Related Experiment Video
Updated: Aug 16, 2025
Point-of-Care Ultrasound for Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation Without Left Ventricular Venting
Published on: January 17, 2025
Predictors of Mediastinal Exploration While on Extracorporeal Membrane Oxygenation After Pediatric Cardiac Surgery
Jason S Kerstein1, Phillip S Adams2, Timothy M Maul3
1From the Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA.
Insights
Early chest tube output in pediatric cardiac surgery patients on extracorporeal membrane oxygenation (ECMO) can predict bleeding complications. An average output of 11.6 mL/kg/h in the first three hours accurately identifies patients needing mediastinal exploration.
Area of Science:
- Pediatric Cardiac Surgery
- Extracorporeal Membrane Oxygenation (ECMO)
- Hemorrhage Management
Background:
- Patients undergoing cardiac surgery and requiring ECMO face significant hemorrhage risks.
- These risks stem from anticoagulation, indwelling cannulas, and altered hemostasis.
- Effective bleeding management is critical for patient outcomes.
Purpose of the Study:
- To identify early predictors of hemorrhage in pediatric cardiac surgical patients on ECMO.
- To differentiate bleeding severity and guide management decisions.
- To assess the utility of chest tube output in predicting the need for mediastinal exploration.
Main Methods:
- Retrospective, cross-sectional study of 69 pediatric patients (0-18 years) on ECMO.
- Patients categorized into no bleeding (NB), bleeding stopped (BS), and bleeding requiring mediastinal exploration (BME) groups.
- Analysis of coagulation profiles and serial chest tube output within 48 hours of ECMO cannulation.
Main Results:
- Coagulation profiles differed significantly between groups upon CICU admission.
- Early chest tube output during the first three post-cannulation hours was strongly associated with mediastinal exploration.
- An average chest tube output of 11.6 mL/kg/h in the first three hours correctly classified 84% of patients requiring mediastinal exploration.
Conclusions:
- Early chest tube output is a valuable, non-invasive predictor of significant hemorrhage in pediatric ECMO patients.
- This metric can aid in timely identification and intervention for bleeding complications.
- Optimizing bleeding risk assessment is crucial for improving outcomes in this high-risk population.
Abstract:
Cardiac surgical patients requiring extracorporeal membrane oxygenation (ECMO) are at increased risk for hemorrhage due to necessary anticoagulation, in-situ cannulas, and disturbed hemostasis. We performed a retrospective, cross-sectional study of patients 0-18 years old in our cardiac intensive care unit (CICU) cannulated to ECMO within 48 h of cardiopulmonary bypass. The 69 patients included in the study were divided into three analysis groups based on serial chest tube output per hour: no bleeding (NB) on admission to the CICU (21/69, 30%), bleeding stopped (BS) with medical management (26/69, 38%), bleeding requiring emergent mediastinal exploration (BME) (22/69, 32%). The NB group had a more favorable coagulation profile upon admission to the CICU (PTT 53 s NB, 105 s BS, 83 s BME p < 0.001, ACT 169 s NB, 225 s BS, 211 s BME, p =0.013). Only chest tube output during the first three postcannulation hours remained associated with the need for mediastinal exploration by multivariable analysis. An average chest-tube output of 11.6 mL/kg/h during the first three hours had the highest percentage of patients classified correctly (84%) for requiring mediastinal exploration during their ECMO run (sensitivity 91%, specificity 81%).
Related Concept Videos
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:26Endoscopic Studies II: Thoracocentesis
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...