ECMO simulation training during a worldwide pandemic: The role of ECMO telesimulation.

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is a supportive therapy used in the most severe forms of acute respiratory distress syndrome. Due to its intrinsic complexity and relatively low annual volume, simulation is essential for efficient and appropriate ECMO management. COVID-19 has limited the opportunities for high-fidelity in-person simulation training when many hospitals are looking to expand their ECMO services to battle the ongoing pandemic. To meet this demand, the National Cardiovascular Center Harapan Kita, Jakarta, Indonesia, conducted a 3-day ECMO course entailing online didactic lectures (adult and paediatric stream), water drills and telesimulation. PURPOSE: The purpose of the study is to report the evaluation result of this novel model of education during COVID-19 outbreak. DATA COLLECTION: Participants were given an ECMO knowledge pre-course and post-course test and a telesimulation evaluation survey at the conclusion and these data were collected. RESULTS: The course was attended by 104 physicians, critical care nurses and perfusionists. Pre-course and post-course assessments showed a significant improvement in ECMO knowledge (60.0% vs 73.3%, respectively). Overall, the participants rated the telesimulation positively, and most found it acceptable to in-person simulation training considering the pandemic restrictions. CONCLUSION: Despite the complexities of ECMO, our recent experience demonstrates ECMO education and simulation delivered online is feasible, welcomed and supportive of a change in ECMO training course format. As we incorporate more innovative digital technologies, telesimulation may further enhance the quality of future ECMO training.

Thiamine levels in Indonesian children with congenital heart diseases undergoing surgery using cardiopulmonary bypass machine.

BACKGROUND: This study evaluated thiamine levels in Indonesian children with congenital heart diseases before and after cardiopulmonary bypass and their relationship with clinical and surgical outcomes. METHOD: A prospective, single center cross-sectional study was conducted to evaluate thiamine levels in 25 children undergoing congenital heart diseases surgery with cardiopulmonary bypass procedure. Thiamine levels were quantified using a high-performance liquid chromatography method. RESULT: Preoperative thiamine deficiency was observed in one subject. Thiamine levels did not differ statistically between nutritional status and clinical outcomes categories. There were no significant changes in thiamine levels before and after cardiopulmonary bypass (median pre versus post (P25-75): 50 ng/mL (59.00-116.00) and 83.00 ng/mL (70.00-101.00), p = 0.84), although a significant reduction in thiamine levels were observed with longer cardiopulmonary bypass duration (p = 0.017, R = -0.472). CONCLUSION: Thiamine levels were not significantly impacted by cardiac surgery except in patients undergoing extremely long cardiopulmonary bypass duration. However, clinical outcome was not affected by thiamine levels.

Prevalence and predictors of postoperative peritoneal dialysis in infants.

BACKGROUND: Data regarding predictors of the eventual need for postoperative peritoneal dialysis in infants undergoing open heart surgery is still limited. We aimed to determine whether prolonged cardiopulmonary bypass time, surgical complexity classified according to Risk Adjustment for Congenital Heart Surgery category, younger age, and lower body weight increase the probability of requiring postoperative peritoneal dialysis. METHODS: We retrospectively analyzed data of 181 infants who underwent open heart surgery at our institution from January 1 to December 31, 2018. Cardiopulmonary bypass time, Risk Adjustment for Congenital Heart Surgery category, age, body weight, and the need for postoperative peritoneal dialysis were recorded and analyzed. RESULTS: Thirteen (7.2%) of the 181 patients required postoperative peritoneal dialysis. This group was found to have a longer cardiopulmonary bypass time, younger age, and lower body weight. Longer cardiopulmonary bypass time (p = 0.001), higher Risk Adjustment for Congenital Heart Surgery category (p = 0.018), younger age (p < 0.001), and lower body weight (p < 0.001) significantly increased the risk of postoperative peritoneal dialysis. CONCLUSION: Longer cardiopulmonary bypass time, more complex surgery, younger age, and lower body weight increase the probability of requiring postoperative peritoneal dialysis in infants undergoing open heart surgery.

Did Malnutrition Affect Post-Operative Somatic Growth in Pediatric Patients Undergoing Surgical Procedures for Congenital Heart Disease?

OBJECTIVES: This study aims to investigate the impact of pre-operative malnutrition on nutritional outcome following congenital heart defects surgery. DESIGN: This is a prospective cohort study. SETTING: Pediatric Cardiac Intensive Care, Harapan Kita National Cardiovascular Center, Jakarta, Indonesia. PATIENT: Pediatric patients, aged younger than 36 months old with Aristotle score of 6-10, undergoing congenital heart defects surgery with cardiopulmonary bypass were included in this study. MEASUREMENT: The measured outcome was nutritional outcome based on body weight changes before and after corrective surgery. The measured variables were age, gender, Aristotle score, caloric intake (in pediatric cardiac intensive care unit and pediatric ward), length of stay, albumin level, and prealbumin level. RESULTS: Among 185 patients, 6% increase of body weight was observed within 12 days of observation (p = 0.007). From bivariate analysis, post-operative nutritional status improvement was significantly associated with pre-operative Z-score for weight-for-age (p = 0.011), caloric intake in pediatric ward (p < 0.0001), and prealbumin level (p = 0.038). From multivariate analysis, caloric intake in pediatric ward remained as a factor which significantly determined post-operative nutritional status (p = 0.001, OR = 1.33, 95% CI 1.014-1.053). CONCLUSION: Malnourished patients may have significant improvement in somatic growth following corrective surgery but no effect was observed on the post-operative body weight gain. Adequate nutritional support is important to ensure optimal recovery and better nutritional outcome.