Post-cardiotomy ECMO in pediatric and congenital heart surgery: impact of team training and equipment in the results

Revista Brasileira de Cirurgia Cardiovascular

Leonardo Augusto Miana¹  Luiz Fernando Canêo¹  Carla Tanamati¹  Juliano Gomes Penha¹  Vanessa Alves Guimarães¹  Nana Miura¹  Filomena Regina Barbosa Gomes Galas¹  Marcelo Biscegli Jatene¹ 

关键词: Extracorporeal Membrane Oxygenation;    Evaluation of Results of Preventive Actions;    Heart Defects;    Congenital;    Health Human Resource Training;    Cardiovascular Surgical Procedures;    Membrana de Oxigenação Extracorpórea;    Avaliação de Resultado de Ações Preventivas;    Cardiopatias Congênitas;    Capacitação de Recursos Humanos em Saúde;    Procedimentos Cirúrgicos Cardiovasculares;   

DOI  :  10.5935/1678-9741.20150053

来源: SciELO

【 摘 要 】

AbstractIntroduction: Post-cardiotomy myocardial dysfunction requiring mechanical circulatory support occurs in about 0.5% of cases. In our environment, the use of extracorporeal membrane oxygenation has been increasing in recent years.Objective: To evaluate the impact of investment in professional training and improvement of equipment in the rate of weaning from extracorporeal membrane oxygenation and survival.Methods: A retrospective study. Fifty-six pediatric and/or congenital heart patients underwent post-cardiotomy extracorporeal membrane oxygenation at our institution between November 1999 and July 2014. We divided this period into two phases: phase I, 36 cases (before the structuring of the extracorporeal membrane oxygenation program) and phase II, 20 cases (after the extracorporeal membrane oxygenation program implementation) with investment in training and equipment). Were considered as primary outcomes: extracorporeal membrane oxygenation weaning and survival to hospital discharge. The results in both phases were compared using Chi-square test. To identify the impact of the different variables we used binary logistic regression analysis.Results: Groups were comparable. In phase I, 9 patients (25%) were weaned from extracorporeal membrane oxygenation, but only 2 (5.5%) were discharged. In phase II, extracorporeal membrane oxygenation was used in 20 patients, weaning was possible in 17 (85%), with 9 (45%) hospital discharges (P<0.01). When the impact of several variables on discharge and weaning of extracorporeal membrane oxygenation was analyzed, we observe that phase II was an independent predictor of better results (P<0.001) and need for left cavities drainage was associated with worse survival (P=0.045).Conclusion: The investment in professional training and improvement of equipment significantly increased extracorporeal membrane oxygenation results.

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