Paediatric cardiac anaesthesia in a developing country. Guatemala Heart Team
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Published on: June 2, 2022
W S Schechter1, A Navedo, D Jordan
1Department of Anesthesiology, Columbia-Presbyterian Medical Center, College of Physicians and Surgeons, New York, N.Y. 10032, USA.
Insights
Pediatric cardiac surgery in developing countries is safe and effective when using established care standards. This mission successfully repaired complex heart conditions in 42 children, demonstrating successful outcomes.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Global Health Initiatives
Background:
- Complex congenital and acquired valvular heart disease in children presents significant challenges, particularly in resource-limited settings.
- Access to advanced pediatric cardiac surgical care is often limited in developing countries.
Purpose of the Study:
- To evaluate the feasibility and safety of performing pediatric cardiac surgery in a developing country.
- To assess outcomes of complex congenital and acquired valvular heart disease repair in pediatric patients during a medical mission.
Main Methods:
- A multidisciplinary team of 65 medical professionals conducted a cardiac surgery mission in Guatemala City, Guatemala.
- Surgical interventions were performed on 42 pediatric patients with complex valvular heart disease between October 15-24, 1995.
- Cardiopulmonary bypass was utilized in 36 cases; patient selection and adherence to developed country standards of care were prioritized.
Main Results:
- A total of 42 pediatric patients underwent successful surgical repair of valvular heart lesions.
- No anesthetic or surgical deaths occurred during the mission.
- High rates of early extubation were achieved: 100% for non-cardiopulmonary bypass cases and 64% for cardiopulmonary bypass cases, with no reintubations.
Conclusions:
- Pediatric cardiac surgery for complex congenital and acquired valvular heart disease can be performed safely and effectively in developing countries.
- Strict patient selection and maintaining high standards of care are crucial for successful outcomes in resource-limited environments.
- This mission demonstrated the viability of international collaborations to improve pediatric cardiac surgical care globally.
Abstract:
During the week of October 15-24, 1995 a team of 65 medical, anaesthesiology, surgical, nursing and paramedical personnel travelled to Guatemala City, Guatemala to perform cardiac surgery on children with complex congenital and acquired valvular heart disease. During this mission 42 patients had their lesions surgically repaired. Cardiopulmonary bypass was required in 36 cases. There were no anaesthetic or surgical deaths. All six patients who did not require cardiopulmonary bypass were extubated in the operating room. Of the patients who required cardiopulmonary bypass, 23 were extubated in the operating room (64%). There was no intraoperative anaesthetic morbidity nor postoperative respiratory complications. No patients was reintubated after planned extubation. Cardiac surgery in paediatric age patients can safely be performed in developing countries if close attention is paid to proper patient selection and one maintains the standards of care practised in developed countries.
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