistically significant lower PH and HCO3 levels and significantly higher serum lactate levels in Group II (hypothermic) than Group I (normothermic) after weaning from CPB. Furthermore, ACT level was statistically significantly higher in Group II than Group I after weaning of CPB. During postoperative period, hypothermic group showed significantly higher liver enzymes than the normothermic group. The duration of inotropes administration and duration of intubation were significantly longer in Group II than Group I. Conclusion: Normothermia during CPB showed better global tissue perfusion than hypothermia in elective surgeries for repair of AV defects in the f...

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“…Technical advances in surgical procedures with CPB have been possible due to minimization of the bypass circuits resulting in minimal priming volumes, decreased hemodilution on CPB to achieve higher hematocrit, and fewer blood product transfusions. 17…”

Section: Perfusion-related Issuesmentioning

confidence: 99%

Surgeries in Neonates and Small-Weight Babies With Congenital Heart Diseases: Challenges and Gratification

Dharmapuram

Ramakrishnan

Goutami

et al. 2020

Indian Journal of Clinical Cardiology

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Background: Complex cardiac surgery in neonates and small-weight babies is a challenge. In addition to the surgical expertise and skill required, accurate diagnosis, management of anesthesia, perfusion, and postoperative critical care are equally challenging. Methods: We have analyzed the data of 4 different examples of complex cardiac surgery in neonates and small-weight babies from February 2012 to July 2019 in our unit. The first group included 118 cases of arterial switch operations for transposition of great arteries with and without ventricular septal defect (group 1). The second group included 52 patients of aortic arch repair from midline using selective cerebral perfusion avoiding total circulatory arrest (group 2). The third group included 75 patients of repair of coarctation of aorta from thoracotomy using the modified end-to-side technique (group 3). The fourth group included 40 neonates and small-weight babies who underwent repair of total anomalous pulmonary venous connection (group 4). Results: In group 1, there was hospital mortality in 6 babies. In group 2, there was no hospital mortality. In group 3, there was 1 hospital death; in group 4, there were 5 hospital deaths. The major contributing cause of death was respiratory or blood-borne infection causing respiratory issues leading to prolonged ventilation. Left diaphragm palsy contributed to morbidity and eventual death in 2 babies. Only 2 patients required tracheostomy to wean off the ventilator. Conclusions: In the present day, it is possible to achieve satisfactory results with acceptable mortality in neonatal cardiac surgery. Morbidity associated with very early repair in neonatal age, low weight, and infection-related issues is manageable with good outcomes.

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Recent innovations in perfusion and cardiopulmonary bypass for neonatal and infant cardiac surgery

Cited by 26 publications

References 96 publications

Hemodynamic Response to Fluid Boluses for Hypotension in Children in a Cardiac ICU

Hemodynamic Response to Fluid Boluses for Hypotension in Children in a Cardiac ICU

Normothermia versus hypothermia during cardiopulmonary bypass in cases of repair of atrioventricular septal defect

Surgeries in Neonates and Small-Weight Babies With Congenital Heart Diseases: Challenges and Gratification

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