Andersons pediatric cardiology 1727

Bedside Care of the Patient on Temporary Mechanical Support The bedside care of patients on ECLS is typically provided by ECLS specialists, in collaboration with the regular clinical team ECLS specialists can be ICU trained nurses, respiratory therapists, or perfusionists These individuals are required to undertake focused training in core competencies that includes physiology, anatomy, scenario, and skills training in the context of simulation and/or wet labs In addition, while requirements are not standardized between institutions, ECLS specialists are typically required to log a number of bedside hours in order to maintain their competency or certification They are also required to have a detailed understanding of the pathophysiology of coagulation management of patients on ECLS Most centers have a set curriculum with certification, and then periodic recertification, in order to ensure that all team members retain the necessary skill set.34,93 For the ECLS specialists and bedside nurses, an understanding of the benefits and limitations of ECLS in general and in relationship to the patient they are caring is essential This patient population requires a high degree of acute care resources and specialist care The nursing team's efforts can directly impact outcomes of these patients throughout the ECLS continuum In addition to maintaining the clinical status of the child, the nursing team also provides support to the psychosocial aspects of the family during this critical time The nursing team effort, along with other multidisciplinary teams, must continue to evaluate treatment modalities and update techniques to maintain quality of care for this challenging patient population Survival After Extracorporeal Life Support In 2016, the ELSO registry released their international report for ECLS from 2009 to 2015.2,3 Despite some survival variation by ECLS indication and age, the figures have remained relatively stable over nearly two decades.94 The registry contains nearly 80,000 total ECLS cases including children and adults The overall success to wean off from ECLS was 70%, with 58% surviving to discharge In neonates, the registry contains 7243 cases with 45% surviving to discharge, whereas in children, the registry contains 9479 cases with 57% surviving to discharge Patients with cardiomyopathy and myocarditis continued to have higher survival rates at 76%, while those requiring ECLS for cardiac arrest and congenital cardiac disease had the lowest, with 45% and 44%, respectively Children with congenital cardiac disease such as hypoplastic left heart syndrome, LV outflow obstruction, and cyanosis with increased pulmonary blood flow had lower survival rate, irrespective of their age, while right-sided obstructive lesions were associated with highest survival of 62% Summary In recent years, ECLS has experienced remarkable advances in the management of children with acute circulatory failure, which have been associated with improved outcomes in increasingly complex patient groups These advances include the programmatic approach to support, refinements in circuitry, proactive decision-making, and a better understanding of the circulatory physiology of patients during acute mechanical support It is essential to fully inform families when considering ECLS, since it is a therapy that only provides temporary support One of the main goals of ECLS is to optimize cardiovascular function while allowing for myocardial recovery from the cardiovascular insult In order to maximize the chance of weaning from support, it is important to consider additional investigations and therapeutic interventions as necessary After weaning support and successful decannulation, patients will typically require a prolonged recovery It is important for providers to recognize the serious comorbidities associated with ECLS Therefore ECLS success should not only be examined in terms of survival, but also in terms of presence of comorbidities and the long-term neurologic state of these patients Annotated References Thiagarajan RR, Barbaro RP, Rycus PT Extracorporeal life support organization registry international report ASAIO J 2016;60–67 A recent report from the ELSO registry, with specific reference to contemporary outcomes in children and adult requiring ECLS Hoffman TM, Wernovsky G, Atz AM Efficacy and safety of milrinone in preventing low cardiac output syndrome in infants and children after corrective surgery for congenital heart disease Circulation 2003;996–1002 A classic study that demonstrated the utility of supplemental vasoactive support in children after cardiac surgery Ghanayem NS, Wernovsky G, Hoffman GM Nearinfrared spectroscopy as a hemodynamic monitor in critical illness Pediatr Crit Care Med 2011;S27–S32 A well-written study of the use of NIRS during pediatric critical illness Penny DJ, Redington AN Doppler echocardiographic evaluation of pulmonary blood flow after the fontan operation: the role of the lungs Br Heart J 1991;372–374  ... monitor in critical illness Pediatr Crit Care Med 2011;S27–S32 A well-written study of the use of NIRS during pediatric critical illness Penny DJ, Redington AN Doppler echocardiographic evaluation of pulmonary