Abstract | OBJECTIVE: Following corrective cardiac surgery in infants and children for congenital heart disease, a persistent low cardiac output refractory to conventional modes of treatment is associated with a mortality approaching 100%. We advocate the use of whole body hypothermia to reduce tissue oxygen demand and provide a degree of cellular protection against ischaemia allowing time for recovery. We describe our experience. METHODS: Between July 1986 and December 1995, 1885 infants and children underwent surgery (operative mortality, 6%), 1302 requiring cardiopulmonary bypass. Fifty-seven patients had a persistent low cardiac output, impaired respiratory function, decreased urine output and acidosis despite maximal intensive care treatment. Cooling to 32-33 degrees C was therefore started using a thermostatically controlled water filled cooling blanket. RESULTS: Following cooling, there was a fall in heart rate (P<0.001), a rise in mean arterial pressure (P<0.001) and a fall in mean atrial pressure (P<0.001). Significant (P<0.001) increases in pH and urine output were also recorded. Thirty-one (54%) of the 57 patients treated with cooling survived to leave hospital. No long-term sequelae have been noted in these patients. CONCLUSION:
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Authors | M J Dalrymple-Hay, C D Deakin, H Knight, J C Edwards, B Keeton, A P Salmon, J L Monro |
Journal | European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
(Eur J Cardiothorac Surg)
Vol. 15
Issue 4
Pg. 515-8
(Apr 1999)
ISSN: 1010-7940 [Print] Germany |
PMID | 10371131
(Publication Type: Journal Article)
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Topics |
- Cardiac Output, Low
(etiology, therapy)
- Child
- Heart Defects, Congenital
(surgery)
- Hemodynamics
- Humans
- Hypothermia, Induced
- Infant
- Postoperative Complications
(therapy)
- Retrospective Studies
- Salvage Therapy
- Treatment Outcome
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