Ajay Desai

Guy's and St Thomas' NHS Foundation Trust · Paediatric Intensive Care Unit (PICU)

Postoperative survival for complete atrioventricular septal defect (cAVSD) is excellent. Common complications of surgery include valvular stenosis/regurgitation, left ventricular outflow tract obstruction, arrythmias, and residual defects. We report a challenging case of a 7-month old girl with Trisomy 21, preoperative obstructive sleep apnea with...

Objective Chronic lung disease (CLD) is more common in preterm babies whereas childhood Interstitial lung disease (chILD) is less frequently seen in that cohort. We describe an emerging pattern of chILD in premature infants. Methods Retrospective descriptive analysis of three ex-premature infants sharing clinical&radio logical findings out-of-keep...

Background and Aim: Cor triatriatum sinistrum (CTS) is a rare congenital heart defect usually diagnosed in childhood. Cases may remain asymptomatic into adulthood, depending on degree of flow obstruction from the pulmonary venous system into the left ventricle by an intra-atrial fibromuscular membrane, and presence of other anomalies. We report an...

There are significant differences in the cardiovascular physiology between the neonates, infants, children, and the adolescent. The fetal circulation is a parallel circulation and is shunt dependent. The fetal hemoglobin (HbF) plays a key role in oxygen uptake from the placenta and delivery to the fetal tissues. Important and radical cardiorespirat...

Introduction/Aims: Cardiac Catheterisation (CC) is frequently performed in patients supported on ECMO. This study aimed to assess indications, outcomes, safety, and impact on ECMO weaning. Methods: Retrospective review of CC performed in paediatric patients on ECMO at our centre between January 2013 and June 2022. Results: 122 episodes of cardiac E...

We present two neonates requiring extracorporeal membrane oxygenation for undiagnosed recalcitrant pulmonary hypertension, highlighting the clinical and ethical dilemmas in management of very rare diseases.

Background Neonatal Marfan Syndrome (nMFS), the most severe form of Marfan syndrome, is a rare condition that presents a clinical and treatment challenge. nMFS has high infant mortality related to progressive valvular dysfunction. Valve replacement in this setting might improve long-term prognosis but also carries high morbidity and mortality; thus...

Anomalous left coronary artery from pulmonary artery (ALCAPA) is a congenital coronary abnormality associated with high infant mortality. This chapter reviews the management of children born with ALCAPA from the prehospital setting to clinical management and cannulation of extracorporeal membrane oxygenation (ECMO) in the intensive care unit. Key f...

Background: Panton-Valentine leukocidin (PVL) is an exotoxin secreted by Staphylococcus aureus (S. aureus), responsible for skin and soft tissue infections. As a cause of severe necrotising pneumonia, it is associated with a high mortality rate. A rare entity, the epidemiology of PVL S. aureus (PVL-SA) pneumonia as a complication of influenza coin...

Objective: To evaluate medium term functional out comes of children requiring ECMO treatment using the Pediatric-Evaluation-of-Disability-Inventory computer-adaptive-test (PEDI-CAT) which can be used from birth to 20 years. Methods: Since the COVID19 pandemic, post-ECMO telepractice was offered instead of face-to-face clinic review. Completed comp...

Objective: ECMO has provided a recognized and validated mode of advanced life-support during the COVID19 pandemic with good outcome. Here we report an institutional experience of delivering ECMO care for severe COVID disease at our commissioned centre with co-located paediatric ECMO team for learning outcomes. Methods: 93 referrals, signposted via...

Objective: Cerebral stroke is a frequent complication in patients supported on ECMO, specially in VA-ECMO. We aim to review our ECMO population to determine potential risk factors for cerebral stroke. Methods: Retrospective review study of all patients supported on ECMO from January 2017 till December 2019 using electronical patients records. Demog...

Aims & Objectives: To identify indirect impact of COVID-19 pandemic on rehabilitation of paediatric ECMO survivors. Methods: ECMO-survivors who were 6-12 months post-discharge between Feb-August2020 were prospectively followed up via newly set-up secure video-call clinics between June-August 2020 by biprofessional team (physiotherapist and ECMO ph...

Cardiohelp System use for pediatric extracorporeal membrane oxygenation (ECMO) beyond the transport setting is sparsely described in literature. We report the use of Getinge's Cardiohelp System in children and integrated utilization of Mobile ECMO Retrieval Team (MERT) at an all-age specialized cardiorespiratory center. Electronic database of all p...

Objective: To describe a multidisciplinary post-ECMO follow-up clinic evaluation of capturing rehabilitation outcome for children and carers, and identify needs specific to our patient cohort. Methods: Children who recovered from an event of ECMO therapy were offered follow-up at 3 to 12 months after hospital discharge. We reviewed the modes of int...

Objective: Neurodevelopmental (ND) outcomes in children who were supported with extracorporeal life support (ECLS) are reported in mixed population reviews. [1,2] In the UK, process is underway to develop a national framework for ND follow-up. Since 2018, all patients who survived to discharge from our hospital after ECLS have been invited to atten...

Objective: To describe a paediatric case of severe community-acquired pneumonia and hypoxic cardiac arrest requiring rescue extracorporeal cardiopulmonary resuscitation (ECPR) with timely re-configuration and management with venovenous (VV)-ECMO. Methods: Case report. Results: A previously well 8-year-old girl, with PVL Staphylococcus aureus pneumo...

Objectives: The interstage mortality rate after a Norwood stage 1 operation remains 12-20% in current series. In-hospital interstage facilitates escalation of care, possibly improving outcome. Methods: A retrospective study was designed for hypoplastic left heart syndrome (HLHS) and HLHS variants, offering an in-hospital stay after the Norwood o...

Core Topics in Cardiothoracic Critical Care - edited by Kamen Valchanov July 2018

Objective To assess the impact of service improvements implemented because of latent threats (LTs) detected during in situ simulation. Design Retrospective review from April 2008 to April 2015. Setting Paediatric Intensive Care Unit in a specialist tertiary hospital. Intervention Service improvements from LTs detection during in situ simulation....

Outcome after cardiopulmonary resuscitation (CPR) is influenced by the resuscitation team response.1–3 Our in-situ simulation training programme aims to improve patient outcome by rehearsing the team response to simulated crises including cardiac arrests.⁴ There is a relative paucity of translational research on the impact of simulated team trainin...

Objective Crisis resource management (CRM) training improves team performance, which is essential for better and safer patient care in crisis situation. Team-based self-monitoring scales can reliably assess team performance but individual professions’ perception of teamwork has not been described. The Simulated InterPRofessional Team Training (SPRi...

Background and aims Human factors (HF) is the science of human performance within a given system.1 It was adopted by healthcare from safety critical industries to improve patient safety. HF training is recommended by the General Medical Council (GMC), World Health Organisation and Royal Colleges.2 3 Despite the importance of HF to patient safety, t...

Background The benefits of education through simulation are augmented when coupled to quality improvement and educational initiatives by improving patient safety.1 We harnessed the strengths of simulation to develop a quality improvement project (SAFEQIP) aiming to improve anticipatory care, using role allocation through a multifaceted educational...

Background Limited attention has been given to the challenge of providing family-centred care alongside simulations in the clinical area.1 The validated2 interprofessional in-situ SPRinT (Simulated Paediatric Resuscitation Team Training) programme delivers courses aimed at improving team performance and patient safety during critical events. We hyp...

We studied the clinical profile and outcomes of children admitted to a tertiary paediatric cardio-respiratory intensive care unit with special reference to aetiology, morbidity and mortality. It was a retrospective review of all children with clinical diagnosis of acute myocarditis/cardiomyopathy admitted to tertiary paediatric cardio-respiratory i...

Teamwork is a critical component during critical events. Assessment is mandatory for remediation and to target training programmes for observed performance gaps. The primary purpose was to test the feasibility of team-based self-monitoring of crisis resource management with a validated teamwork assessment tool. A secondary purpose was to assess ite...

To evaluate the impact of Down syndrome on the early postoperative outcomes of children undergoing complete atrioventricular septal defect repair. Retrospective cohort study. Single tertiary pediatric cardiac center. All children admitted to PICU following biventricular surgical repair of complete atrioventricular septal defect from January 2004 to...

To develop an affordable realistic open-chest extracorporeal membrane oxygenation (ECMO) model for embedded in situ interprofessional crisis resource management training in emergency management of a post-cardiac surgery child. An innovative attachment to a high-fidelity mannequin (Laerdal Simbaby™) was used to enable a cardiac tamponade/ECMO stands...

A 2-week-old girl was transferred to PICU following cardiopulmonary resuscitation locally. Echocardiogram showed severe aortic coarctation and closed ductus arteriosus. She was commenced on infusion of prostaglandin E1 at 10 ng/kg/min increased to 50 ng/kg/min as the ductus arteriosus remained closed. She was referred to cardiac centre for further...

Background Adrenal dysfunction is associated with increased inotrope requirement and worse clinical outcome in children with sepsis. In children after bypass surgery a very low incidence of adrenal dysfunction is reported. However, use of hydrocortisone has been shown to improve hemodynamics of children requiring catecholamine after cardiac surgery...

Severe left ventricular outflow obstruction often is associated with diastolic left ventricular myocardial dysfunction and tachycardia despite successful initial treatment. The authors have used esmolol to lower heart rate in this setting for successful weaning of patients from ventilation in postoperative recovery. Their limited experience support...

To determine pre- and postoperative predictors of energy expenditure in children with congenital heart disease requiring open heart surgery; and to compare measured resting energy expenditure with current predictive equations. Prospective resting energy expenditure data were collected, using indirect calorimetry, for ventilated children admitted co...

Invasive ventilation is associated with both pulmonary and non-pulmonary complications. There has been a renewed interest in the use of negative pressure ventilation (NPV) for various medical conditions to minimise the complications associated with positive pressure ventilation. The routine use of NPV in an ICU setting still requires further studie...

Acute respiratory distress syndrome, a diagnosis based on physiologic and radiological criteria, occurs commonly in critical care setting. A major challenge in evaluating therapies that may improve survival in ARDS is that it is not a single disease entity but, rather, numerous different diseases that result in endothelial injury, where the most ob...