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Published on: July 18, 2014
[Prognostic markers of mortality after congenital heart defect surgery]
J A García-Hernández1, I L Benítez-Gómez, A I Martínez-López
1Unidad de Gestión Clínica de Cuidados Críticos y Urgencias, Hospital Infantil Universitario Virgen del Rocío, Sevilla, España. garcier@gmail.com
Insights
Peak lactate levels after pediatric cardiac surgery are strong predictors of mortality. High lactate levels may indicate the need for extracorporeal membrane oxygenation (ECMO) support.
Area of Science:
- Pediatric cardiac surgery
- Congenital heart disease
- Intensive care medicine
Context:
- Surgery for congenital heart disease in children carries significant mortality risks.
- Identifying reliable predictors of mortality is crucial for optimizing patient care.
- Extracorporeal membrane oxygenation (ECMO) is a potential life-saving intervention for critically ill pediatric cardiac surgery patients.
Purpose:
- To identify risk factors for mortality in children undergoing cardiac surgery for congenital heart disease.
- To establish potential indications for extracorporeal membrane oxygenation (ECMO) support.
- To evaluate the predictive value of various physiological parameters in the pediatric intensive care unit (PICU).
Summary:
- A study of 186 children undergoing cardiac surgery identified several mortality risk factors, including bypass time, inotropic score, and lactate levels.
- Peak lactate levels, lactate levels upon PICU admission, and bypass time were the strongest predictors of mortality.
- Multivariate analysis revealed a lactate level of 6.3 mmol/l and sustained high blood lactate for 24 hours as independent predictors of mortality.
Impact:
- Peak lactate level emerges as a significant and strong predictor of mortality post-pediatric cardiac surgery.
- This finding suggests that peak lactate level can serve as a valuable indicator for initiating ECMO support.
- The study contributes to refining risk stratification and decision-making for mechanical circulatory support in critically ill pediatric cardiac surgery patients.
Introduction:
Our aim is to identify risk factors for mortality after surgery for congenital heart disease in children, in order to establish indications for extracorporeal membrane oxygenation (ECMO).
Patients And Methods:
One hundred and eighty six children underwent cardiac surgery with extracorporeal circulation from April 2007 to June 2009. The following parameters were measured serially during their stay in Paediatric Intensive Care (PICU): Arterial and venous blood pH, pCO2, base excess, oxygen saturation, arterio-venous oxygen saturation difference, oxygen extraction ratio, ventilatory dead space and intrapulmonary shunting.
Results:
Hospital mortality was 13,4%. The following risk factors for mortality were identified: age, bypass time, inotropic score, lactate level upon arrival in PICU including its peak value and its rate of variation, mixed venous saturation, base excess, ventilatory dead space, oxygen extraction ratio, and intrapulmonary shunting. However, the strongest predictors of mortality were bypass time, lactate levels upon admission on PICU, and the peak lactate level. Multivariate analysis showed a lactate level of 6.3mmol/l and a high blood lactate for 24hours to be independent predictors of mortality.
Conclusions:
The peak lactate level is a strong predictor of mortality. As such, it would be a useful indicator of the need for ECMO support.
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