Initial Clinical Experiences With Novel Diagonal ECLS System in Pediatric Cardiac Patients

Abstract

Extracorporeal life support (ECLS) provides mechanical support following cardiac surgery when respiratory or cardiac failure occurs. The aim of this study was to analyze the safety and feasibility of the Medos Deltastream diagonal pump (DP3) ECLS system in pediatric cardiac patients. We described the technical considerations and risk factors related to the survival outcomes in 102 pediatric cardiac patients who received ECLS support between March 2011 and April 2016. We switched from the DP2 system, which was used for the initial 25 patients, to the DP3 system after November 2012. The DP3 was then used in a consecutive series of 77 patients (4.5% of all pediatric patients who underwent congenital heart surgery during the same time period). The patients' median age was 90 days (range: 2 days-12 years), while their median weight was 4 kg (range: 2.1-40 kg). Fifty four patients (70%) were weaned off ECLS, while 28 patients (36.3%) were successfully discharged from the hospital by means of the DP3 system. The median ECLS duration for survivors was 8.2 days (range: 4-14.5 days). The ECLS indications, durations, and initiation times had no statistical significance in terms of survival. Renal, hemorrhagic, and neurologic complications were all associated with decreased hospital discharge rates (P = 0.003, P = 0.045, and P < 0.001 respectively). Higher lactate levels (P = 0.009) and longer duration for normalization (P < 0.001) were both associated to failure to wean off ECLS support and, hence, to hospital deaths. The weaning rate was 36% prior to November 2012. It increased to 70.3% after that time (P = 0.009). The mechanical complication rate was 9% with the DP3 system and 32% with the DP2, which was statistically significant (P = 0.009). Additionally, the lactate levels were higher and decreased more slowly in the patients supported by the DP2. As a result of the shift to the DP3 system, a revised ECLS protocol, and increased ECLS experience, a significant improvement was observed in our clinical outcomes. The results of this study suggested that the combination of a DP3 pump and a Hilite oxygenator in pediatric ECLS circuits may improve durability and reduce circuit-induced complications.

In Vitro Evaluation of ECG‐Synchronized Pulsatile Flow Using the i‐cor Diagonal Pump in Neonatal and Pediatric ECLS Systems

“…The percent of THE lost across the arterial tubing increased with increasing pulsatility (P < 0.05), and the differences in THE lost were larger at lower flow rates (3.1-15.1% at 200 mL/min vs. 14. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19].7% at 1600 mL/min). The percent of THE lost across the oxygenator was greater when using the pediatric Hilite 2400 LT oxygenator (20.0-24.6% at 1600 mL/min) rather than the neonatal Hilite 800 LT oxygenator (7.2-9.0% at 600 mL/min).…”

Impact of Istanbul Symposiums and Artificial Organs on education and training of young clinicians and the outcomes of congenital heart surgery patients in Turkey

“…A handful of talented young clinicians started the congenital heart surgery program in this particular public hospital in 2010. In only a few years, this particular program significantly improved the outcomes of congenital heart surgery as well as pediatric ECLS patients in Turkey . Despite patients having very high‐risk stratification scores, overall mortality rates after congenital heart surgery at this particular public hospital were one of the lowest in Turkey in 2018 [presented at the 10th Istanbul Symposium on November 16, 2018].…”

“…In only a few years, this particular program significantly improved the outcomes of congenital heart surgery as well as pediatric ECLS patients in Turkey. [14][15][16][17][18][19] Despite patients having very high-risk stratification scores, overall mortality rates after congenital heart surgery at this particular public hospital were one of the lowest in Turkey in 2018 [presented at the 10th Istanbul Symposium on November 16, 2018]. This is partially due to their multidisciplinary weekly morbidity and mortality conference, which has allowed them to successfully analyze and improve their outcomes throughout the past several years.…”

Outcomes of the 10th Istanbul Symposium on pediatric extracorporeal life support systems and cardiopulmonary perfusion

“…IMAEH patient selection for ECMO consists of age, diagnosis, operation type, life expectancy, severe prematurity, central nervous system disfunction, sepsis, and syndromes (especially syndromes like trisomy 13 and 18). Patient selection is still an uncertain area, and further studies should be done according to Yıldız et al ECMO should be started in patients when conventional treatments fail, before the onset of multiple organ failure, and for potentially reversible conditions. IMAEH used ECMO under these circumstances: hypotension despite the use of 2 inotropic agents, low cardiac output syndrome symptoms, pulmonary artery oxygen saturation (MvSO 2 ) less than 50%, persistent high lactate values (>5 mg/dL), and fifth minute of CPR (E‐CPR protocol).…”