Hostname: page-component-8448b6f56d-jr42d Total loading time: 0 Render date: 2024-04-25T06:10:08.743Z Has data issue: false hasContentIssue false

Complications relating to perfusion and extracorporeal circulation associated with the treatment of patients with congenital cardiac disease: Consensus Definitions from the Multi-Societal Database Committee for Pediatric and Congenital Heart Disease

Published online by Cambridge University Press:  01 December 2008

Kenneth G. Shann*
Affiliation:
Department of Cardiothoracic Surgery, Montefiore-Einstein Heart Center, Bronx, New York, United States of America
Carmen R. Giacomuzzi
Affiliation:
Oregon Health and Sciences University – Doernbecher Children’s Hospital, Portland, Oregon, United States of America
Lynn Harness
Affiliation:
Department of Cardiothoracic Surgery, Arkansas Children’s Hospital, Little Rock, Arkansas, United States of America
Gerard J. Myers
Affiliation:
Queen Elizabeth II Health Sciences Center, IWK Health Center, Halifax, Nova Scotia, Canada
Theron A. Paugh
Affiliation:
University of Michigan Medical Center, Ann Arbor, Michigan, United States of America
Nicholas Mellas
Affiliation:
Department of Cardiothoracic Surgery, Montefiore-Einstein Heart Center, Bronx, New York, United States of America
Robert C. Groom
Affiliation:
Maine Medical Center, Portland, Maine, United States of America
Daniel Gomez
Affiliation:
Nationwide Children’s Hospital, Columbus, Ohio, United States of America
Clarke A. Thuys
Affiliation:
Department of Cardiac Surgery, Royal Children’s Hospital, Melbourne, Victoria, Australia
Kevin Charette
Affiliation:
Children’s Hospital of New York, New York, New York, United States of America
Jorge W. Ojito
Affiliation:
The Congenital Heart Institute at Miami Children’s Hospital, Miami, Florida, United States of America
Julie Tinius-Juliani
Affiliation:
Department of Cardiothoracic Surgery, University of Southern California, Los Angeles, California, United States of America
Christos Calaritis
Affiliation:
Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada
Craig M. McRobb
Affiliation:
Duke University Health Systems, Durham, North Carolina, United States of America
Michael Parpard
Affiliation:
The Congenital Heart Institute of Florida (CHIF), Divisions of Thoracic and Cardiovascular Surgery, Perfusion, and Critical Care, All Children’s Hospital and Children’s Hospital of Tampa, University of South Florida College of Medicine, Cardiac Surgical Associates (CSA), Florida Perfusion Services, and Florida Pediatric Associates, Saint Petersburg and Tampa, Florida, United States of America
Tom Chancy
Affiliation:
The Congenital Heart Institute of Florida (CHIF), Divisions of Thoracic and Cardiovascular Surgery, Perfusion, and Critical Care, All Children’s Hospital and Children’s Hospital of Tampa, University of South Florida College of Medicine, Cardiac Surgical Associates (CSA), Florida Perfusion Services, and Florida Pediatric Associates, Saint Petersburg and Tampa, Florida, United States of America
Emile Bacha
Affiliation:
Department of Cardiac Surgery, Children’s Hospital Boston, Boston, Massachusetts, United States of America
David S. Cooper
Affiliation:
The Congenital Heart Institute of Florida (CHIF), Divisions of Thoracic and Cardiovascular Surgery, Perfusion, and Critical Care, All Children’s Hospital and Children’s Hospital of Tampa, University of South Florida College of Medicine, Cardiac Surgical Associates (CSA), Florida Perfusion Services, and Florida Pediatric Associates, Saint Petersburg and Tampa, Florida, United States of America
Jeffrey Phillip Jacobs
Affiliation:
The Congenital Heart Institute of Florida (CHIF), Divisions of Thoracic and Cardiovascular Surgery, Perfusion, and Critical Care, All Children’s Hospital and Children’s Hospital of Tampa, University of South Florida College of Medicine, Cardiac Surgical Associates (CSA), Florida Perfusion Services, and Florida Pediatric Associates, Saint Petersburg and Tampa, Florida, United States of America
Donald S. Likosky
Affiliation:
Departments of Surgery and Community and Family Medicine, Dartmouth Medical School, and The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, New Hampshire, United States of America
*
Correspondence to: Kenneth G. Shann, CCP, Assistant Director, Perfusion Services, Senior Advisor, Cardiac Surgery Performance Improvement, Montefiore-Einstein Heart Center, Bronx, New York, United States of America. Tel: 718 920 8951; Fax: 718 652 1833; E-mail: kshann@montefiore.org

Abstract

The International Consortium for Evidence-Based Perfusion (www.bestpracticeperfusion.org) is a collaborative partnership of societies of perfusionists, professional medical societies, and interested clinicians, whose aim is to promote the continuous improvement of the delivery of care and outcomes for patients undergoing extracorporeal circulation. Despite the many advances made throughout the history of cardiopulmonary bypass, significant variation in practice and potential for complication remains. To help address this issue, the International Consortium for Evidence-Based Perfusion has joined the Multi-Societal Database Committee for Pediatric and Congenital Heart Disease to develop a list of complications in congenital cardiac surgery related to extracorporeal circulation conducted via cardiopulmonary bypass, extracorporeal membrane oxygenation, or mechanical circulatory support devices, which include ventricular assist devices and intra-aortic balloon pumps. Understanding and defining the complications that may occur related to extracorporeal circulation in congenital patients is requisite for assessing and subsequently improving the care provided to the patients we serve. The aim of this manuscript is to identify and define the myriad of complications directly related to the extracorporeal circulation of congenital patients.

Type
Original Article
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Stammers, AH. Perfusion education in the United States at the turn of the century. J Extra Corpor Technol 1999; 31: 112117.CrossRefGoogle ScholarPubMed
2.Galletti, PM, Brecher, GA. Heart-lung bypass: principles and techniques of extracorporeal circulation. Grune & Stratton, New York, 1962.Google Scholar
3.Gibbon, JH Jr. Application of a mechanical heart and lung apparatus to cardiac surgery. Minn Med 1954; 37: 171185; passim.Google ScholarPubMed
4.Lillehei, CW, Dewall, RA, Read, RC, Warden, HE, Varco, RL. Direct vision intracardiac surgery in man using a simple, disposable artificial oxygenator. Dis Chest 1956; 29: 18.CrossRefGoogle ScholarPubMed
5.DeWall, RA, Bentley, DJ, Hirose, M, Battung, V, Najafi, H, Roden, T. A temperature controlling (omnithermic) disposable bubble oxygenator for total body perfusion. Dis Chest 1966; 49: 207211.CrossRefGoogle ScholarPubMed
6.Bartlett, RH, Harken, DE. Instrumentation for cardiopulmonary bypass--past, present, and future. Med Instrum 1976; 10: 119124.Google ScholarPubMed
7.Lande, AJ, Dos, SJ, Carlson, RG, et al. A new membrane oxygenator-dialyzer. Surg Clin North Am 1967; 47: 14611470.CrossRefGoogle ScholarPubMed
8.Hirayama, T, Yamaguchi, H, Allers, M, Roberts, D. Evaluation of red cell damage during cardiopulmonary bypass. Scand J Thorac Cardiovasc Surg 1985; 19: 263265.CrossRefGoogle ScholarPubMed
9.Nilsson, L, Bagge, L, Nystrom, SO. Blood cell trauma and postoperative bleeding: comparison of bubble and membrane oxygenators and observations on coronary suction. Scand J Thorac Cardiovasc Surg 1990; 24: 6569.CrossRefGoogle ScholarPubMed
10.Padayachee, TS, Parsons, S, Theobold, R, Linley, J, Gosling, RG, Deverall, PB. The detection of microemboli in the middle cerebral artery during cardiopulmonary bypass: a transcranial Doppler ultrasound investigation using membrane and bubble oxygenators. Ann Thorac Surg 1987; 44: 298302.CrossRefGoogle ScholarPubMed
11.Blauth, C, Smith, P, Newman, S, et al. Retinal microembolism and neuropsychological deficit following clinical cardiopulmonary bypass: comparison of a membrane and a bubble oxygenator. A preliminary communication. Eur J Cardiothorac Surg 1989; 3: 135138; discussion 139.CrossRefGoogle Scholar
12.Groom, RC, Froebe, S, Martin, J, et al. Update on pediatric perfusion practice in North America: 2005 survey. J Extra Corpor Technol 2005; 37: 343350.CrossRefGoogle ScholarPubMed
13.Chang, RK, Klitzner, TS. Resources, use, and regionalization of pediatric cardiac services. Curr Opin Cardiol 2003; 18: 98101.CrossRefGoogle ScholarPubMed
14.Cooley, DA, Beall, AC Jr. Surgical treatment of acute massive pulmonary embolism using temporary cardiopulmonary bypass. Dis Chest 1962; 41: 102104.CrossRefGoogle ScholarPubMed
15.Kolobow, T, Bowman, RL. Construction and evaluation of an alveolar membrane artificial heart-lung. Trans Am Soc Artif Intern Organs 1963; 9: 238243.Google ScholarPubMed
16.Khoshbin, E, Westrope, C, Pooboni, S, et al. Performance of polymethyl pentene oxygenators for neonatal extracorporeal membrane oxygenation: a comparison with silicone membrane oxygenators. Perfusion 2005; 20: 129134.CrossRefGoogle ScholarPubMed
17.Bartlett, RH, Gazzaniga, AB, Jefferies, MR, Huxtable, RF, Haiduc, NJ, Fong, SW. Extracorporeal membrane oxygenation (ECMO) cardiopulmonary support in infancy. Trans Am Soc Artif Intern Organs 1976; 22: 8093.Google ScholarPubMed
18.Bartlett, RH, Roloff, DW, Cornell, RG, Andrews, AF, Dillon, PW, Zwischenberger, JB. Extracorporeal circulation in neonatal respiratory failure: a prospective randomized study. Pediatrics 1985; 76: 479487.CrossRefGoogle ScholarPubMed
19.O’Rourke, PP, Crone, RK, Vacanti, JP, et al. Extracorporeal membrane oxygenation and conventional medical therapy in neonates with persistent pulmonary hypertension of the newborn: a prospective randomized study. Pediatrics 1989; 84: 957963.CrossRefGoogle ScholarPubMed
20.Conrad, SA, Rycus, PT, Dalton, H. Extracorporeal Life Support Registry Report 2004. Asaio J 2005; 51: 410.CrossRefGoogle ScholarPubMed
21.Pierce, WS, Parr, GV, Myers, JL, Pae, WE Jr, Bull, AP, Waldhausen, JA. Ventricular-assist pumping patients with cardiogenic shock after cardiac operations. New Engl J Med 1981; 305: 16061610.CrossRefGoogle ScholarPubMed
22.Rogers, AJ, Trento, A, Siewers, RD, et al. Extracorporeal membrane oxygenation for postcardiotomy cardiogenic shock in children. Ann Thorac Surg 1989; 47: 903906.CrossRefGoogle ScholarPubMed
23.Stiller, B, Weng, Y, Hubler, M, et al. Pneumatic pulsatile ventricular assist devices in children under 1 year of age. Eur J Cardiothorac Surg 2005; 28: 234239.CrossRefGoogle ScholarPubMed
24.Zwischenberger, JB, Bartlett, RH. and Extracorporeal Life Support Organization ECMO: extracorporeal cardiopulmonary support in critical care. Extracorporeal Life Support Organization, Ann Arbor, Mich, 2000.Google Scholar
25.Hetzer, R, Stiller, B, Potapov, E, Lehmkuhl, H. Ventricular assist device and mechanical circulatory support for children. Curr Opin Organ Transpl 2007; 12: 522528.CrossRefGoogle Scholar
26.Vaughan, D. The Challenger launch decision: risky technology, culture, and deviance at NASA. University of Chicago Press, Chicago, 1996.Google Scholar
27.Rodriguez, RA, Belway, D. Comparison of two different extracorporeal circuits on cerebral embolization during cardiopulmonary bypass in children. Perfusion 2006; 21: 247253.CrossRefGoogle ScholarPubMed
28.Gando, S, Iba, T, Eguchi, Y, et al. A multicenter, prospective validation of disseminated intravascular coagulation diagnostic criteria for critically ill patients: comparing current criteria. Crit Care Med 2006; 34: 625631.CrossRefGoogle ScholarPubMed
29.Lehman, CM, Wilson, LW, Rodgers, GM. Analytic validation and clinical evaluation of the STA LIATEST immunoturbidimetric D-dimer assay for the diagnosis of disseminated intravascular coagulation. Am J Clin Pathol 2004; 122: 178184.CrossRefGoogle ScholarPubMed
30.Bentall, H. Protection of the myocardium during surgery. J Cardiovasc Surg (Torino) 1975; 16: 228231.Google ScholarPubMed
31.Allen, BS. Pediatric myocardial protection: a cardioplegic strategy is the “solution”. Semin Thorac Cardiovasc Surg 2004; 7: 141154.CrossRefGoogle ScholarPubMed
32.Romero, TE, Friedman, WF. Limited left ventricular response to volume overload in the neonatal period: a comparative study with the adult animal. Pediatr Res 1979; 13: 910915.CrossRefGoogle ScholarPubMed
33.Allen, BS. Pediatric myocardial protection: where do we stand? J Thorac Cardiovasc Surg 2004; 128: 1113.CrossRefGoogle ScholarPubMed
34.Allen, BS, Barth, MJ, Ilbawi, MN. Pediatric myocardial protection: an overview. Semin Thorac Cardiovasc Surg 2001; 13: 5672.CrossRefGoogle ScholarPubMed
35.Hammon, JW Jr. Myocardial protection in the immature heart. Ann Thorac Surg 1995; 60: 839842.CrossRefGoogle ScholarPubMed
36.Demmy, TL, Biddle, JS, Bennett, LE, Walls, JT, Schmaltz, RA, Curtis, JJ. Organ preservation solutions in heart transplantation--patterns of usage and related survival. Transplantation 1997; 63: 262269.CrossRefGoogle ScholarPubMed
37.Amark, K, Berggren, H, Bjork, K, et al. Myocardial metabolism is better preserved after blood cardioplegia in infants. Ann Thorac Surg 2006; 82: 172178.CrossRefGoogle ScholarPubMed
38.Modi, P, Suleiman, MS, Reeves, B, et al. Myocardial metabolic changes during pediatric cardiac surgery: a randomized study of 3 cardioplegic techniques. J Thorac Cardiovasc Surg 2004; 128: 6775.CrossRefGoogle ScholarPubMed
39.Makinde, AO, Gamble, J, Lopaschuk, GD. Upregulation of 5’-AMP-activated protein kinase is responsible for the increase in myocardial fatty acid oxidation rates following birth in the newborn rabbit. Circ Res 1997; 80: 482489.CrossRefGoogle ScholarPubMed
40.Landymore, RW, Myers, G. Evaluation of delivery systems for oxygenated cardioplegia. Can J Surg 1988; 31: 346348.Google ScholarPubMed
41.Guyton, RA, Dorsey, LM, Craver, JM, et al. Improved myocardial recovery after cardioplegic arrest with an oxygenated crystalloid solution. J Thorac Cardiovasc Surg 1985; 89: 877887.CrossRefGoogle ScholarPubMed
42.Naik, SK, Knight, A, Elliott, M. A prospective randomized study of a modified technique of ultrafiltration during pediatric open-heart surgery. Circulation 1991; 84: III422431.Google ScholarPubMed
43.Naik, SK, Knight, A, Elliott, MJ. A successful modification of ultrafiltration for cardiopulmonary bypass in children. Perfusion 1991; 6: 4150.CrossRefGoogle ScholarPubMed
44.Grunenfelder, J, Zund, G, Schoeberlein, A, et al. Modified ultrafiltration lowers adhesion molecule and cytokine levels after cardiopulmonary bypass without clinical relevance in adults. Eur J Cardiothorac Surg 2000; 17: 7783.CrossRefGoogle ScholarPubMed
45.Myers, GJ, Leadon, RB, Mitchell, LB, Ross, DB. Simple modified ultrafiltration. Perfusion 2000; 15: 447452.CrossRefGoogle ScholarPubMed
46.Hennein, HA, Kiziltepe, U, Barst, S, et al. Venovenous modified ultrafiltration after cardiopulmonary bypass in children: a prospective randomized study. J Thorac Cardiovasc Surg 1999; 117: 496505.Google ScholarPubMed
47.Chaturvedi, RR, Shore, DF, White, PA, et al. Modified ultrafiltration improves global left ventricular systolic function after open-heart surgery in infants and children. Eur J Cardiothorac Surg 1999; 15: 742746.CrossRefGoogle ScholarPubMed
48.Davies, MJ, Nguyen, K, Gaynor, JW, Elliott, MJ. Modified ultrafiltration improves left ventricular systolic function in infants after cardiopulmonary bypass. J Thorac Cardiovasc Surg 1998; 115: 361369; discussion 369–370.CrossRefGoogle ScholarPubMed
49.Raja, SG, Yousufuddin, S, Rasool, F, Nubi, A, Danton, M, Pollock, J. Impact of modified ultrafiltration on morbidity after pediatric cardiac surgery. Asian Cardiovasc Thorac Annals 2006; 14: 341350.CrossRefGoogle ScholarPubMed
50.Aggarwal, NK, Das, SN, Sharma, G, Kiran, U. Efficacy of combined modified and conventional ultrafiltration during cardiac surgery in children. Ann Card Anaesthesia 2007; 10: 2733.CrossRefGoogle ScholarPubMed