Extracorporeal membrane oxygenation after stage I reconstruction for hypoplastic left heart syndrome

Ravishankar, Chitra; Dominguez, Troy E.; Kreutzer, Jacqueline; Wernovsky, Gil; Marino, Bradley S.; Godinez, Rodolfo I.; Priestley, Margaret A.; Gruber, Peter J.; Gaynor, William; Nicolson, Susan C.; Spray, Thomas L.; Tabbutt, Sarah

doi:10.1097/00130478-200607000-00042

Cited by 26 publications

(55 citation statements)

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“…Once on ECMO, outcomes were better in patients with shorter ECMO duration, consistent with prior reports (3,13,16). Thus, prompt diagnosis and management of the etiology of cardiac arrest while on ECMO are essential.…”

Section: Discussionsupporting

confidence: 86%

“…Birth weight and gestational age have been shown to be risk factors for neonates undergoing cardiac surgery with poorer outcomes reported for low birth weight (LBW) and premature infants (19)(20)(21). Similarly, body weight has shown to be a predictor of survival to hospital discharge in some but not all prior studies of neonates supported by ECMO after cardiac surgery (3,4,9,13,16,22). Both LBW and lower gestational age have been shown to be risk factors for CNS injury during ECMO (18).…”

Section: Discussionmentioning

confidence: 99%

“…Thus, generalizing these findings to children with HLHS undergoing S1P may be difficult. Current single-center reports of survival following ECPR in HLHS patients following S1P report variable survival outcomes (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). Because cardiac arrest and use of ECPR in neonates with HLHS undergoing S1P is commonplace and maintaining an ECPR program is expensive, improving our understanding of potential benefits, namely survival to discharge, morbidity, and long-term outcomes in this population, is critical.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Extracorporeal Membrane Oxygenation–Supported Cardiopulmonary Resuscitation Following Stage 1 Palliation for Hypoplastic Left Heart Syndrome*

Jolley

Yarlagadda

Rajagopal

et al. 2014

Pediatric Critical Care Medicine

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Extracorporeal Membrane Oxygenation–Supported Cardiopulmonary Resuscitation Following Stage 1 Palliation for Hypoplastic Left Heart Syndrome*

Jolley

Yarlagadda

Rajagopal

et al. 2014

Pediatric Critical Care Medicine

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“…Survival in our patients who required ECMO was 41.4%, which is favorable compared with hospital survival of 31% in a recent Extracorporeal Life Support Organization report that examined the outcomes in 738 neonates who required ECMO after the Norwood operation [24]. Furthermore, several reports showed that the long-term outcomes in hospital survivors who required ECMO support after the Norwood operation is poor [9,[25][26][27]. The report from the SVR trial showed that transplantation-free survival at 2 years was 26% after nonrescue ECMO and 30% after rescue ECMO [9].…”

Section: Commentmentioning

confidence: 61%

Impact of Patient Characteristics and Anatomy on Results of Norwood Operation for Hypoplastic Left Heart Syndrome

Alsoufi

Mori

Gillespie

et al. 2015

The Annals of Thoracic Surgery

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This current single-institution experience demonstrates that patients' factors (ie, prematurity, low weight, genetic/extracardiac anomalies) continue to adversely affect survival. Conversely, surgical and perioperative management advances, along with the use of the right ventricle to pulmonary artery shunt, might have neutralized the effects of anatomic factors on survival. Technical imperfections requiring reoperations are associated with failure to progress through palliation stages and diminished survival.

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“…More than one third of the patients survived to discharge. Specific to the cardiac surgery population, patients with shunted single-ventricle circulation supported with ECMO showed survival-to-hospital-discharge rates of 39% [46].…”

Section: Cardiopulmonary Arrestmentioning

confidence: 99%

Perioperative Mechanical Circulatory Support in Children with Critical Heart Disease

Checchia

2011

Curr Treat Options Cardio Med

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The treatment of cardiovascular failure in the perioperative period with the use of mechanical circulatory support is a well-recognized, well-developed, and commonly utilized treatment modality. Regardless of the exact circumstances of initiation, the use of a support device is a "bridge." Where there has been an acute myocardial insult, short-term assist devices can serve as a "bridge to immediate survival," a "bridge to recovery," or even a "bridge to the next decision." Mechanical circulatory support can serve as a treatment of cardiovascular decompensation caused by myocarditis, acute myocardial insult, low cardiac output following surgery, and congenital heart disease. The utilization of such support carries significant risks such as bleeding, infection, and thrombosis. However, these can be minimized in order to allow for the safe and effective deployment of this therapeutic strategy. One specific therapeutic domain in which these devices provide immediate impact is during cardiac arrest. Although outcomes of cardiac arrest remain poor, use of a mechanical device as an intervention has allowed salvage of otherwise certain mortality. However, it is important to note that the utility of support was most pronounced in patients that were not on either extreme of the survival prediction curve. This can be best summarized by the concept of "not too early, not too late." Therefore, it is the responsibility of the entire care team to find the appropriate patient population in which to "pull the trigger" on mechanical support as a therapy. This decision point is supported by a monitoring strategy that can be utilized to predict deterioration and intervene adequately. Most importantly, an effective monitoring strategy allows the practitioner to judge the effectiveness of treatment and support strategies and make adjustments in a timely manner, potentially with mechanical support in the perioperative period.

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Extracorporeal membrane oxygenation after stage I reconstruction for hypoplastic left heart syndrome

Cited by 26 publications

References 0 publications

Extracorporeal Membrane Oxygenation–Supported Cardiopulmonary Resuscitation Following Stage 1 Palliation for Hypoplastic Left Heart Syndrome*

Extracorporeal Membrane Oxygenation–Supported Cardiopulmonary Resuscitation Following Stage 1 Palliation for Hypoplastic Left Heart Syndrome*

Impact of Patient Characteristics and Anatomy on Results of Norwood Operation for Hypoplastic Left Heart Syndrome

Perioperative Mechanical Circulatory Support in Children with Critical Heart Disease

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