The emergent use of Cardiopulmonary bypass and extracorporeal membrane oxygenator in a child with sickle cell disease

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Published Sep 7, 2016
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Vol. 94 No. 4 (2016): Issue Apr 2016

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Ben Ameur Wassim
Ouerghi Sonia
Dridi Amira
Bousnina Mouna
Ben Youssef Atef
Kilani Tarek
Mestiri Tahar

Abstract

SUMMARY
The use of Cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenator (ECMO) in patients suffering from Sickle cell disease (SCD) needs specific precautions. Whereas, no consensual protocols have been established to clarify therapeutic management.
CASE REPORT: A 7-year-old boy was admitted to the hospital for surgery of advanced endocarditis.  Major dyspnea, hemodynamic distress and fever were noted on physical examination. Biological tests exploring anaemia revealed Haemoglobin (Hb) S levels of 39.1%. Echocardiography showed important right heart cavities dilation with multiple aortic vegetations. The child was accepted for emergent surgery. Ten minutes after anesthetic induction, serious hemodynamic distress was established. The patient was put on normothermic CPB when he received four packed red-blood-cell. After surgery, he was placed on ECMO support for 2 days than he succumbed.
CONCLUSION:Urgent cardiac surgery in patients suffering from SCD poses a major therapeutic dilemma. Multiplying case reports and encouraging prospective studies are necessary to define the right place of cardio-pulmonary assistance in treatment protocols for better management.

Keywords:

cardiopulmonary bypass, sickle cell disease, heart failure, anaemia, extracorporeal membrane oxygenator.

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References

  1. Carey PJ. Addressing the global health burden of sickle cell disease. Int Health. 2014 Dec;6(4):269-70.
  2. Sanders DB, Smith BP, Sowell SR, Nguyen DH, Derby C, Eshun F, et al. Sickle cell disease and complex congenital cardiac surgery: a case report and review of the pathophysiology and perioperative management. Perfusion. 2014;29(2):153-8.
  3. Bocchieri KA, Scheinerman SJ, Graver LM. Exchange transfusion before cardiopulmonary bypass in sickle cell disease. The Annals of thoracic surgery. 2010;90(1):323-4.
  4. Al-Ebrahim KE. Cardiac surgery and sickle cell disease. Asian Cardiovascular and Thoracic Annals. 2008;16(6):479-82.
  5. Marchant WA, Walker I. Anaesthetic management of the child with sickle cell disease. Paediatr Anaesth. 2003 Jul;13(6):473-89.
  6. Firth PG, Head CA. Sickle cell disease and anesthesia. ANESTHESIOLOGY-PHILADELPHIA THEN HAGERSTOWN-. 2004;101:766-86.
  7. Farrell K, Dent L, Nguyen ML, Buchowski M, Bhatt A, Aguinaga M del P. The relationship of oxygen transport and cardiac index for the prevention of sickle cell crises. J Natl Med Assoc. 2010 Nov;102(11):1000-7.
  8. Sachithanandan A, Nanjaiah P, Wright CJ, Rooney SJ. Mitral and tricuspid valve surgery in homozygous sickle cell disease: perioperative considerations for a successful outcome. Journal of cardiac surgery. 2008;23(2):167-8.
  9. Maddali MM, Rajakumar MC, Vishnu PP, Valliattu J. Management of sickle cell disease during CABG surgery--a case report. Middle East J Anaesthesiol. 2006 Oct;18(6):1139-45.
  10. Frimpong-Boateng K, Amoah AGB, Barwasser HM, Kallen C. Cardiopulmonary bypass in sickle cell anaemia without exchange transfusion. European journal of cardio-thoracic surgery. 1998;14(5):527-9.
  11. Usman S, Saiful FB, DiNatale J, McGinn JT. Warm, beating heart aortic valve replacement in a sickle cell patient. Interactive cardiovascular and thoracic surgery. 2010;10(1):67-8.
  12. Edwin F, Aniteye E, Tamatey M, Frimpong-Boateng K. eComment: Cardiopulmonary bypass without exchange transfusion in sickle cell disease-An update. Interactive cardiovascular and thoracic surgery. 2010;10(1):68-9.
  13. Poludasu S, Ramkissoon K, Salciccioli L, Kamran H, Lazar JM. Left ventricular systolic function in sickle cell anemia: a meta-analysis. J Card Fail. 2013 May;19(5):333-41
  14. Voskaridou E, Christoulas D, Terpos E. Sickle-cell disease and the heart: review of the current literature. Br J Haematol. 2012 Jun;157(6):664-73.
  15. Gladwin MT, Sachdev V. Cardiovascular abnormalities in sickle cell disease. J Am Coll Cardiol. 2012 Mar 27;59(13):1123-33.
  16. Harban FMJ, Connor P, Crook R, Bingham R. Cardiopulmonary bypass for surgical correction of congenital heart disease in children with sickle cell disease: a case series. Anaesthesia. 2008 Jun;63(6):648-51.
  17. Yousafzai SM, Ugurlucan M, Al Radhwan OA, Al Otaibi AL, Canver CC. Open heart surgery in patients with sickle cell hemoglobinopathy. Circulation. 2010 Jan 5;121(1):14-9.
  18. Djaiani GN, Cheng DC, Carroll JA, Yudin M, Karski JM. Fast-track cardiac anesthesia in patients with sickle cell abnormalities. Anesthesia & Analgesia. 1999;89(3):598.
  19. Edwin F, Tettey M, Aniteye E, Tamatey M, Sereboe L, Entsua-Mensah K, et al. The development of cardiac surgery in West Africa--the case of Ghana. Pan Afr Med J. 2011;9:15.
  20. Sharma A, Pokharel JN, Upreti MR, Koirala B, Sharma J, Pradhan S, et al. Initial experience with extracorporeal membrane oxygenation following cardiac surgery in children with congenital heart disease. Nepalese Heart Journal. 2014;11(1):39-44.
  21. Hoashi T, Kagisaki K, Yamashita K, Tatsumi E, Nishigaki T, Yoshida K, et al. Early clinical outcomes of new pediatric extracorporeal life support system (Endumo® 2000) in neonates and infants. Journal of Artificial Organs. 2013;16(3):267-72.
  22. Chauhan S, Malik M, Malik V, Chauhan Y, Kiran U, Bisoi AK. Extra corporeal membrane oxygenation after pediatric cardiac surgery: a 10 year experience. Ann Card Anaesth. 2011 Apr;14(1):19-24.
  23. Coskun KO, Coskun ST, Popov AF, Hinz J, El-Arousy M, Schmitto JD, et al. Extracorporeal life support in pediatric cardiac dysfunction. J Cardiothorac Surg. 2010;5:112.
  24. Balasubramanian SK, Tiruvoipati R, Amin M, Aabideen KK, Peek GJ, Sosnowski AW, et al. Factors influencing the outcome of paediatric cardiac surgical patients during extracorporeal circulatory support. J Cardiothorac Surg. 2007;2:4.
  25. Kolovos NS, Bratton SL, Moler FW, Bove EL, Ohye RG, Bartlett RH, et al. Outcome of pediatric patients treated with extracorporeal life support after cardiac surgery. Ann Thorac Surg. 2003 Nov;76(5):1435-1441; discussion 1441-1442.
  26. Baslaim G, Bashore J, Al-Malki F, Jamjoom A. Can the outcome of pediatric extracorporeal membrane oxygenation after cardiac surgery be predicted? Ann Thorac Cardiovasc Surg. 2006 Feb;12(1):21-7.
  27. Kuo KW, Cornell TT, Shanley TP, Odetola FO, Annich GM. The use of extracorporeal membrane oxygenation in pediatric patients with sickle cell disease. Perfusion. 2013 Sep;28(5):424-32.