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IPA

Category: Pediatric

TOF Repair

Comparison of Immediate Outcomes of Pulmonary Valve-Sparing and Transannular Patch Techniques for Correction of Tetralogy of Fallot

This retrospective cohort study compared pulmonary valve-sparing and transannular patch techniques for correcting Tetralogy of Fallot (ToF) in 102 pediatric patients. The study found that the valve-sparing approach led to shorter durations of mechanical ventilation, ICU stays, and hospitalization, with fewer complications like arrhythmias. However, transannular patch patients had higher rates of severe pulmonary regurgitation. Weight was identified as an independent predictor of ventilation duration.

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December 12, 2024
Ped CV Volume

Center Volume and Survival in Inter-Hospital Transfers for Pediatric Cardiac Surgery: No Significant Association

This study analyzed 25,749 pediatric cardiac surgery cases requiring cardiopulmonary bypass (CPB) using the Kids’ Inpatient Database (2016 and 2019) to evaluate whether hospital case volume impacts inpatient mortality for transferred patients. Among 3,511 transferred patients, unadjusted mortality was higher than for direct admissions across low-, mid-, and high-volume centers. However, risk-adjusted inpatient mortality showed no significant differences based on hospital volume, even for high-complexity cases. The findings suggest that transfer decisions should not rely solely on annual case volume.

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December 1, 2024
Pediatic Cardioplegia

Hyperlactataemia Following Crystalloid Cardiopulmonary Bypass Priming in Paediatric Cardiac Surgery: Benign or Malignant?

This retrospective study examined paediatric patients undergoing cardiac surgery with crystalloid priming to evaluate outcomes related to postoperative hyperlactataemia. Among 186 patients, 53% experienced hyperlactataemia, which was associated with longer cardiopulmonary bypass and ICU stays but did not increase ventilation duration. Findings suggest transient hyperlactataemia may not indicate tissue hypoxaemia, but longer inotropic support and ICU stays necessitate careful management post-surgery.

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November 28, 2024
Pediatric ECMO

Outcomes in Patients Who Received ECMO and/or Volatile Anesthetics as Rescue Therapies for Status Asthmaticus

This study explores the outcomes of pediatric patients with status asthmaticus (SA) who received either inhaled volatile anesthetics (IVA), extracorporeal membrane oxygenation (ECMO), or both as rescue therapies in a PICU setting. Among seven patients, most who received IVA were escalated to ECMO. The results suggest that early ECMO cannulation might be beneficial, though larger studies are needed to form conclusive guidelines for SA management in critically ill children.

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September 21, 2024
Factor VII

Cardiopulmonary Bypass in a Pediatric Patient with Factor XII Deficiency

This case report discusses the challenges of managing cardiopulmonary bypass (CPB) in an 8-month-old pediatric patient with factor XII deficiency, a rare coagulopathy that complicates anticoagulation monitoring. The use of the Hemochron Signature Elite with ACT+ cartridges provided reliable anticoagulation monitoring during surgery. The report reviews current strategies for managing CPB in patients with this condition, highlighting the importance of specialized tools for predictable results.

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September 21, 2024
Pedi Kidney

Association of Hyperoxia During Cardiopulmonary Bypass and Postoperative Delirium in the Pediatric Cardiac ICU

This study examines the relationship between hyperoxia during cardiopulmonary bypass (CPB) and postoperative delirium in pediatric patients in a cardiac ICU. Analyzing data from 148 patients, researchers found that 24% experienced delirium within 72 hours post-CPB. However, no significant association was found between hyperoxia and delirium. Exploratory analysis suggested that nutritional status, specifically weight z scores, might influence delirium risk, indicating a need for further research on risk factors.

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July 12, 2024
ECMO Pressure Monitoring

Quantifying Potential Fluid Transfused Through Pressure Monitoring and Circuit Flushes in Pediatric ECMO Patients

This study investigates the fluid volume transfused to pediatric ECMO patients via pressure monitoring circuits, an area currently lacking published data or guidelines. Using in vitro experiments with Edwards True Wave transducers and pressure bags, the study measured fluid volumes from passive and active flushing methods. Results showed that maintaining patency with a pressurized IV bag can transfuse approximately 319.6 mL daily, close to a neonate’s total blood volume. Automated syringe pumps, however, significantly reduce this volume to 24 mL per day. The findings suggest the need for further research to establish best practices.

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June 22, 2024
Pedi Pump

Perfusion Techniques for an 800 g Premature Neonate Undergoing Arterial Switch Procedure for Transposition of the Great Arteries

This article highlights the groundbreaking success in utilizing cardiopulmonary bypass (CPB) techniques for congenital heart surgery in premature neonates weighing less than 1000 g. Focusing on a case of a 28-week-old, 800 g neonate with transposition of the great arteries, the study discusses the challenges and innovations in perfusion techniques. Miniaturization of the CPB circuit, careful management of patient-to-circuit ratios, pharmacological distribution volumes, pressure gradients, and meticulous physiological environment control were key to mitigating risks such as volume shifts, electrolyte imbalance, and intracranial hemorrhage. This report underscores the feasibility and critical adjustments needed for successful CPB in extremely low birth weight neonates.

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March 20, 2024
Perfusion Heart

Statistics in the Operating Room: A Cardiovascular Surgeon’s Guide to Numbers That Matter

This editorial emphasizes the critical role of statistical analysis in pediatric cardiac surgery, highlighting how surgeons can use statistical tools to improve patient outcomes. It covers the importance of descriptive statistics, hypothesis testing, regression analysis, and survival analysis in crafting personalized treatment plans. By integrating statistical data, surgeons can make informed decisions, enhancing the success of surgeries and the well-being of their young patients.

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February 17, 2024
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