Cardiopulmonary Bypass in a Pediatric Patient with Factor XII Deficiency

September 21, 2024 No Comments

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.

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

July 12, 2024 No Comments

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.

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

June 22, 2024 No Comments

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.

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

March 20, 2024 No Comments

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.

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

February 17, 2024 No Comments

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.

Outcomes of Prophylactic Peritoneal Dialysis Catheter Insertion in Children Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis

February 12, 2024 No Comments

This systematic review and meta-analysis evaluated the association between prophylactic peritoneal dialysis (PD) catheter insertion during pediatric cardiac surgery and improved short-term outcomes. Analyzing seventeen studies, including four randomized controlled trials, the study found no significant link between prophylactic PD catheter insertion and reduced in-hospital mortality. Results for ICU stay length and time to achieve negative fluid balance were inconclusive, with some studies indicating benefits and others showing no difference. The analysis highlights the need for further research on short-term outcomes and fluid overload markers in this context, acknowledging the high risk of bias in the included studies.

Intra-abdominal Hypertension Predicts Worse Hospital Outcomes in Children After Cardiac Surgery: A Pilot Study

February 8, 2024 No Comments

This study highlights the incidence and impact of postoperative intra-abdominal hypertension (IAH) in children undergoing open-heart surgery, showing that 24.7% of patients experienced IAH, with significant occurrences within the first 24 hours of ICU admission. Factors like right-sided heart lesions, redo sternotomies, and prolonged cardiopulmonary bypass were identified as predictors of IAH. The condition was associated with increased inotropic support needs, gastrointestinal complications, sepsis, multiple organ dysfunction syndrome, and extended stays in the ICU and hospital. This underscores the importance of monitoring and managing IAH to improve postoperative outcomes in pediatric cardiac surgery patients

Randomized Controlled Trial of Remote Ischemic Preconditioning in Children Having Cardiac Surgery

January 6, 2024 No Comments

In a study on children undergoing cardiac surgery, remote ischemic preconditioning showed a potential for reducing kidney injury, but there were no significant differences in cardiac markers or secondary clinical outcomes. Although there was a minor trend towards kidney protection, larger studies are needed to confirm the efficacy of this intervention in a high-risk pediatric population.

Impact of Pre-Bypass Ultrafiltration on Prime Values and Clinical Outcomes in Neonatal and Infant Cardiopulmonary Bypass

December 21, 2023 No Comments

Pre-bypass Ultrafiltration (PBUF) was found to standardize and make more physiologic the values for electrolytes, glucose, and lactate in blood primes used for cardiopulmonary bypass in congenital cardiac surgery, without significantly affecting in-hospital outcomes. This retrospective study compared patients ≤ 1 year old undergoing cardiac surgery with PBUF to those without, showing significant improvements in the physiologic values of PBUF-treated circuits.

An in vitro Comparison of Intra-Operative Isohemagglutinin and Human Leukocyte Antigen Removal Techniques in Pediatric Heart Transplantation

December 21, 2023 No Comments

This study compared two plasmapheresis techniques, membrane-based (MP) and centrifuge-based (CP), for their effectiveness in reducing isohemagglutinin titers (IT) and human leukocyte antigen (HLA) antibodies in highly sensitized pediatric patients awaiting heart transplants. Both methods, incorporated into extracorporeal circuits, effectively reduced circulating antibodies, with CP showing slightly greater efficiency in reducing ITs and anti-HLA class II antibody mean fluorescence intensity, although further in vivo studies are needed for confirmation.

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Cardiopulmonary Bypass in a Pediatric Patient with Factor XII Deficiency

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

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

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

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

Outcomes of Prophylactic Peritoneal Dialysis Catheter Insertion in Children Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis

Intra-abdominal Hypertension Predicts Worse Hospital Outcomes in Children After Cardiac Surgery: A Pilot Study

Randomized Controlled Trial of Remote Ischemic Preconditioning in Children Having Cardiac Surgery

Impact of Pre-Bypass Ultrafiltration on Prime Values and Clinical Outcomes in Neonatal and Infant Cardiopulmonary Bypass

An in vitro Comparison of Intra-Operative Isohemagglutinin and Human Leukocyte Antigen Removal Techniques in Pediatric Heart Transplantation

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