Características y desenlaces clínicos de pacientes menores de 18 años tratados con oxigenación con membrana extracorpórea posterior a cirugía para la reparación o paliación de cardiopatías congénitas

Iván A. Pinto-Martínez, Gustavo A. Cruz-Suárez, Walter Mosquera-Álvarez, V. Mejía-Quiñones, Daniela Burbano-Gálviz
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Abstract

Objective: to determine the characteristics and clinical outcomes of patients under 18 years of age treated with extracorporeal membrane oxygenation (ECMO) after surgery for the repair or palliation of congenital heart disease. Method: longitudinal descriptive study with retrospective data collection. Results: between January 2015 and December 2020, 77 patients required ECMO after pediatric cardiac surgery with a median age of < 1 month, median weight of 4 kg, ECC time 202 minutes (IQR 125-272 minutes), aortic cross-clamp time 95 minutes. 76.6% were supported with ECMO prior to their return to the ICU. The congenital heart disease most frequently admitted to ECMO was hypoplastic left heart syndrome (19.4%) in the Norwood postoperative period (18.1%). The median time of ECMO was 111 hours. The most frequent indication was ventricular dysfunction (80.5%). 80.5% presented complications and reoperation for bleeding was the most frequent of these (46.7%). ECMO survival was 48% and overall survival at discharge was 25.97%. Age < 1 month (p = 0.030), pre-ECMO lactic acid ≥ 5 mmol/l (p = 0.014), OR 0.260 and time of normalization of lactate ≥ 24 hours (0.021), OR 0.24 were asso - ciated with a higher risk of mortality at hospital discharge. Conclusions: ECMO provides adequate support after surgery for the repair or palliation of congenital heart disease. Age < 1-month, pre-ECMO lactic acid ≥ 5 mmol/l, and lactate normaliza - tion time ≥ 24 hours were the variables that were associated with poor outcome and hospital mortality.
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18岁以下先天性心脏病术后体外膜氧合治疗的特点和临床结果
目的:探讨18岁以下先天性心脏病手术后应用体外膜肺氧合(ECMO)治疗的特点及临床效果。方法:采用回顾性资料收集的纵向描述性研究。结果:2015年1月至2020年12月,77名患者在儿童心脏手术后需要ECMO,中位年龄<1个月,中位体重4kg,ECC时间202分钟(IQR 125-272分钟),主动脉阻断时间95分钟。76.6%的患者在返回ICU之前接受了ECMO支持。在诺伍德术后(18.1%),ECMO最常见的先天性心脏病是左心发育不全综合征(19.4%)。ECMO的中位时间为111小时。最常见的指征是心室功能障碍(80.5%)。80.5%出现并发症,其中出血最常见的是再次手术(46.7%)。ECMO生存率为48%,出院时总生存率为25.97%。年龄<1个月(p=0.030),ECMO前乳酸≥5 mmol/l(p=0.014),OR 0.260,乳酸恢复正常时间≥24小时(0.021),OR 0.24与出院时较高的死亡率相关。结论:ECMO为先天性心脏病的修复或缓解提供了充分的术后支持。年龄<1个月、ECMO前乳酸≥5 mmol/l和乳酸正常化时间≥24小时是与不良预后和住院死亡率相关的变量。
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来源期刊
Revista Colombiana de Cardiologia
Revista Colombiana de Cardiologia Medicine-Cardiology and Cardiovascular Medicine
CiteScore
0.50
自引率
0.00%
发文量
90
审稿时长
80 weeks
期刊介绍: The Colombian Cardiology Review is an official publication of the Colombian Cardiology and Cardiovascular Surgery Society, emitted bimonthly. Its uninterrupted circulation was initiated in 1985. The main objective of the review is the publication of the scientific, investigative, academic and administrative activities of the society members, of the medical professionals or of those connected with the health sector, nationals or foreigners, that may be working in the Cardiology field or related sciences.
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