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Mechanical support of the pediatric cardiac patient
Ralph E. Delius1, Christopher Caldarone
1Division of Cardiothoracic Surgery, University of California, Davis, Medical Center, Sacramento, CA.
Insights
Mechanical support, including extracorporeal membrane oxygenation (ECMO), offers rescue for congenital heart surgery patients with myocardial or pulmonary failure. Promising results are seen even in cardiac arrest cases.
Area of Science:
- Cardiology
- Pediatric Surgery
- Biomedical Engineering
Background:
- Advances in congenital heart defect surgery have improved outcomes.
- A subset of patients still experience myocardial or pulmonary failure post-surgery.
- Mechanical support is crucial for managing these critical cases.
Purpose of the Study:
- To review the role and advancements of mechanical circulatory support in congenital heart surgery.
- To highlight the efficacy of extracorporeal membrane oxygenation (ECMO) and ventricular support devices.
- To discuss future directions in mechanical support for this patient population.
Main Methods:
- Review of current literature on mechanical support in congenital heart surgery.
- Analysis of extracorporeal membrane oxygenation (ECMO) applications.
- Discussion of ventricular support devices and novel applications like cardiac arrest rescue.
Main Results:
- Extracorporeal membrane oxygenation (ECMO) is a widely used and effective mechanical support.
- Ventricular support devices show potential utility in pediatric congenital heart patients.
- Mechanical support demonstrates surprisingly good results in rescuing patients during cardiac arrest.
Conclusions:
- Mechanical support is vital for select patients undergoing congenital heart surgery.
- Future developments aim for better patient selection and improved device biocompatibility.
- Intelligent application of mechanical support can rescue critically ill patients.
Abstract:
Increased understanding of the anatomical nuances of congenital heart defects, improved methods of myocardial preservation, and advances in surgical techniques have led to improved results and need for postoperative mechanical support in patients undergoing congenital heart surgery. However, there remains a small portion of patients with myocardial or pulmonary failure that can can be rescued by intelligent use of mechanical support. The most widely used form of mechanical support is extracorporeal membrane oxygenation (ECMO), which has been adapted for use in congenital heart patients as well as patients with respiratory failure. Recent reports have suggested that ventricular support devices may also be useful in this patient population. A promising new application of mechanical support is for rescue during cardiac arrest; surprisingly good results have been obtained in this obviously moribund group of patients. Future developments in mechanical support include more accurate identification of patients who will benefit from this therapy and technological advances that will provide greater biocompatibility and simplification of the support circuit. Copyright 2000 by W.B. Saunders Company