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. 2023 Jun 1;69(6):610-617.
doi: 10.1097/MAT.0000000000001872. Epub 2022 Dec 23.

Predictors of Mediastinal Exploration While on Extracorporeal Membrane Oxygenation After Pediatric Cardiac Surgery

Jason S Kerstein  1 , Phillip S Adams  2 , Timothy M Maul  3 , Jamie Stebler  4 , Tracy Baust  5 , Lucas Saenz  6 , Oluchi Albert  4 , David Palmer  4 , Victor O Morell  4 , Yuliya Domnina  7
Affiliations

Predictors of Mediastinal Exploration While on Extracorporeal Membrane Oxygenation After Pediatric Cardiac Surgery

Jason S Kerstein et al. ASAIO J. .

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%).

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Conflict of interest statement

Disclosure: There are no funding or conflicts of interest to disclose.

References

    1. Aiello S, Loomba RS: Factors associated with the need for, and the impact of, extracorporeal membrane oxygenation in children with congenital heart disease during admissions for cardiac surgery. Children (Basel) 4: 101, 2017.
    1. Annich G, Adachi I: Anticoagulation for pediatric mechanical circulatory support. Pediatr Crit Care Med 14(5 Suppl 1): S37–S42, 2013.
    1. Muntean W: Coagulation and anticoagulation in extracorporeal membrane oxygenation. Artif Organs 23: 979–983, 1999.
    1. Dalton HJ, Garcia-Filion P, Holubkov R, et al.; Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network: Association of bleeding and thrombosis with outcome in extracorporeal life support. Pediatr Crit Care Med 16: 167–174, 2015.
    1. Balasubramanian SK, Tiruvoipati R, Amin M, et al.: Factors influencing the outcome of paediatric cardiac surgical patients during extracorporeal circulatory support. J Cardiothorac Surg 2: 4, 2007.