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Eur J Cardiothorac Surg 1999;15:515-518
© 1999 Elsevier Science NL

Induced hypothermia as salvage treatment for refractory cardiac failure following paediatric cardiac surgery¹

`Wessex Cardiothoracic Centre', Southampton, UK

Received 21 September 1998; received in revised form 26 January 1999; accepted 2 February 1999.

Corresponding author. Department of Cardiothoracic Surgery, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD UK. Tel.: +44-170-379-6241; Fax: +44-170-379-6614.

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°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. Conclusion: Induced hypothermia is a useful salvage treatment, in children following corrective cardiac surgery when all conventional treatment has been tried and failed.

Key Words: Cooling • Hypothermia • Cardiac failure • Paediatrics • Cardiac surgery