Experience with ECMO support after congenital cardiac surgery in a single tertiary center
Détails
ID Serval
serval:BIB_E2E66E9D3379
Type
Actes de conférence (partie): contribution originale à la littérature scientifique, publiée à l'occasion de conférences scientifiques, dans un ouvrage de compte-rendu (proceedings), ou dans l'édition spéciale d'un journal reconnu (conference proceedings).
Sous-type
Abstract (résumé de présentation): article court qui reprend les éléments essentiels présentés à l'occasion d'une conférence scientifique dans un poster ou lors d'une intervention orale.
Collection
Publications
Institution
Titre
Experience with ECMO support after congenital cardiac surgery in a single tertiary center
Titre de la conférence
175e Réunion de la Société Suisse de Neurologie, 33e Réunion annuelle de la Société Suisse de Médecine Intensive, Réunion annuelle de la Communauté Suisse d'Intérêts pour soins intensifs et Réunion annuelle de la Société Suisse d'Ethique Biomédicale
Adresse
Bienne, Suisse, 28-30 avril 2005
ISBN
0258-7661
Statut éditorial
Publié
Date de publication
2005
Volume
154
Série
Schweizer Archiv für Neurologie und Psychiatrie = Archives suisses de neurologie et de psychiatrie = Swiss archives of neurology and psychiatry
Pages
212
Langue
anglais
Résumé
Introduction: Extracorporeal membrane oxygenation
(ECMO) has been used as rescue
therapy in children since the 1980s for persistent
pulmonary hypertension (PHT) of the
newborn or in congenital heart disease
(CHD) either before or after cardiac surgery.
We report here our overall experience.
Methods: Retrospective study with chart
review of all patients necessitating ECMO
support after congenital cardiac surgery between
April 1999 and December 2004.
Results: 17 children needed ECMO support
after congenital heart surgery. Their
mean age was 1.8 ± 3.3 years (2 days-10
years). The mean weight was 8.4 kg (2.7-30
kg). 4 patients (24%) presented a transposition
of the great arteries; 4 patients an unbalanced
double outlet right ventricle with or
without aortic malposition; 4 patients a ventricular
septal defect or aorto-pulmonary window
or a complete atrio-ventricular septal
defect with secondary pulmonary hypertension;
3 patients a tetralogy of Fallot; 1 patient
a critical aortic stenosis and 1 patient a cardiac
transplantation. Surgery was in 12 patients
(70%) a corrective procedure and in the
5 others patients (30%) a palliation. ECMO
was initiated in the OR after failure of weaning
from cardiopulmonary bypass in 11 children
(65%). In 6 children (35%), it was
started in the ICU within 24 hours for low
cardiac output or cardiac arrest. The ECMO
pump consisted of a Biomedicus membrane
oxygenator. In the first 5 patients regular
cardiopulmonary bypass canulas were used,
thereafter ECMO canulas were used with a
completely heparinised circuit and activated
clotting time ideally at 190-210. Mean time
on ECMO was 98 hours (20-249 hours). In
4 patients the intensive care was stopped
because of multiple organ failure or severe
cerebral lesions, in 3 patients a technical problem
of the ECMO (massive haemorrhage,
canulas dislocation or massive thrombosis)
lead to death of the patient. 10 patients could
be weaned from the ECMO. The immediate
survival rate of the ECMO was 59% and the
overall survival rate at 30 days post surgery
was 41%.
Conclusions: Cardiac support with ECMO
after congenital heart surgery permits a longterm
survival in about 40% of patients in
critical condition who would otherwise die.
These results correspond to the results published
in big series. It should be available to
centres performing congenital heart surgery
as a rescue therapy in selected cases.
(ECMO) has been used as rescue
therapy in children since the 1980s for persistent
pulmonary hypertension (PHT) of the
newborn or in congenital heart disease
(CHD) either before or after cardiac surgery.
We report here our overall experience.
Methods: Retrospective study with chart
review of all patients necessitating ECMO
support after congenital cardiac surgery between
April 1999 and December 2004.
Results: 17 children needed ECMO support
after congenital heart surgery. Their
mean age was 1.8 ± 3.3 years (2 days-10
years). The mean weight was 8.4 kg (2.7-30
kg). 4 patients (24%) presented a transposition
of the great arteries; 4 patients an unbalanced
double outlet right ventricle with or
without aortic malposition; 4 patients a ventricular
septal defect or aorto-pulmonary window
or a complete atrio-ventricular septal
defect with secondary pulmonary hypertension;
3 patients a tetralogy of Fallot; 1 patient
a critical aortic stenosis and 1 patient a cardiac
transplantation. Surgery was in 12 patients
(70%) a corrective procedure and in the
5 others patients (30%) a palliation. ECMO
was initiated in the OR after failure of weaning
from cardiopulmonary bypass in 11 children
(65%). In 6 children (35%), it was
started in the ICU within 24 hours for low
cardiac output or cardiac arrest. The ECMO
pump consisted of a Biomedicus membrane
oxygenator. In the first 5 patients regular
cardiopulmonary bypass canulas were used,
thereafter ECMO canulas were used with a
completely heparinised circuit and activated
clotting time ideally at 190-210. Mean time
on ECMO was 98 hours (20-249 hours). In
4 patients the intensive care was stopped
because of multiple organ failure or severe
cerebral lesions, in 3 patients a technical problem
of the ECMO (massive haemorrhage,
canulas dislocation or massive thrombosis)
lead to death of the patient. 10 patients could
be weaned from the ECMO. The immediate
survival rate of the ECMO was 59% and the
overall survival rate at 30 days post surgery
was 41%.
Conclusions: Cardiac support with ECMO
after congenital heart surgery permits a longterm
survival in about 40% of patients in
critical condition who would otherwise die.
These results correspond to the results published
in big series. It should be available to
centres performing congenital heart surgery
as a rescue therapy in selected cases.
Création de la notice
25/01/2008 11:28
Dernière modification de la notice
20/08/2019 17:06
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