CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
45
significantly lower than prior literature reports. Our findings also
suggest that ECG LVH criteria do not correlate with LVH findings
by echo. We suggest that ECG may be redundant for initial evaluation
of hypertension.
1237:THE SCVO
2
/LACTATE RATIO FOLLOWING SURGERY
FOR HYPOPLASTIC LEFT HEART SYNDROME
Richard Ing
1
, Christoph Hornick
2
, Kevin Hill
2
, Warwick Ames
2
, Guy
Dear
2
, Scott Stenquist
1
, Andrew Lodge
2
, James Jaggers
1
1
Children’s Hospital Colorado, University of Colorado, Denver, USA
2
Duke University Medical Center, Durham, North Carolina, USA
Introduction:
Mortality following stage I hypoplastic left heart
syndrome (HLHS) surgical repair is variable and may be as high as
25%. Postoperative low cardiac output is a significant risk factor for
mortality and has been shown to be associated with a low central
venous oxygen saturation (ScvO
2
) and high lactate level. In cases
where a ScvO
2
/lactate ratio is
<
5, major postoperative adverse events
have previously been reported in a heterogenous group of patients.
Hypothesis:
A ScvO
2
/lactate ratio
<
5 is a predictor of major adverse
postoperative events following stage I HLHS repair.
Methods:
Following IRB approval, 37 infants having undergone
HLHS stage I repair at one institution from 2004 to 2009 were
examined retrospectively. Outcomes for subjects with a ScvO
2
/lactate
ratio
≥
5 or
<
5 were compared using a Mann-Whitney
U
-test and
Chi-square test. A two-tailed
p-
value
<
0.05 was considered signifi-
cant. Analyses were performed using Stata 12.0 (College Station, TX).
Results:
Overall 30-day mortality was 19% (7/37). Six/36 infants
had a ScvO
2
/lactate ratio
<
5 within 24 hours ofg surgery. One of
seven deaths (14.3%) occurred following hospital discharge. ECMO
was required in three/37 infants (8%) and one/three survived to
hospital discharge. Prolonged mechanical ventilation (
>
14 days) was
necessary in 10/37 (27%). The ScvO
2
/lactate ratio was not signifi-
cantly correlated with overall mortality (
p
=
0.6), need for ECMO
(
p
=
0.7), hospital LOS (
p
=
0.3), and ICU LOS (
p
=
0.3). However,
a ScvO
2
/lactate ratio
<
5 was associated with need for prolonged
mechanical ventilation (83 vs 25%,
p
=
0.01).
Conclusion:
A ScvO
2
/lactate ratio
<
5 was not significantly associ-
ated with outcomes following stage I repair for HLHS except for the
need for prolonged mechanical ventilation. Further studies of mark-
ers of postoperative low-cardiac output syndrome are needed in this
patient population.
1243: DEVELOPMENT OF A NOVEL CONGENITAL CARDI-
AC ANAESTHESIA DATABASE
David Vener
Baylor College of Medicine, Texas Children’s Hospital, Houston,
TX, USA
The Congenital Cardiac Anesthesia Society (CCAS) partnered with
the Society of Thoracic Surgeons’ Congenital Heart Surgery data-
base (STSCHSD) beginning on 1 January 2010. The CCAS chose
to collaborate with the STSCHSD because of the interconnected
nature of our patient populations and the multiple data fields of
interest to both groups. This combined dataset would minimise the
duplication of efforts in entering data such as patient demographics,
diagnoses and procedures for those cases occurring in the operating
room. In addition, for the first time, the STSCHSD was opened up
to procedures occurring outside the operating room on patients with
congenital cardiac lesions undergoing non-surgical procedures such
as cardiac catheterisations, radiological procedures (cardiac MRI, CT
and interventional radiology), and non-cardiac operations on patients
requiring cardiovascular anaesthesia because of their underlying
physiology. Anaesthesia is one of the common denominators in the
care of these patients throughout their hospitalisations and it has
been well established that this subset of patients experiences cardiac
arrests at a far higher rate than comparably aged children undergoing
similar procedures without congenital heart defects. By the Spring
2012 data harvest, representing 1 January 2010 to 31 December
2011, 30 institutions from a wide geographic and programme size in
the United States had submitted data on over 20 000 discrete anes-
thetics. Data submitted included information on patient demograph-
ics, pre-operative medications, intra-operative anaesthetic manage-
ment and monitoring and anesthesia-related adverse events. As this
data set grows it can serve as a model for other anaesthesia popula-
tions as well as act as an enormous ‘data sink’ that can be mined for
both care- and outcomes analysis.
1258: UTILITY OFARGININEVASOPRESSIN IN NEONATES
WITH PERSISTENT PULMONARY HYPERTENSION OF
THE NEWBORN RETRIEVED FOR EXTRA-CORPOREAL
MEMBRANE OXYGENATION
Mark Duthie, Nana-Akyaa Yao, Simon Robinson, Jenny Burgess
Glenfield Hospital, Leicester, UK
Background:
Our institution uses arginine vasopressin (0.06–0.09
U/kg/h) in stabilisation of PPHN infants with high inotropic require-
ments (
≥
0.1 mcg/kg/min of adrenalin) for potentiation of adrenalin
and sparing pulmonary vascular resistance. This application of vaso-
pressin is unpublished.
Methods:
A retrospective chart review was done of neonatal ECMO
retrieval deom January 2010 to August 2012. Inclusion criteria:
echo-proven PPHN, structurally normal heart, vasopressin used for
transport, complete dataset at pickup and on return (before ECMO).
Exclusion criteria: congenital diaphragmatic hernia. Paired
t
-test
(two-tailed) was used to analyse data. Group characteristics: 14
term neonates, five girls, aged one to four days, mean weight 3.8
kg. Ten had meconium aspiration, eight proven or suspected sepsis,
six received hydrocortisone, all inhaled nitric oxide. Transport times
were two to four hours (mean 2 h 50 min), 11 were given ECMO
(seven veno-arterial, four veno-venous). All survived back-transfer
to the referring unit at a median of six days.
Conclusions:
Despite small numbers, retrospective design and
patients as own controls, this data suggests vasopressin improves
blood pressure and reduces vasoactive inotrope score in PPHN. A
larger prospective study is warranted.
1263: EFFECT OF CARDIOPULMONARY BYPASS ON
NERVE CONDUCTION VELOCITES IN INFANTS
Vishal Jatana
1
, Christopher Troedson
1
, Russell Dale
1,2
, David Baines
1
,
David Winlaw
1,2
, Andrew Cole
1
1
Children’s Hospital, Westmead, Australia
2
University of Sydney (CHW), Sydney, Australia
Objectives:
To report on the effect of cardiopulmonary bypass
(CPB)-induced systemic inflammatory response syndrome (SIRS)
on nerve conduction velocities (NCV) in infants undergoing elective
cardiac surgery.
Methods:
This was a pilot study with prospective recruitment of six
infants admitted to hospital requiring elective cardiac surgery under
bypass. Non-syndromic infants aged between three and 12 months
who were to undergo elective ventricular septal defect or tetralogy of
Fallot repair were consented for study at the pre-admission clinic. On
the morning of surgery, an initial nerve conduction study (NCS) was
performed under anaesthesia before administration of any muscle
relaxants. After surgery, patients were shifted to the paediatric inten-
sive care unit where a second study was performed 24 hours after
the initial study if infants remained intubated for 24 hours or longer.
Preliminary
results:
Critical illness polyneuropathy (CIPN) and
critical illness myopathy are commonly reported in the intensive
care setting. SIRS, induced by various mechanisms, is a known risk
factor for the development of both. Our aim was to study whether
SIRS induced by CPB altered NCV in any detectable way. Five of six
patients underwent a second NCS 24 hours after the first study. None
had any clinical change in their neurological examination or NCV
as assessed by a paediatric neurologist proficient in performing this
