Outcomes in Pediatric Post-Cardiotomy ECMO Support With Modification of Systematic Support Strategy.

Autor:	Sorabella RA; 9967Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA., Padilla L; 9967Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA., Byrnes JW; Division of Pediatric Cardiology, Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA., Timpa J; 22078Department of Cardiovascular Perfusion Children's of Alabama, Birmingham, AL, USA., O'Meara C; 22078Department of Cardiovascular Perfusion Children's of Alabama, Birmingham, AL, USA., Buckman JR; 9967Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA., Maxwell K; 9967Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA., Borasino S; Division of Pediatric Cardiology, Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA., Zaccagni H; Division of Pediatric Cardiology, Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA., Asfari A; Division of Pediatric Cardiology, Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA., Law MA; Division of Pediatric Cardiology, Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA., Cleveland DC; 9967Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA., Dabal RJ; 9967Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.
Jazyk:	angličtina
Zdroj:	World journal for pediatric & congenital heart surgery [World J Pediatr Congenit Heart Surg] 2022 Jan; Vol. 13 (1), pp. 46-52.
DOI:	10.1177/21501351211060335
Abstrakt:	Background: Utilization of extracorporeal membrane oxygenation (ECMO) support in the post-cardiotomy setting is vital to successful perioperative outcomes following pediatric cardiac surgery. Specific analysis of protocolized management strategies and staff preparedness is imperative to optimizing institutional ECMO outcomes. Methods: All patients requiring post-cardiotomy ECMO support at a single institution from 2013 to 2019 were retrospectively reviewed. In 2015, several modifications were made to the ECMO support paradigm that addressed deficiencies in equipment, critical care protocols, and staff preparedness. Cases were stratified according to era of ECMO support; patients supported prior to paradigm change from 2013 to 2015 (Group EARLY, n = 20), and patients supported following the implementation of systematic modifications from 2016 to 2019 (Group LATE, n = 26). The primary outcomes of interest were survival to decannulation and hospital discharge. Results: Median age at cannulation was 24.5 days (IQR 7-96) and median duration of support was 4 days (IQR 2-8). Overall survival to decannulation was 78.3% (65% EARLY vs. 88.5% LATE, P  = .08) and overall survival to hospital discharge was 58.7% (35% EARLY vs. 76.9% LATE, P  = .004). Conclusion: Systematic modifications to ECMO support strategy and staff preparation are associated with a significant increase in perioperative survival for pediatric patients requiring post-cardiotomy ECMO support.
Databáze:	MEDLINE
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