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Background and Aims

To assess the long-term outcome of the right common carotid artery (RCCA) and right internal jugular vein (RIJV) patency after ECMO in newborn infants for non-cardiac indications.

Methods

We reviewed all the newborn infants included in the cohort of infants treated by ECMO from 1992 to 2005 admitted in the NICU at the University hospital of Lille, France. Serial Doppler ultrasound of neck vessels were performed prospectively.

Results

73 newborn infants were treated by ECMO during the study period. 20 infants died and 2 infants were lost to follow-up. The remaining 51 infants were included in the study. 14 newborns were treated with double lumen Veno-Venous ECMO and 37 newborns were treated with Veno-Arterial ECMO for congenital diaphragmatic hernia (33%), Neonatal sepsis (31%) and meconium aspiration syndrome (22%). The RCCA and/or RIJV were systematically reconstructed at the completion of ECMO. Reconstructions were successful in 97% of RCCA and 88% of RIJV. All infants were treated with acetylsalicylic acid for an average of 7 [4-12] years.

At 15 years-old, the RCCA and the RIJV were patent (or stenosis < 50%) in respectively 65% and 5%. Severe stenosis (>50%) of RCCA was noted in 15% of the children.

Conclusions

Our data shows that 2/3 of the RCCA is still patent at 15 years of the follow-up after reconstruction of the vessel performed at the completion of neonatal ECMO.

Background and Aims

Hyperoxia is associated with adverse outcomes in critical illness. Venoarterial (VA) ECMO may increase the likelihood of hyperoxia .We evaluated the the incidence of hyperoxia and association with adverse effects in children with cardiac pathology on VA ECMO.

Methods

60 children underwent VA ECMO for cardiac pathology between January 2016- December 2018 at our hospital Hyperoxia was defined as partial pressure of oxygen in the arterial blood (PaO)2>13.3 kpa.Children bridged on ECMO to ventricular assist device and heart transplant were excluded.Data was retrospectively collected for (i)oxygen parameters such as mean, median and maximum PaO2 levels for the duration of the ECMO (ii)mortality and (iii)complications.Primary outcome was mortality in intensive care unit.

Results

31 children were included in the analysis. 26/31 (84%) of children had median PaO2 greater than 13.3 kpa. 9/31 (29%) children who died had higher PaO2 parameters as compared to the survivors(although difference not statistical significant). max PaO2 performed best for discriminating ICU mortality (AUC =0.62; 95% CI.40-.83). A cut off value of max PaO2 of 28.7kpa gave a sensitivity of 78%, specificity 45%, PPV 37%, NPV 83%,+LR 1.43% and a –LR 0.49% for ICU mortality. Deaths(77.8%) and complications such as renal failure(56.5%), seizures(100%),Sepsis(60%),Chest Reexploration (60%) and gut failure(56%) were all higher in the group with max pao2 >28.7kpa (percent with max pao2 >28.7kpa in parentheses) but without statistical significance .

Conclusions

Hyperoxia was common. Mortality and complications were higher in the group with higher oxygen levels although not statistically significant. ‘Less is more’ here needs further investigation by robust prospective trials.

Background and Aims

Persistent elevation of lactate 24–48 hrs has been associated with increased mortality in septic patients. The aim of this study is to assess the role of lactate clearance in determining outcome after pediatric cardiac surgery.

Methods

Prospective study of pediatric patients with CHD who were admitted in a Pediatric Cardiac Intensive Care (PCICU) after cardiac surgery from 01/01/2018 to 31/12/2019. Blood lactate levels were obtained at admission and then serially until normalization (<2 mmol/L). Lactime, time during which the lactate remains >2 mmol/L, was recorded. Patients were categorized into low and high-risk group, with a cut-off value of lactime 24 hrs. Patient’s and surgery characteristics, postoperative complications, length of hospitalization (LOS) and mortality were compared.

Results

88 patients were enrolled, with a median age of 13 months. Males represented 50%. The summary of patients’ characteristics and our results are shown in the Table A.

Patients who underwent more complex surgery, defined by RACHS-1 score, had a significant longer lactime. Duration of Cardiopulmonary Bypass (CPB), when used, is also a factor prolonging lactime.

High risk patients had significantly longer Mechanical Ventilation and inotrope days, as long as more postoperative complications, both cardiac (LOS, arrhythmias, tamponade), and extracardiac (SIRS, AKI, liver dysfunction, DIC). Finally, we also found lactime to be significantly associated with prolonged length of stay and higher mortality rates.

Conclusions

Lactime, as marker of lactate clearance, could be used as a predictive marker for serious early postoperative complications and mortality, in pediatric cardiac surgery patients.

Background and Aims

Cardiopulmonary bypass (CPB) surgery is associated with metabolic acidosis in the immediate post-operative period in PICU. In infants following CPB surgery, metabolic acidosis, expressed as the strong ion gap (SIG), is a better predictor of mortality than lactate concentration at admission to PICU.

Methods

We prospectively measured lactate, components of SIG, and requirement for fluid boluses in 35 infants requiring CPB surgery at a single institution as part of a broader study on mechanisms of inflammation and outcome in infants requiring CPB surgery. All patients received intravenous dexamethasone at induction and CPB circuits were primed with blood.

Results

Lactate increased from baseline median 1.2 (IQR 1.1–1.5) mmol/l to peak 2.1 (IQR 1.3–2.9) at end of CPB, before returning to near baseline by 24 hour post-operative in most patients (p<0.001, Figure 1A). SIG increased from baseline median 5.8 (IQR 4.1–7.4) mEq/l to peak 13.1 (IQR 9.8–14.4) mEq/l and remained raised from baseline for up to 5 days post-operative in most patients (p<0.001, Figure 1B). There was a wide distribution of cumulative fluid boluses received (median 0, IQR 0–33, range 0–181 ml/kg) in infants (Figure 1C).

Conclusions

Metabolic acidosis follows a dynamic course prior to, during and following CPB surgery. Modelling the trajectory of the infant immune response to CPB surgery from baseline to convalescence may provide the basis for improved immunomodulation in this group of patients, and in other severe acute inflammatory conditions of childhood.

Background and Aims

Amplitude integrated electroencephalography (aEEG) is a bedside neuromonitoring tool, increasing in popularity across intensive care units (ICUs) worldwide. Normative amplitude values for aEEG traces have been demonstrated to evolve with age from pre-term babies to neonates but values have not been determined in children older than 3.5 months. We aim to determine normative values in children from the ages of 2 months to 16 years, to allow accurate interpretation of aEEG recordings at the bedside, in real-time, in the paediatric intensive care unit.

Methods

A total of 350 electroencephalography (EEG) recordings were collected from an extensive database of normal EEG studies in Children’s Health Ireland at Crumlin (CHI@C).

5 minute epochs of waking and sleeping EEG per patient were gathered, processed, and collated to produce an overall maximum and minimum amplitude and bandwidth value as reference values for each age group.

Results

Mean amplitude values were variable across ages, most notably an increase in toddlers which diminished in older children.

A significant difference in amplitude between waking and sleeping states, in both the minimum and maximum amplitudes, was seen in children less than 6 years of age. Strong correlation exists between the upper and lower margin of aEEG trace was shown in all ages, both awake and asleep.

Conclusions

Normative values for aEEG have never been determined beyond 3.5 months of age. We have demonstrated that amplitudes change as an infant progresses through childhood, both in waking and sleeping states. These values will facilitate interpretation of aEEG at the bedside in ICUs worldwide.