ABSTRACT
ABSTRACT
Introduction:
The current recommendation for systemic to
pulmonary artery shunt (SPS)
patients requiring
extracorporeal life support (ECLS) is to keep the shunt open, maintaining a higher pump flow. The practice in our center is to totally occlude the shunt while on ECLS, and we are presenting the outcome of this strategy.
Methods:
This is a retrospective
analysis of
patients who underwent SPS for cyanotic
congenital heart disease with decreased
pulmonary blood flow and required postoperative ECLS between January 2016 and December 2020. ECLS indication was excessive
pulmonary blood flow, leading to either refractory
low cardiac output syndrome (LCOS) or
cardiac arrest. All
patients had their shunts totally occluded soon after ECLS establishment.
Results:
Of the 27 SPS
patients who needed postoperative ECLS (13 refractory LCOS, 14 extracorporeal
cardiopulmonary resuscitation), wherein the strategy of occluding the shunt on ECLS initiation was followed, 16 (59.3 %) survived ECLS
weaning and eight (29.6%) survived to discharge.
Conclusion:
Increased flow to maintain systemic circulation for a SPS
patient while on ECLS is an accepted strategy, but it should not be applied universally. A large subset of SPS
patients,
who require ECLS either due to
cardiac arrest or refractory LCOS due to excessive pulmonary flow, might benefit from complete occlusion of the shunt soon after commencement of ECLS, especially in cases with frank
pulmonary edema or haemorrhage in the pre-ECLS period. A prospective randomized trial could be ethically justified for the subset of
patients receiving ECLS for the indication of excessive
pulmonary blood flow.