Pediatric cardiac surgery in low- and middle-income countries – Fighting the odds

Iyer, Krishna Subramony

doi:10.4103/apc.apc_192_18

Cited by 8 publications

(10 citation statements)

References 6 publications

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“…To the best of our knowledge this is probably the first study demonstrating performance of this algorithm on post-operative patients in LMICs. CHD patients in LMICs are considered to have a very different spectrum of disease (2,5,6,18,19). These patients present late and majority of the time have associated co-morbidities like infections, severe malnourishment, and significant lung injury (especially in shunt lesions) due to repeated pneumonia (20)(21)(22)(23)(24)(25).…”

Section: Discussionmentioning

confidence: 99%

“…In low middle income countries (LMICs), this is complicated due to a low provider to patient ratio, limited expertise, and the complex clinical states of patients' (i.e., delayed diagnosis or referral, comorbidities like malnutrition and infections etc.) (1)(2)(3)(4)(5)(6). All these factors make the postoperative period extremely vulnerable and complex, precluding early identification of inadequate tissue oxygen delivery which can lead to increased morbidity and mortality (2,7).…”

Section: Introductionmentioning

confidence: 99%

“…(1)(2)(3)(4)(5)(6). All these factors make the postoperative period extremely vulnerable and complex, precluding early identification of inadequate tissue oxygen delivery which can lead to increased morbidity and mortality (2,7). If this abnormal tissue oxygen delivery can be identified early coupled with a frame work of intervention to address it, the outcomes can be changed for the better (8).…”

Section: Introductionmentioning

confidence: 99%

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Performance of a Risk Analytic Tool (Index of Tissue Oxygen Delivery “IDO2”) in Pediatric Cardiac Intensive Care Unit of a Developing Country

et al. 2022

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ObjectiveTo determine the performance of a commercially available risk analytic tool (IDO2) to estimate the risk for SVO2 < 40% in patients admitted in cardiac intensive care unit (CICU).MethodsMedical and T3 records of all patients (aged 1 day to 12 years, weight >2 kg) who received care in the CICU between October 1st, 2019 and October 1st, 2020, had SvO2 lab(s) drawn during CICU course and whose data was transmitted to T3, were included. The average IDO2 Index was computed in the 30-min period immediately prior to each SvO2 measurement and used as a predictor score for SvO2 < 40%.ResultsA total of 69 CICU admissions from 65 patients, median age 9.3 months (interquartile range 20.8) were identified. Surgical and medical patients were 61 (88%) and 8 (12%) respectively; 4 (5.7%) patients had single ventricle physiology. Tetralogy of Fallot n = 23 (33.3%) and ventricular septal defects 17 (24.6%) were major cardiac diagnosis. Sixty-one (89.9%) of the admissions were successfully discharged from the hospital. Of the 187-total included SvO2 labs, 17 (9%) were <40%. The AUC of estimating SvO2 < 40% IDO2 was 0.87 [confidence interval (CI): 0.79–0.94]. Average IDO2 above 75 had the highest absolute risk (42.11, CI: 20.25–66.50) and highest RR (4.63, CI: 2.31–9.28, p-value < 0.0001) of SvO2 < 40%.ConclusionIDO2 performed well in estimating low SvO2 (<40%) in pediatric patients presenting to a CICU in a low resource setting. Future work is needed to determine the effect of this risk analytic tool on clinical outcomes in such a setting.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Performance of a Risk Analytic Tool (Index of Tissue Oxygen Delivery “IDO2”) in Pediatric Cardiac Intensive Care Unit of a Developing Country

et al. 2022

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“…11 If the surgical outcomes in these babies have to be good, a dedicated unit has to work out its own ways to fight the odds and tackle the problems associated with late presentation, malnutrition, respiratory and blood-borne infections, and limitations of financial resources to perform these complex operations. 12, 13, 14…”

Section: Introductionmentioning

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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“…2 Attempts to deliver cardiac services in low-resource settings may seem like "fighting the odds" against late disease presentation, fragile health-care infrastructures, and inadequate workforce and financial resources. 3 Governments of sub-Saharan African (SSA) states are working to improve workforce capacity and strengthen infrastructures to keep pace with new diseases and backlog of untreated cases. 4 However, it is unclear how such health-care systems should go about projecting supply and demands for health-care services.…”

mentioning

confidence: 99%

Micro-Costing Estimation of Workforce Needs: Will That Work for Cardiac Services in Kenya?

Nguyen

2019

World J Pediatr Congenit Heart Surg

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Pediatric cardiac surgery in low- and middle-income countries – Fighting the odds

Cited by 8 publications

References 6 publications

Performance of a Risk Analytic Tool (Index of Tissue Oxygen Delivery “IDO2”) in Pediatric Cardiac Intensive Care Unit of a Developing Country

Performance of a Risk Analytic Tool (Index of Tissue Oxygen Delivery “IDO2”) in Pediatric Cardiac Intensive Care Unit of a Developing Country

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

Micro-Costing Estimation of Workforce Needs: Will That Work for Cardiac Services in Kenya?

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