11:25 〜 11:55
[I-IL-02] Minimizing Morbidity in Pediatric Cardiac Surgery
In 2016, mortality following cardiac surgery for congenital heart disease is uniformly low and continues to improve. In addition to maximizing survival, minimization of morbidity is paramount for these children. This presentation will highlight two areas of perioperative care which may decrease morbidity of patients after cardiac surgery: (1) minimizing the use of blood products and (2) early postoperative extubation.
Allogeneic blood products, common in pediatric cardiac surgery, have several associated potential deleterious consequences; decreasing their usage may mitigate certain adverse effects. We retrospectively reviewed pediatric open-heart surgery cases to investigate the feasibility and clinical outcomes of a restrictive blood transfusion strategy. Our data suggests a restrictive transfusion strategy can be safely implemented in pediatric cardiac surgery. The majority of children with a body weight (BW) >8 kg require no blood products and those with a BW ≤8 kg require only 1 unit of blood, to prime the bypass circuit, during their hospitalization. Zero transfusion is a realistic and a safe option in children >10 kg with a predicted cardiopulmonary bypass duration of less than 90 minutes.
Early extubation has been adopted in some centres for select children following cardiac surgery. This strategy has been associated with improved resource utilization by shortening hospital length of stays, with the potential to reduce postoperative morbidities. We determined the feasibility and assessed the clinical outcomes associated with an early extubation strategy for all children undergoing congenital heart surgery, including neonates (<30 days). We assert that the majority of children undergoing congenital heart surgery can be extubated in the operating room. Most neonates, including many undergoing complex procedures, can be extubated in the first 24 hours after surgery. Early extubation is associated with low morbidity rates and short length of ICU and hospital stays.
Allogeneic blood products, common in pediatric cardiac surgery, have several associated potential deleterious consequences; decreasing their usage may mitigate certain adverse effects. We retrospectively reviewed pediatric open-heart surgery cases to investigate the feasibility and clinical outcomes of a restrictive blood transfusion strategy. Our data suggests a restrictive transfusion strategy can be safely implemented in pediatric cardiac surgery. The majority of children with a body weight (BW) >8 kg require no blood products and those with a BW ≤8 kg require only 1 unit of blood, to prime the bypass circuit, during their hospitalization. Zero transfusion is a realistic and a safe option in children >10 kg with a predicted cardiopulmonary bypass duration of less than 90 minutes.
Early extubation has been adopted in some centres for select children following cardiac surgery. This strategy has been associated with improved resource utilization by shortening hospital length of stays, with the potential to reduce postoperative morbidities. We determined the feasibility and assessed the clinical outcomes associated with an early extubation strategy for all children undergoing congenital heart surgery, including neonates (<30 days). We assert that the majority of children undergoing congenital heart surgery can be extubated in the operating room. Most neonates, including many undergoing complex procedures, can be extubated in the first 24 hours after surgery. Early extubation is associated with low morbidity rates and short length of ICU and hospital stays.