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Induced hypothermia as salvage treatment for refractory cardiac failure following paediatric cardiac surgery.

AbstractOBJECTIVE:
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:
Induced hypothermia is a useful salvage treatment, in children following corrective cardiac surgery when all conventional treatment has been tried and failed.
AuthorsM J Dalrymple-Hay, C D Deakin, H Knight, J C Edwards, B Keeton, A P Salmon, J L Monro
JournalEuropean 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
PMID10371131 (Publication Type: Journal Article)
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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