“Neurosurgical intervention in children with ventricular assist devices: A single-center case series review” describes all pediatric VAD patients at a single center who underwent a neurosurgical procedure for an intracranial hemorrhage or ischemic stroke from April 2014 through January 2020.
The aim of this case series review was to explain perioperative management for major neurological injuries. Looking at 78 patients implanted with 90 VADs, five neurosurgical interventions were performed. Four of the patients were intracranial hemorrhages and were receiving anticoagulation at the time of their event; the fifth patient had an ischemic stroke. Three patients on warfarin received emergent reversal with prothrombin concentrate complex and vitamin K. Three patients also received pre-procedural platelet transfusions.
Of the five interventions performed, two were emergent bedside external ventricular drain placements, had no further surgical interventions, and died from the severity of their neurological injuries. The other three were surgical operations during which they received invasive hemodynamic monitoring and were supported with a combination of inotropes and afterload reduction. One patient required a massive blood product transfusion. The three patients who underwent operative procedures survived, received a transplant and were discharged to go home.
This single-center case series review highlighted key perioperative concerns for the anesthesiologist, which include VAD hemodynamic management, bleeding, VAD thrombosis, and prevention of secondary brain injury.
The authors concluded the review by emphasizing that a systematic, multidisciplinary approach to management is a major part of achieving favorable outcomes in major neurosurgical interventions.
ACTION members part of the review include:
- Jenna Murray
- Sharon Chen
- Sarah Lee
- Kathleen Ryan
- Katsuhide Maeda