emprego do suporte cardiopulmonar com bomba centrífuga e oxigenador de membrana em cirurgia cardiovascular pediátrica use of centrifugal pump and extracorporeal membrane oxygenation as cardiopulmonary support in pediatric cardiovascular surgery

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ID: 178216
2008
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Abstract
FUNDAMENTO: O suporte cardiopulmonar com oxigenador de membrana é um método de ressuscitação de distúrbios hemodinâmicos, pulmonares ou ambos, consagrado em centros internacionais. OBJETIVOS: Descrever diversos aspectos relacionados ao suporte cardiopulmonar com oxigenador de membrana em um serviço de cirurgia cardiovascular nacional e determinar seus resultados imediatos e tardios. MÉTODOS: Entre outubro de 2005 e janeiro de 2007, 10 pacientes foram submetidos a suporte circulatório e/ou respiratório em candidatos ou submetidos a cirurgia cardiovascular pediátrica, com idade mediana de 58,5 dias (40% de neonatos) e peso mediano de 3,9 kg. O suporte foi mantido com a intenção de recuperação e desmame, de acordo com critérios clínicos e ecocardiográficos diários. O suporte foi descontinuado nos pacientes sem indicação de transplante, com incapacidade de recuperação e com sobrevida limitada, de acordo com julgamento multidisciplinar. RESULTADOS: O suporte circulatório foi utilizado no pós-operatório de operações corretivas ou paliativas em 80% e no pré-operatório no restante. Instabilidade hemodinâmica grave irresponsiva (40%), falência miocárdica na saída de circulação extracorpórea (20%) e parada cardíaca no pós-operatório (20%) foram as indicações mais freqüentes. O tempo médio de permanência em suporte circulatório foi de 58 ± 37 horas. O suporte foi retirado com sucesso em 50% e 30% obtiveram alta hospitalar. A sobrevida atuarial foi de 40%, 30% e 20% aos 30 dias, 3 meses e 24 meses, respectivamente. CONCLUSÃO: O suporte cardiopulmonar com oxigenador de membrana foi um método eficaz e útil na ressuscitação de distúrbios cardiovasculares e pulmonares graves no perioperatório de cirurgia cardiovascular pediátrica.
BACKGROUND: Extracorporeal membrane oxygenation is a well-documented resuscitation method in patients with severe hemodynamic and/or respiratory impairment. OBJECTIVE: To describe several aspects related to the use of extracorporeal membrane oxygenation in a pediatric heart center and determine its immediate and late outcomes. METHODS: Between October 2005 and January 2007, 10 patients who were submitted to pediatric cardiac surgery underwent extracorporeal membrane oxygenation implant. Median age was 58.5 days (40% neonates) and median body weight was 3.9 kg. Circulatory assistance was initiated aiming at the recovery and the weaning protocols followed daily clinical and echocardiographic criteria. Support was discontinued when transplant was contraindicated, when the patient was unable to recover or when survival was considered to be limited by a multidisciplinary team. RESULTS: Extracorporeal membrane oxygenation was employed after corrective or palliative heart surgery in 80% and preoperatively in the remaining ones. It was most often indicated for irresponsive hemodynamic instability (40%), post-cardiotomy shock (20%) and post-cardiac arrest (20%). The mean duration on support was 58 ± 37 hours. Weaning was successfully in 50% of the cases and 30% were discharged home. Actuarial survival was 40%, 30% and 20% at 30 days, 3 months and 24 months, respectively. CONCLUSION: Extracorporeal membrane oxygenation is an effective and useful tool for the resuscitation of patients presenting severe hemodynamic and/or respiratory failure in the perioperative period of pediatric cardiovascular surgery.
Reference Key
atik2008arquivosemprego Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors ;Fernando A. Atik;Rodrigo Santos de Castro;Fabiana Moreira Passos Succi;Maria Regina Barros;Cristina Afiune;Guilherme de Menezes Succi;Ricardo B. Corso;Cristiano N. Faber;Jorge Y. Afiune;Luiz Fernando Caneo
Journal revista cubana de ciencias informáticas
Year 2008
DOI
10.1590/S0066-782X2008000400001
URL
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2008000400001
Keywords
extracorporeal membrane oxygenation cardiovascular surgical procedures circulação extracorpórea com oxigenador de membrana

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