Proactive Patient Management After Cardiac Bypass Surgery Improves Survival Rates
Proactive management of children who undergo cardiac surgery and receive extracorporeal membrane oxygenation (ECMO) support may significantly increase survival rates, according to results of a new study presented here November 1st at the American Academy of Paediatrics national conference.
Recently initiated post-surgery management modifications such as starting ECMO sooner after surgery and using left-atrial decompression are proving beneficial and may reduce the need for cardiopulmonary resuscitation (CPR) in the early days after surgery, noted chief investigator David Chun, MD, Riley Hospital for Children, Indianapolis, Indiana, United States.
To determine whether modifications in post-surgical management were resulting in improved outcomes, the researchers evaluated 76 patients with a mean age 7 months, who required ECMO following cardiac surgery. Patient assessment included overall survival rates, time of ECMO initiation, use of left atrial decompression and need to perform CPR before ECMO. Of the patients studied, 60 were treated between 1995 and 2000 and 16 in 2001-2002. More than 2,083 children underwent cardiac surgery at the institution during the 7-year period.
In addition to increased ECMO use — from 3.5% of patients between 1995 and 2000 to 4.4% in 2001-2002 — Dr. Chun and colleagues found that use of left atrial decompression nearly doubled in 2001-2002 (81%) compared to 1995-2000 (42%). The most significant change was the more rapid initiation of ECMO; treatment was initiated an average of 49 hours after surgery in the first study period, compared to 6 hours post-surgery in the later period. A corresponding decrease in need for CPR was found — from 43% to 25% respectively.
The most dramatic finding was that ECMO survival increased from 45% to 88%, an improvement that Dr. Chun attributed largely to the increased use of left atrial decompression, which enables the heart to recover function faster. He noted that the survival increase occurred without a concurrent increase in ECMO use, suggesting that the trend toward more proactive management of actual and potential post-surgery complications and risk factors are resulting in better long-term outcomes.
