Cargando…

Experience with Mechanical Circulatory Support for Medically Intractable Low Cardiac Output in a Pediatric Intensive Care Unit

BACKGROUND AND OBJECTIVES: Mechanical circulatory support with extracorporeal membrane oxygenation (ECMO) and ventricular assist device has always been the optimal choice for treating the majority of medically intractable low cardiac output case. We retrospectively investigated our institution'...

Descripción completa

Detalles Bibliográficos
Autores principales: Park, Jung Bin, Kwak, Jae Gun, Lim, Hong-Gook, Kim, Woong-Han, Lee, Jeong Ryul, Kim, Yong Jin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Society of Cardiology 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5537151/
https://www.ncbi.nlm.nih.gov/pubmed/28765741
http://dx.doi.org/10.4070/kcj.2016.0320
_version_ 1783254111277285376
author Park, Jung Bin
Kwak, Jae Gun
Lim, Hong-Gook
Kim, Woong-Han
Lee, Jeong Ryul
Kim, Yong Jin
author_facet Park, Jung Bin
Kwak, Jae Gun
Lim, Hong-Gook
Kim, Woong-Han
Lee, Jeong Ryul
Kim, Yong Jin
author_sort Park, Jung Bin
collection PubMed
description BACKGROUND AND OBJECTIVES: Mechanical circulatory support with extracorporeal membrane oxygenation (ECMO) and ventricular assist device has always been the optimal choice for treating the majority of medically intractable low cardiac output case. We retrospectively investigated our institution's outcomes and variables associated with a high risk of mortality. SUBJECTS AND METHODS: From 1999 to 2014, 86 patients who were of pediatric age or had grown-up congenital heart disease underwent mechanical circulatory support for medically intractable low cardiac output in our pediatric intensive care unit. Of these, 9 grown-up congenital heart disease patients were over 18 years of age, and the median age of the subject group was 5.82 years (range: 1 day to 41.6 years). A review of all demographic, clinical, and surgical data and survival analysis were performed. RESULTS: A total of 45 (52.3%) patients were successfully weaned from the mechanical assist device, and 25 (29.1%) survivors were able to be discharged. There was no significant difference in results between patients over 18 years and under 18 years of age. Risk factors for mortality were younger age (<30 days), functional single ventricle anatomy, support after cardiac operations, longer support duration, and deteriorated pre-ECMO status (severe metabolic acidosis and increased levels of lactate, creatinine, bilirubin, or liver enzyme). The survival rate has improved since 2010 (from 25% before 2010 to 35% after 2010), when we introduced an upgraded oxygenator, activated heart transplantation, and also began to apply ECMO before the end-stage of cardiac dysfunction, even though we could not reveal significant correlations between survival rate and changed strategies associated with ECMO. CONCLUSION: Mechanical circulatory support has played a critical role and has had a dramatic effect on survival in patients with medically intractable heart failure, particularly in recent years. Meticulous monitoring of acid-base status, laboratory findings, and early and liberal applications are recommended to improve outcomes without critical complication rates, particularly in neonates with single ventricle physiology.
format Online
Article
Text
id pubmed-5537151
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher The Korean Society of Cardiology
record_format MEDLINE/PubMed
spelling pubmed-55371512017-08-01 Experience with Mechanical Circulatory Support for Medically Intractable Low Cardiac Output in a Pediatric Intensive Care Unit Park, Jung Bin Kwak, Jae Gun Lim, Hong-Gook Kim, Woong-Han Lee, Jeong Ryul Kim, Yong Jin Korean Circ J Original Article BACKGROUND AND OBJECTIVES: Mechanical circulatory support with extracorporeal membrane oxygenation (ECMO) and ventricular assist device has always been the optimal choice for treating the majority of medically intractable low cardiac output case. We retrospectively investigated our institution's outcomes and variables associated with a high risk of mortality. SUBJECTS AND METHODS: From 1999 to 2014, 86 patients who were of pediatric age or had grown-up congenital heart disease underwent mechanical circulatory support for medically intractable low cardiac output in our pediatric intensive care unit. Of these, 9 grown-up congenital heart disease patients were over 18 years of age, and the median age of the subject group was 5.82 years (range: 1 day to 41.6 years). A review of all demographic, clinical, and surgical data and survival analysis were performed. RESULTS: A total of 45 (52.3%) patients were successfully weaned from the mechanical assist device, and 25 (29.1%) survivors were able to be discharged. There was no significant difference in results between patients over 18 years and under 18 years of age. Risk factors for mortality were younger age (<30 days), functional single ventricle anatomy, support after cardiac operations, longer support duration, and deteriorated pre-ECMO status (severe metabolic acidosis and increased levels of lactate, creatinine, bilirubin, or liver enzyme). The survival rate has improved since 2010 (from 25% before 2010 to 35% after 2010), when we introduced an upgraded oxygenator, activated heart transplantation, and also began to apply ECMO before the end-stage of cardiac dysfunction, even though we could not reveal significant correlations between survival rate and changed strategies associated with ECMO. CONCLUSION: Mechanical circulatory support has played a critical role and has had a dramatic effect on survival in patients with medically intractable heart failure, particularly in recent years. Meticulous monitoring of acid-base status, laboratory findings, and early and liberal applications are recommended to improve outcomes without critical complication rates, particularly in neonates with single ventricle physiology. The Korean Society of Cardiology 2017-07 2017-07-27 /pmc/articles/PMC5537151/ /pubmed/28765741 http://dx.doi.org/10.4070/kcj.2016.0320 Text en Copyright © 2017 The Korean Society of Cardiology http://creativecommons.org/licenses/by-nc/3.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Park, Jung Bin
Kwak, Jae Gun
Lim, Hong-Gook
Kim, Woong-Han
Lee, Jeong Ryul
Kim, Yong Jin
Experience with Mechanical Circulatory Support for Medically Intractable Low Cardiac Output in a Pediatric Intensive Care Unit
title Experience with Mechanical Circulatory Support for Medically Intractable Low Cardiac Output in a Pediatric Intensive Care Unit
title_full Experience with Mechanical Circulatory Support for Medically Intractable Low Cardiac Output in a Pediatric Intensive Care Unit
title_fullStr Experience with Mechanical Circulatory Support for Medically Intractable Low Cardiac Output in a Pediatric Intensive Care Unit
title_full_unstemmed Experience with Mechanical Circulatory Support for Medically Intractable Low Cardiac Output in a Pediatric Intensive Care Unit
title_short Experience with Mechanical Circulatory Support for Medically Intractable Low Cardiac Output in a Pediatric Intensive Care Unit
title_sort experience with mechanical circulatory support for medically intractable low cardiac output in a pediatric intensive care unit
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5537151/
https://www.ncbi.nlm.nih.gov/pubmed/28765741
http://dx.doi.org/10.4070/kcj.2016.0320
work_keys_str_mv AT parkjungbin experiencewithmechanicalcirculatorysupportformedicallyintractablelowcardiacoutputinapediatricintensivecareunit
AT kwakjaegun experiencewithmechanicalcirculatorysupportformedicallyintractablelowcardiacoutputinapediatricintensivecareunit
AT limhonggook experiencewithmechanicalcirculatorysupportformedicallyintractablelowcardiacoutputinapediatricintensivecareunit
AT kimwoonghan experiencewithmechanicalcirculatorysupportformedicallyintractablelowcardiacoutputinapediatricintensivecareunit
AT leejeongryul experiencewithmechanicalcirculatorysupportformedicallyintractablelowcardiacoutputinapediatricintensivecareunit
AT kimyongjin experiencewithmechanicalcirculatorysupportformedicallyintractablelowcardiacoutputinapediatricintensivecareunit