Central Venous Catheter Selection, Management, and Treatment of Catheter-Associated Deep Vein Thrombosis in Children Undergoing Cardiac Surgery: A Survey of Pediatric Cardiac Critical Care Consortium Centers
Kim JS, Patregnani JT, Ankola AA, Schumacher K, Klugman D, Giglia TM, Baltagi SA, Baylor JG, Bressler E, Downey LA, Linder J, Marcus BS, Yeh J, Zhang W, Werho DK and
Children undergoing surgery for congenital heart disease (CHD) are at risk for catheter-associated deep vein thrombosis (CA-DVT). We sought to understand the practice variations which may impact the risk for CA-DVT by conducting a comprehensive survey. Analysis of electronic survey of Pediatric Cardiac Critical Care Consortium (PC) hospitals caring for children undergoing surgery for CHD. Responses from 45 respondent PC4 centers was analyzed; 71% of centers (n = 32) had a prophylactic anticoagulation protocol. Two of the 45 respondent centers utilized a protocol for proactive screening for CA-DVT; 64% of centers (29/45) treated CA-DVT for a duration of 6 to 12 weeks. Internal jugular central vein catheters (CVC) were the most common primary access in children who were 1 to 18 years of age undergoing surgery (89% [40/45] of centers) and in infants 1 to 12 months of age (73% [33/45] of centers). Significant variability CVC-type selection was reported in neonates (<30 days of age). More than half of centers reported avoiding upper extremity peripherally inserted central catheter placement in patients both prior to and after stage 2 palliation for single ventricle CHD (58% [26/45] and 53% [24/45], respectively). Significant variability in prevention and management of CA-DVT is reported among PC centers. Only half of respondent PC4 centers reported having an established treatment protocol for CA-DVT. Consensus and evidence-based guidelines for the treatment of CA-DVT are not consistently followed with only 62% (28/45) of centers reported treating for the recommended 6 to 12 weeks with anticoagulation. There is high variability in CVC-type and location selection in neonates undergoing CHD surgery.
Diaphragm dysfunction following congenital heart surgery: Epidemiology and outcomes
Ruppe M, DeWitt A, Schumacher KR, Jacobs JP, Algaze CA, Smith A, Akins R, Mikesell K, Zhang W, Austin E and Lasa JJ
To leverage a large clinical registry of pediatric cardiac critical care patients to better understand current practices related to the diagnosis and management of patients with diaphragm dysfunction (DD) following congenital heart surgery (CHS).
Risk Factors Associated With Central Venous Catheter-Associated Deep Vein Thrombosis After Pediatric Congenital Heart Surgery: An Analysis of the Pediatric Cardiac Critical Care Consortium Registry
Patregnani JT, Ankola AA, Kim JS, Downey L, Klugman D, Baltagi S, Linder J, Banerjee M, Zhang W, Mikesell K, Schumacher K, Giglia T and Werho DK
Infants and children undergoing cardiac surgery are one of the highest-risk groups for thrombosis and its sequelae. We sought to define the current rate of and risk factors for postoperative central venous catheter (CVC)-associated deep vein thrombosis (CA-DVT) using the Pediatric Cardiac Critical Care Consortium (PC) dataset. Retrospective review of PC database from February 2019 to February 2022. Children <18 years of age admitted for a surgical encounter who had a CVC placed. Included were 33,491 patient encounters, of whom 37.6% (12,582/33,491) were infants (<12 months of age). The overall CA-DVT rate was 2.5% (844/33,491), which varied widely among centers (0-11%). Multivariable analysis showed increased risk of CA-DVT with increasing Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) category (STAT 2 HR 1.8, CI [1.26-2.65]; STAT 3 HR 2.2, CI [1.56-3.39]; STAT 4 HR 2.1, CI [1.55-2.93]; STAT 5 HR 2.5, CI [1.69-3.82]), ( < .001 for all), low cardiac output syndrome (HR 1.5, CI [1.25-1.91]), < .001, and postoperative arrhythmia (HR 1.23, CI [1.03-1.47]) = .024). Patients with CA-DVT were less likely to have an internal jugular vein catheter or intracardiac line and more likely to have an umbilical venous catheter, femoral vein CVC, peripherally inserted CVC, and/or multiple CVCs. CA-DVT remains an important postoperative complication after pediatric cardiac surgery, with greatest risk of occurrence in the younger, smaller, more surgically complex by STAT category, and hemodynamically vulnerable patients. These risk factors must be considered when developing paradigms for CVC placement, thromboprophylaxis, and diagnosis/treatment of CA-DVT in the future.
Impact of impaired foetal maternal environment on neonates with CHD: are we ready for the mother-baby dyad?
Savla J, Schumacher K, Mikesell K, Banerjee M, Ball M, Bhat P, Bhat A, Bhatt S, Chan T, Chaudhry P, Frank DU, Killen S, Krishnan A, Mistry K, Neumayr TM, Patel A, Savorgnan F, Son S, Zakaria D, Tabbutt S and Steurer M
Emerging evidence suggests that an impaired foetal environment-defined as maternal factors such as hypertensive disorders and diabetes-might contribute to outcomes in neonates with CHD. With this multicentre study, we prospectively collected data regarding impaired foetal environment to assess the impact on mortality in two ventricle and single ventricle neonates with CHD.
Proactive versus Resuscitative Extracorporeal Membrane Oxygenation for Low Cardiac Output Syndrome after Cardiac Surgery
Halloum A, Tabbutt S, Ghanayem N, Lasa JJ, Banerjee M, Zhang W, Mikesell K, Charpie JR, McCammond AN, Moynihan KM, Panchal A, Raymond TT and Steurer MA
We sought to evaluate extracorporeal membrane oxygenation (ECMO) use for low cardiac output syndrome (LCOS) following congenital heart surgery. Our primary aims were: (1) To compare hospital mortality and morbidity for proactive ECMO versus extracorporeal cardiopulmonary resuscitation (ECPR). (2) To assess the impact of CPR duration. Our secondary aim was to investigate pre-ECMO vasoactive inotropic scores (VIS).
