Perioperative Mechanical Circulatory Support in Children with Critical Heart Disease |
| |
Authors: | Paul A Checchia |
| |
Institution: | Divisions of Critical Care Medicine and Cardiology, St. Louis Children's Hospital, Washington University School of Medicine, One Children's Place, NWT 8th Floor, St. Louis, MO, 63110, USA, pchecchia@wustl.edu. |
| |
Abstract: | The treatment of cardiovascular failure in the perioperative period with the use of mechanical circulatory support is a well-recognized,
well-developed, and commonly utilized treatment modality. Regardless of the exact circumstances of initiation, the use of
a support device is a “bridge.” Where there has been an acute myocardial insult, short-term assist devices can serve as a
“bridge to immediate survival,” a “bridge to recovery,” or even a “bridge to the next decision.” Mechanical circulatory support
can serve as a treatment of cardiovascular decompensation caused by myocarditis, acute myocardial insult, low cardiac output
following surgery, and congenital heart disease. The utilization of such support carries significant risks such as bleeding,
infection, and thrombosis. However, these can be minimized in order to allow for the safe and effective deployment of this
therapeutic strategy. One specific therapeutic domain in which these devices provide immediate impact is during cardiac arrest.
Although outcomes of cardiac arrest remain poor, use of a mechanical device as an intervention has allowed salvage of otherwise
certain mortality. However, it is important to note that the utility of support was most pronounced in patients that were
not on either extreme of the survival prediction curve. This can be best summarized by the concept of “not too early, not
too late.” Therefore, it is the responsibility of the entire care team to find the appropriate patient population in which
to “pull the trigger” on mechanical support as a therapy. This decision point is supported by a monitoring strategy that can
be utilized to predict deterioration and intervene adequately. Most importantly, an effective monitoring strategy allows the
practitioner to judge the effectiveness of treatment and support strategies and make adjustments in a timely manner, potentially
with mechanical support in the perioperative period. |
| |
Keywords: | |
本文献已被 PubMed SpringerLink 等数据库收录! |
|