CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
63
etc) and are performed not only for diagnosis but also for monitoring
management.
The presentation will give the results of four years of experience
in our centre with regard to this new essential skill in PCICU in
obtaining hour-by-hour information to help the management of criti-
cally ill paediatric cardiac patients. In addition, it shows the multiple
procedures that were guided by ultrasound, such as vascular access,
lumbar puncture or pleural tap. It will also shed light on its important
application in the telemedicine field.
1765: IDENTIFYING THE RISK FACTORS FOR CHYLO-
THORAX FOLLOWING CARDIAC SURGERY IN CHIL-
DRENWITH CONGENITAL HEART DISEASE
Antigoni Deri
1
, Trinette Steenhuis
1
, Rachel Meskell
2
, Kathryn
Lightfoot
2
, John Thomson
1
1
Yorkshire Heart Centre, Leeds, UK
2
Leeds Teaching Hospitals, NHS Trust, Leeds, UK
Background:
Chylothorax is a rare but well-recognised complication
following cardiac surgery in paediatric patients with congenital heart
disease (CHD).
Methods:
We retrospectively studied the paediatric patients with
CHD who developed chylothorax following cardiothoracic surgery
at the Yorkshire Heart Centre. Data regarding age, diagnosis, type of
surgery, management and outcome were collected from the cardiac
database and the dietetic records of the department for a seven-year
period (July 2005 to June 2012).
Results:
A total of 2 290 cardiothoracic operations were performed
in our centre in paediatric patients with CHD during the above
period. Chylothorax complicated 117 of these procedures, incidence
of 5.1% (95% CI: 4.2–6%). The age ranged from one day to 14
years: 59% were under the age of one year, 31.6% between one and
five years, and the rest were older. The incidence of chylothorax was
higher following repair of tetralogy of Fallot (
n
=
22, 18.8%), atrio-
ventricular septal defect repair (
n
=
16, 13.7%), Glenn (
n
=
14, 12%),
ventricular septal defect closure (
n
=
11, 9.4%), arch repair (
n
=
11,
9.4%), arterial switch (
n
=
8, 6.8%), Fontan (
n
=
6, 5.1%), totally
anomalous pulmonary venous drainage (
n
=
5, 4.3%). Previous
cardiac surgery was performed in 40 (34.2%) patients. Median
sternotomy was the approach in 103 (88%) patients, whereas a left
thoracotomy was performed in 14 (12%). There was no difference in
the percentage of patients requiring further treatment with octreotide
(
n
=
29, 28.2% for the median sternotomy group,
n
=
4, 28.6% for the
left thoracotomy group). Death occurred in 14 patients, 12 of whom
were under the age of one year.
Conclusions:
Younger age, median sternotomy and certain types of
operation (TOF, AVSD repair, Glenn) seem to constitute risk factors
for the development of chylothorax. Increased mortality rate was
observed in infants. The type of sternotomy did not correlate with the
need for the use of octreotide.
1776: ULTRASOUND-GUIDED VASCULAR ACCESS IN
CRITICALLY ILL CARDIAC CHILDREN
Mahmoud Elbarbary, Ghassan Shaath, Abdulraouf Jijeh, Mohamed
Kabbani
King Abdulaziz Cardiac Centre, Saudi Arabia
Vascular access in the paediatric age group is a challenging proce-
dure, especially in compromised children and those who require
multiple vascular cannulation. Critically ill paediatric cardiac patients
particularly are in frequent need of vascular access. We report on our
experience of vascular access under ultrasound guidance in children
with congenital heart disease and we discuss the technique of line
insertion and its difficulties in small infants.
Methods:
In the paediatric cardiac intensive care unit we prospec-
tively enrolled all the trials of vascular access (central or arterial
lines) guided by ultrasound from January to September 2010. Age,
weight, the time from first needle puncture to wire insertion, site of
insertion, number of attempts, type of the line and complications
were documented.
Results:
Seventy-seven vascular access trials were performed in 43
patients. They included 15 arterial and 62 venous cannulations (32
femoral veins and 30 internal jugular veins). Mean age and weight
of patients were 15 months (6 days – 11 years, median 2.5 months)
and 7.2 kg (2 – 46 kg, median 3.8), respectively. Success rates were
93 and 95% for arterial and venous cannulation, respectively. Mean
time from first needle puncture to wire insertion was 3.9 min (0.5–15
min, median 2 min). Fifty-five central-line cannulations (75%) were
successful from the first puncture, 17 (23%) were successful from the
second puncture and one case (2%) required three punctures. Lower
body weight did not affect success rate, as 30 patients (45%) were
less than 3.5 kg with 96.6% successful cannulation rates. There were
no associated complications.
Conclusion:
Ultrasound-guided vascular cannulation in critically ill
paediatric patients is very useful. It is associated with high success
rates and minimal complications.
1802: COMBINED ECMO AND CRRT IN CHILDREN
Rolf Dall, A Nielsen, P Fjeldborg
Department of Anesthesiology and Intensive Care, Aarhus University
Hospital, Skejby, Denmark
Background
: Venous–arterial/venous–venous extracorporeal circu-
latory membrane oxygenation (VA/VV-ECMO) is needed in cases
of severe respiratory and/or circulatory failure. Reported mortal-
ity rates for ECMO-treated paediatric patients are high and even
higher when combined with renal failure (
>
80%). These children
are often grossly fluid overloaded and oliguric. Successful CRRT in
infants depends on good vascular access, which can be impossible
to achieve. Therefore we have incorporated connections for CRRT
apparatus as a standard in our paediatric ECMO circle.
Methods
: Seven PICU patients were enrolled [median age 10 days
(3–665); median weight 3.4 kg (2.9–10)]. Six of the patients were
on VA-ECMO after surgery for congenital heart disease and one
oncological patient with
Aspergillum
pneumonia
was on VV-ECMO.
We used the Prismaflex device (Gambro, Lund, Sweden). Dialysis
filters were HF-20 filters, except for one patient where M60 was
used (Gambro Industries, Lyon, France). The dialysis filters were
primed with blood, apart from the M60 filter, which was primed with
fresh frozen plasma. Blood flow targeting 7.5–10 ml/kg/min; modi
CVVHDF/CVVHF using dialysis/effluent fluid doses targeting 2 000
ml/1.72 m
2
/h. All patients received heparin infusion aiming at APTT
range 60–80 s. Both the inlet and outlet connections for the blood
flow to the Prisma apparatus were placed after the ECMO pump
head and before the oxygenator to minimise the risk of air embolism.
Results
: CRRT treatment time was a median of 89 hours; range
0.8–328 hours. A precise filter lifetime was not recorded but no filter
was reported to have stopped due to clotting. The CRRT treatment
was without impact on the haemodynamic parameters. We obtained
intended negative fluid balance, and were able to administer TPN
and reduce azotemia levels. Unfortunately all seven seven patients
died in hospital.
Conclusion
: In infants, CRRT using Prismaflex with HF20 and
M60 filters inserted into the ECMO circle is technically feasible.
Incorporation of preformed connections for CRRT in ECMO circles
had no impact on ECMO treatment and provided steady blood flow
for the CCRT.
1807: VALIDATION STUDY OF A CLINICAL HEART FAIL-
URE SEVERITY SCORING SCALE IN CHILDREN, USING
BRAIN NATRIURETIC PEPTIDE AND ECHOCARDIO-
GRAPHIC PROFILES
Samuel Omokhodion
1
, Oluwatoyin Ogunkunle
1
, Adanze Asinobi
1
,
Idowu Ayede
1
, Atinuke Agunloye
2
, Bosede Adebayo
1
, Adura
Adedapo
3
, Akin Adedapo
4
, Debowale Ademola
4
1
Department of Paediatrics, College of Medicine, University College
