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Mensink HA, Desai A, Cvetkovic M, Davidson M, Hoskote A, O'Callaghan M, Thiruchelvam T, Roeleveld PP. The approach to extracorporeal cardiopulmonary resuscitation (ECPR) in children. A narrative review by the paediatric ECPR working group of EuroELSO. Perfusion 2024; 39:81S-94S. [PMID: 38651582 DOI: 10.1177/02676591241236139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Extracorporeal Cardiopulmonary Resuscitation (ECPR) has potential benefits compared to conventional Cardiopulmonary Resuscitation (CCPR) in children. Although no randomised trials for paediatric ECPR have been conducted, there is extensive literature on survival, neurological outcome and risk factors for survival. Based on current literature and guidelines, we suggest recommendations for deployment of paediatric ECPR emphasising the requirement for protocols, training, and timely intervention to enhance patient outcomes. Factors related to outcomes of paediatric ECPR include initial underlying rhythm, CCPR duration, quality of CCPR, medications during CCPR, cannulation site, acidosis and renal dysfunction. Based on current evidence and experience, we provide an approach to patient selection, ECMO initiation and management in ECPR regarding blood and sweep flow settings, unloading of the left ventricle, diagnostics whilst on ECMO, temperature targets, neuromonitoring as well as suggested weaning and decannulation strategies.
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Affiliation(s)
- H A Mensink
- Paediatric Intensive Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - A Desai
- Paediatric Intensive Care, Royal Brompton Hospital, London, UK
| | - M Cvetkovic
- Paediatric Cardiac Intensive Care, Great Ormond Street Hospital for Children, London, UK
| | - M Davidson
- Critical Care Medicine, Royal Hospital for Children, Glasgow, UK
| | - A Hoskote
- Paediatric Cardiac Intensive Care, Great Ormond Street Hospital for Children, London, UK
| | - M O'Callaghan
- Paediatric Cardiac Intensive Care, Great Ormond Street Hospital for Children, London, UK
| | - T Thiruchelvam
- Paediatric Cardiac Intensive Care, Great Ormond Street Hospital for Children, London, UK
| | - P P Roeleveld
- Paediatric Intensive Care, Leiden University Medical Centre, Leiden, The Netherlands
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Hayward A, Robertson A, Thiruchelvam T, Broadhead M, Tsang VT, Sebire NJ, Issitt RW. Oxygen delivery in pediatric cardiac surgery and its association with acute kidney injury using machine learning. J Thorac Cardiovasc Surg 2023; 165:1505-1516. [PMID: 35840430 DOI: 10.1016/j.jtcvs.2022.05.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 05/05/2022] [Accepted: 05/30/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Acute kidney injury (AKI) after pediatric cardiac surgery with cardiopulmonary bypass (CPB) is a frequently reported complication. In this study we aimed to determine the oxygen delivery indexed to body surface area (Do2i) threshold associated with postoperative AKI in pediatric patients during CPB, and whether it remains clinically important in the context of other known independent risk factors. METHODS A single-institution, retrospective study, encompassing 396 pediatric patients, who underwent heart surgery between April 2019 and April 2021 was undertaken. Time spent below Do2i thresholds were compared to determine the critical value for all stages of AKI occurring within 48 hours of surgery. Do2i threshold was then included in a classification analysis with known risk factors including nephrotoxic drug usage, surgical complexity, intraoperative data, comorbidities and ventricular function data, and vasoactive inotrope requirement to determine Do2i predictive importance. RESULTS Logistic regression models showed cumulative time spent below a Do2i value of 350 mL/min/m2 was associated with AKI. Random forest models, incorporating established risk factors, showed Do2i threshold still maintained predictive importance. Patients who developed post-CPB AKI were younger, had longer CPB and ischemic times, and required higher inotrope support postsurgery. CONCLUSIONS The present data support previous findings that Do2i during CPB is an independent risk factor for AKI development in pediatric patients. Furthermore, the data support previous suggestions of a higher threshold value in children compared with that in adults and indicate that adjustments in Do2i management might reduce incidence of postoperative AKI in the pediatric cardiac surgery population.
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Affiliation(s)
- Alice Hayward
- Department of Perfusion, Great Ormond Street Hospital, London, United Kingdom
| | - Alex Robertson
- Department of Perfusion, Great Ormond Street Hospital, London, United Kingdom
| | - Timothy Thiruchelvam
- Department of Intensive Care, Great Ormond Street Hospital, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Michael Broadhead
- Department of Anesthetics, Great Ormond Street Hospital, London, United Kingdom
| | - Victor T Tsang
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, United Kingdom
| | - Neil J Sebire
- Digital Research, Informatics and Virtual Environment, NIHR Great Ormond Street Hospital BRC, London, United Kingdom
| | - Richard W Issitt
- Department of Perfusion, Great Ormond Street Hospital, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom; Digital Research, Informatics and Virtual Environment, NIHR Great Ormond Street Hospital BRC, London, United Kingdom.
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Rohde S, Sandica E, Veen K, Kraemer US, Thiruchelvam T, Miera O, Lopez MLP, Sliwka J, Amodeo A, Bogers AJJC, de By TMMH. Outcomes in small children on Berlin Heart EXCOR support: age and body surface area as clinical predictive factors. Eur J Cardiothorac Surg 2022; 63:6809124. [PMID: 36346169 PMCID: PMC9825200 DOI: 10.1093/ejcts/ezac516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/25/2022] [Accepted: 11/07/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES The Berlin Heart EXCOR (BHE) offers circulatory support across all paediatric ages. Clinically, the necessary care and the outcomes differ in various age groups. The EUROMACS database was used to study age- and size-related outcomes for this specific device. METHODS All patients <19 years of age from the EUROMACS database supported with a BHE between 2000 and November 2021 were included. Maximally selected rank statistics were used to determine body surface area (BSA) cut-off values. Multivariable Cox proportional hazard regression using ridge penalization was performed to identify factors associated with outcomes. RESULTS In total, 303 patients were included [mean age: 2.0 years (interquartile range: 0.6-8.0, males: 48.5%)]. Age and BSA were not significantly associated with mortality (n = 74, P = 0.684, P = 0.679). Factors associated with a transplant (n = 175) were age (hazard ratio 1.07, P = 0.006) and aetiology other than congenital heart disease (hazard ratio 1.46, P = 0.020). Recovery rates (n = 42) were highest in patients with a BSA of <0.53 m2 (21.8% vs 4.3-7.6% at 1 year, P = 0.00534). Patients with a BSA of ≥0.73 m2 had a lower risk of early pump thrombosis but a higher risk of early bleeding compared to children with a BSA of <0.73 m2. CONCLUSIONS Mortality rates in Berlin Heart-supported patients cannot be predicted by age or BSA. Recovery rates are remarkably high in the smallest patient category (BSA <0.53 m2). This underscores that the BHE is a viable therapeutic option, even for the smallest and youngest patients.
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Affiliation(s)
- Sofie Rohde
- Corresponding author. Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands. E-mail: (S. Rohde)
| | - Eugen Sandica
- Clinic for Pediatric Cardiac Surgery and Congenital Heart Defects, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Kevin Veen
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Ulrike S Kraemer
- Department of Paediatric Intensive Care, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Oliver Miera
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Maria L Polo Lopez
- Department of Pediatric and Congenital Cardiac Surgery, La Paz University Hospital, Madrid, Spain
| | - Joanna Sliwka
- Department of Cardiac Surgery, Transplantology and Vascular Surgery, Silesian Center for Heart Diseases, Zabrze, Poland
| | | | - Ad J J C Bogers
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
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Gavela J, Sharma S, Thompson D, Cocca A, Thiruchelvam T, Moledina S. Presentation of cardiogenic shock with pulmonary hypertension and arrhythmia secondary to foramen magnum stenosis in a patient with achondroplasia. J Paediatr Child Health 2022; 58:1872-1875. [PMID: 35510831 DOI: 10.1111/jpc.16005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 02/17/2022] [Accepted: 04/04/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Javier Gavela
- Department of Cardiac Intensive Care, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Sudivya Sharma
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National, Mumbai, India
| | - Dominic Thompson
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Alessandra Cocca
- Department of Endocrinology, Evelina Children's Hospital, London, United Kingdom
| | - Timothy Thiruchelvam
- Department of Cardiac Intensive Care, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Shahin Moledina
- Department of Pulmonary Hypertension, Great Ormond Street Hospital for Children, London, United Kingdom
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Rohde S, Sandica E, Veen K, Miera O, Amodeo A, Napoleone CP, Özbaran M, Sliwka J, Thiruchelvam T, Zimpfer D, Schubert S, Bogers AJJC, de By TMMH. Cerebrovascular accidents in paediatric patients supported by the Berlin Heart EXCOR. Eur J Cardiothorac Surg 2022; 62:6645748. [PMID: 35849328 PMCID: PMC9789740 DOI: 10.1093/ejcts/ezac381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 05/16/2022] [Accepted: 07/13/2022] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Ventricular assist device support as a bridge to transplant or recovery is a well-established therapy in children on the cardiac transplant waiting list. The goal of this study was to investigate the incidence of and the associated factors for cerebrovascular accidents in paediatric patients supported by a Berlin Heart EXCOR. METHODS All patients <19 years of age supported by a Berlin Heart EXCOR between January 2011 and January 2021 from the European Registry for Patients with Mechanical Circulatory Support were included. RESULTS In total, 230 patients were included. A total of 140 (60.9%) patients had a diagnosis of dilated cardiomyopathy. 46 patients (20.0%) sustained 55 cerebrovascular accidents, with 70.9% of the episodes within 90 days after the ventricular assist device was implanted. The event rate of cerebrovascular accidents was highest in the first era (0.75). Pump thrombosis and secondary need for a right ventricular assist device were found to be associated with a cerebrovascular accident (hazard ratio 1.998, P = 0.040; hazard ratio 11.300, P = 0.037). At the 1-year follow-up, 44.4% of the patients had received a transplant, 13.1% were weaned after recovery and 24.5% had died. Event rates for mortality showed a significantly decreasing trend. CONCLUSIONS Paediatric ventricular assist device support is associated with important adverse events, especially in the early phase after the device is implanted. Pump thrombosis and the need for a secondary right ventricular assist device are associated with cerebrovascular accidents. Furthermore, an encouragingly high rate of recovery in this patient population was shown, and death rates declined. More complete input of data into the registry, especially concerning anticoagulation protocols, would improve the data.
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Affiliation(s)
- Sofie Rohde
- Corresponding author. Department of Cardio-thoracic surgery, Erasmus University Medical Center, Rotterdam, The Netherlands. e-mail: (S. Rohde)
| | | | - Kevin Veen
- Department of Cardio-thoracic surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Oliver Miera
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | | | - Carlo Pace Napoleone
- Pediatric Cardiac Surgery Department, Regina Margherita Children’s Hospital, Torino, Italy
| | | | - Joanna Sliwka
- Department of Cardiac Surgery, Transplantology and Vascular Surgery, Silesian Center for Heart Diseases, Zabrze, Poland
| | | | | | - Stephan Schubert
- Center of Congenital Heart Disease/Pediatric Cardiology, Heart and Diabetes Center North Rhine Westfalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Ad J J C Bogers
- Department of Cardio-thoracic surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
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de By TMMH, Schweiger M, Hussain H, Amodeo A, Martens T, Bogers AJJC, Damman K, Gollmnan-Tepeköylü C, Hulman M, Iacovoni A, Krämer U, Loforte A, Napoleone CP, Němec P, Netuka I, Özbaran M, Polo L, Pya Y, Ramjankhan F, Sandica E, Sliwka J, Stiller B, Kadner A, Franceschini A, Thiruchelvam T, Zimpfer D, Meyns B, Berger F, Miera O. The European Registry for Patients with Mechanical Circulatory Support (EUROMACS): third Paediatric (Paedi-EUROMACS) report. Eur J Cardiothorac Surg 2022; 62:6618527. [PMID: 35758622 DOI: 10.1093/ejcts/ezac355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/23/2022] [Accepted: 06/25/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Martin Schweiger
- Department of Congenital Pediatric Surgery, Children's Hospital Zürich, Zürich, Switzerland
| | | | | | | | - Ad J J C Bogers
- Department of Cardio-thoracic surgery, Erasmus MC, Rotterdam, Netherlands
| | - Kevin Damman
- University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | | | | | | | - Ulrike Krämer
- Department of Pediatric Intensive Care, Erasmus MC, Rotterdam, Netherlands
| | | | - Carlo Pace Napoleone
- Pediatric Cardiac Surgery Department, Regina Margherita Children's Hospital, Torino, Italy
| | - Petr Němec
- Center for Cardiovascular and Transplant Surgery Brno
| | - Ivan Netuka
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | | | - Luz Polo
- La Paz University Hospital, Madrid, Spain
| | - Yuri Pya
- National Research Cardiac Surgery Center, Astana, Kazakhstan
| | | | - Eugen Sandica
- Clinic for Pediatric Cardiac Surgery and Congenital Heart Defects, Heart and Diabetes Centre North Rhine-Westphalia, Bad Oeynhausen, Germany
| | - Joanna Sliwka
- Department of Cardiac Surgery, Transplantology and Vascular Surgery, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Brigitte Stiller
- Department of Congenital Heart Defects and Pediatric Cardiology, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Germany
| | - Alexander Kadner
- Department of Herz- und Gefässchirurgie, University Hospital Bern, Switzerland
| | | | | | | | - Bart Meyns
- Katholieke Universiteit Leuven, Leuven, Belgium
| | - Felix Berger
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Oliver Miera
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
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Laurence C, Nachum E, Henwood S, Berman MM, Large MSR, Messer MS, Kaul MP, Baxter J, Quigley R, Osman M, Muthialu MN, Davies MB, Bohuta ML, Kostolny MM, BurchChB M, Fenton M, Andrews R, Thiruchelvam T, Hoskote A, Simmonds J. Pediatric heart transplantation following donation after circulatory death, distant procurement, and ex-situ perfusion. J Heart Lung Transplant 2022; 41:1104-1113. [DOI: 10.1016/j.healun.2022.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/24/2022] [Accepted: 04/28/2022] [Indexed: 11/30/2022] Open
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Brown KL, Thiruchelvam T, Kostolny M. Extracorporeal membrane oxygenation after the Norwood operation: making the best of a tough situation. Eur J Cardiothorac Surg 2022; 62:6563075. [PMID: 35373830 DOI: 10.1093/ejcts/ezac221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/21/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Katherine L Brown
- Heart and Lung Division, Great Ormond Street Hospital NHS Foundation Trust and Biomedical Research Centre, London, UK.,Institute of Cardiovascular Science, University College London, London, UK
| | - Timothy Thiruchelvam
- Heart and Lung Division, Great Ormond Street Hospital NHS Foundation Trust and Biomedical Research Centre, London, UK
| | - Martin Kostolny
- Heart and Lung Division, Great Ormond Street Hospital NHS Foundation Trust and Biomedical Research Centre, London, UK.,Institute of Cardiovascular Science, University College London, London, UK
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Affiliation(s)
- Nicholas Lanyon
- Anaesthetic Department, Great Ormond Street Hospital For Children NHS Trust, London, UK
| | - Pascale du Pré
- Paediatric Intensive Care Unit, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | | | - Samiran Ray
- Paediatric Intensive Care Unit, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK.,Institute of Child Health, University College of London, London, UK
| | - Mae Johnson
- Paediatric Intensive Care Unit, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Mark J Peters
- Paediatric Intensive Care Unit, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK.,Institute of Child Health, University College of London, London, UK
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Affiliation(s)
- Craig Laurence
- Department of Cardiology (C.L., G.D., M.B., R.W.M.Y., J.S.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Mohammad Haini
- Department of Histopathology (M.H.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Timothy Thiruchelvam
- Cardiac Intensive Care Unit (T.T.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Graham Derrick
- Department of Cardiology (C.L., G.D., M.B., R.W.M.Y., J.S.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Michael Burch
- Department of Cardiology (C.L., G.D., M.B., R.W.M.Y., J.S.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Robert William Michael Yates
- Department of Cardiology (C.L., G.D., M.B., R.W.M.Y., J.S.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Jacob Simmonds
- Department of Cardiology (C.L., G.D., M.B., R.W.M.Y., J.S.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
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Thiruchelvam T, Cookson K, Wark P, Dorahy D. IPD2.09 Lumacaftor/ivacaftor improves 6 minute walk test distance, FEV1 and reduces exacerbations in severe cystic fibrosis lung disease. J Cyst Fibros 2018. [DOI: 10.1016/s1569-1993(18)30293-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mimic B, Tsang V, Owens CM, Thiruchelvam T, Kostolny M. An unusual case of left bronchial compression caused by a large patent arterial duct in a child with pulmonary atresia with ventricular septal defect. Eur Heart J Cardiovasc Imaging 2016; 17:480. [DOI: 10.1093/ehjci/jev347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Tibballs J, Thiruchelvam T. A case of Commotio cordis in a young child caused by a fall. Resuscitation 2008; 77:139-41. [DOI: 10.1016/j.resuscitation.2007.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2007] [Accepted: 10/23/2007] [Indexed: 10/22/2022]
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Perez A, Butt WW, Millar KJ, Best D, Thiruchelvam T, Cochrane AD, Bennett M, Shekerdemian LS. Long-distance transport of critically ill children on extracorporeal life support in Australia. CRIT CARE RESUSC 2008; 10:34. [PMID: 18304015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND The Royal Children's Hospital, Melbourne, Victoria, provides extracorporeal life support (ECLS) for infants and children from all around Australia. Since 2003, we have offered a mobile ECLS service to retrieve critically ill children whose condition is too unstable for conventional transport. The retrieval team comprises a paediatric intensive care unit specialist, an ECLS nurse specialist, a perfusionist and a cardiac surgeon. PATIENTS AND METHODS Retrospective review of eight children (aged between 1 day and 8 years) who were transported on ECLS to the intensive care unit at the Royal Children's Hospital, Melbourne, between 2003 and 2007. RESULTS Seven patients underwent cannulation by our team in the referring ICU, and one underwent cannulation by the referring centre before our retrieval team arrived. Seven children were placed on ECMO (veno-venous in two, veno-arterial in five), and one was placed on a left ventricular assist device. Five children were retrieved from interstate ICUs by air, and three were transported from a metropolitan ICU by road. The median distance from the referral centre to Melbourne was 803 km, and the median duration of retrieval was 13 hours. Median duration of ECLS was 270 hours. Five patients survived to hospital discharge. There were no adverse outcomes related to transport. CONCLUSIONS This is the first report of ECLS transport in Australia. In our experience, children who would not otherwise be transportable can be safely transported long distances on ECLS, and should be offered this if appropriate resources exist. However, this approach should not replace the timely referral of patients who are likely to need ECLS.
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Affiliation(s)
- Armando Perez
- Department of Intensive Care, Royal Children's Hospital, Melbourne, VIC, Australia
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Sankar NM, Thiruchelvam T, Thirunavukkaarasu K, Pang K, Hanna WM. Symptomatic lipoma in the right atrial free wall. A case report. Tex Heart Inst J 1998; 25:152-4. [PMID: 9654663 PMCID: PMC325530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Benign non-myxomatous neoplasms of the heart are rare, and lipomas are among those least often encountered. We report the case of a 38-year-old man who presented with palpitations of recent onset, and was found to have a lipoma attached to the free wall of the right atrium. The successful surgical excision of the lipoma is described.
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Affiliation(s)
- N M Sankar
- Cardiothoracic Surgical Unit, Westmead Hospital, NSW, Australia
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