Marcadores pronósticos de mortalidad en el postoperatorio de las cardiopatías congénitas

• Autores: J.A. García-Hernández, Isabel Lucía Benítez Gómez, Adoración I. Martínez López, JM Praena-Fernández, J. Cano-Franco, M. Loscertales Abril
• Localización: Anales de Pediatría: Publicación Oficial de la Asociación Española de Pediatría ( AEP ), ISSN-e 1696-4608, ISSN 1695-4033, Vol. 77, Nº. 6, 2012, págs. 366-373
• Idioma: español
• Títulos paralelos:
  • Prognostic markers of mortality after congenital heart defect surgery
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• Resumen

  • Introduction: Our aim is to identify risk factors for mortality after surgery for congenital heart disease in children, in order to establish indications for extracorporeal membrane oxygenation (ECMO).

    Patients and methods: One hundred and eighty six children underwent cardiac surgery with extracorporeal circulation from April 2007 to June 2009. The following parameters were measured serially during their stay in Paediatric Intensive Care (PICU): Arterial and venous blood pH, pCO2, base excess, oxygen saturation, arterio-venous oxygen saturation difference, oxygen extraction ratio, ventilatory dead space and intrapulmonary shunting.

    Results: Hospital mortality was 13,4%. The following risk factors for mortality were identi?ed:

    age, bypass time, inotropic score, lactate level upon arrival in PICU including its peak value and its rate of variation, mixed venous saturation, base excess, ventilatory dead space, oxygen extraction ratio, and intrapulmonary shunting. However, the strongest predictors of mortality were bypass time, lactate levels upon admission on PICU, and the peak lactate level. Multivariate analysis showed a lactate level of 6.3 mmol/l and a high blood lactate for 24 hours to be independent predictors of mortality.

    Conclusions: The peak lactate level is a strong predictor of mortality. As such, it would be a useful indicator of the need for ECMO support.