Induced hypothermia as salvage treatment for refractory cardiac failure following paediatric cardiac surgery.
OBJECTIVE
Following corrective cardiac surgery in infants and children for congenital heart disease, a persistent low cardiac output refractory to conventional modes of treatment is associated with a mortality approaching 100%. We advocate the use of whole body hypothermia to reduce tissue oxygen demand and provide a degree of cellular protection against ischaemia allowing time for recovery. We describe our experience.


METHODS
Between July 1986 and December 1995, 1885 infants and children underwent surgery (operative mortality, 6%), 1302 requiring cardiopulmonary bypass. Fifty-seven patients had a persistent low cardiac output, impaired respiratory function, decreased urine output and acidosis despite maximal intensive care treatment. Cooling to 32-33 degrees C was therefore started using a thermostatically controlled water filled cooling blanket.


RESULTS
Following cooling, there was a fall in heart rate (P<0.001), a rise in mean arterial pressure (P<0.001) and a fall in mean atrial pressure (P<0.001). Significant (P<0.001) increases in pH and urine output were also recorded. Thirty-one (54%) of the 57 patients treated with cooling survived to leave hospital. No long-term sequelae have been noted in these patients.


CONCLUSIONS
Induced hypothermia is a useful salvage treatment, in children following corrective cardiac surgery when all conventional treatment has been tried and failed.
Dalrymple-Hay
M J
MJ
Wessex Cardiothoracic Centre, Southampton, UK.
Deakin
C D
CD
Knight
H
H
Edwards
J C
JC
Keeton
B
B
Salmon
A P
AP
Monro
J L
JL
D002303:Cardiac Output, Low / Q000209:etiology / Q000628:therapy*; D002648:Child; D006330:Heart Defects, Congenital / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D007036:Hypothermia, Induced; D007223:Infant; D011183:Postoperative Complications / Q000628:therapy*; D012189:Retrospective Studies; D016879:Salvage Therapy; D016896:Treatment Outcome