INCONTRO CON LA CARDIOCHIRURGIA PEDIATRICA DI PADOVA: STORIE DA - - PowerPoint PPT Presentation

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Dec 23, 2023 301 likes •754 views

INCONTRO CON LA CARDIOCHIRURGIA PEDIATRICA DI PADOVA: STORIE DA RACCONTARE E DA CONOSCERE Le missioni umanitarie: Progetto Elias Prof. Giovanni Stellin UOC Cardiochirurgia Pediatrica e Cardiopatie Congenite Universit degli Studi di

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UOC Cardiochirurgia Pediatrica e Cardiopatie Congenite Università degli Studi di Padova

INCONTRO CON LA CARDIOCHIRURGIA PEDIATRICA DI PADOVA: STORIE DA RACCONTARE E DA CONOSCERE

Le missioni umanitarie: « Progetto Elias»

  • Prof. Giovanni Stellin
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Eritrea

  • Italian colonization 1881-1941
  • British administration 1941-1952
  • Struggle for liberation 1952-1991
  • Independency 1991

5 millions inhabitants

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Capital: ASMARA 804.000 Inhabitants Altitude: 2.333 m Old Colonial City

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Why Eritrea?

  • One of the poorest countries of the world
  • Past 30 years war region (1962-1991)
  • No human and economic resources
  • No medical school until 2004
  • No pediatric, no cardiac surgery
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SLIDE 5

Demographics

Er USA I GER Population (mio) 6,08 313 61,3 81,3 Total fertility rate 4,4 2,06 1,40 1,41 Birth rate (per 1000 pop.) 32 13,7 9,06 8,33 Population growth rate (%) 2,4 0,96 0,38

  • 0,2

Median age of pop. (years) 18,7 36,9 43,5 44,9

(Urban, 06.2011)

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Health Workforce

Er USA F Physicians 1,2 5 293 350 Nurses 1 56 982 868 Midwifes 1 2

  • 26

1 per 100.000 population 2 in all: 12 pediatricians and 7 surgeons

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Maternal and Child Health Indicators

Er USA F Births (%) attended 1 28 98 100 Maternal mortality 2 240 21 8 Neonatal mortality 3 17 4 2 Infant mortality 3 42 6,1 3,3 Child < 5 years mortality 3 55 8 4

1 by skilled personnel 2 per 100.000 births 3 per 1.000 life births

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Incidence of CHD in Eritrea

185.000 Life births per year 4.000 Neonates with congenital anomalies 1.300 Newborns with CHD

(Urban, 06.2011)

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  • Hammer Forum is a German group of physicians

who care for children in war and precarious regions

  • f Europe
  • In 1996 Hammer Forum started an humanitarian

project in Eritrea THE GOAL

  • To build an equipe at the International Operation

Center for Children in Asmara (IOCCA)

  • To commence surgical treatment for children in

Asmara on a multidisciplinary basis including open heart surgery

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The Model Project

  • Central organization by ArcheMed (NGO)
  • Infrastructure & equipment from all CT-teams
  • Individual team funding by respective NGO
  • Conjoint CT-team strategy & quality control
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Participating NGOs

  • ArcheMed e.V.

Möhnesee, Germany

  • Un Cuore Un Mondo

Massa Carrara, Italy

  • Un Cuore Un Mondo

Padova, Italy

  • Kinderherzen.ch

Zurich, Switzerland

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Participants teams

Andreas Urban, M.D.

Former Director of Pediatric Cardiac Surgery, Saint Agostin Hospital - Germany (Teams Coordinator)

Bruno Murzi, M.D.

Massa Carrara Hospital, Italy

Pascal Berdat, M.D.

Heart Care Medical AG Zurich, Switzerland

Giovanni Stellin, M.D.

Director of Pediatric Cardiac Surgery, Padova, Italy

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Mission Eritrea

Local coordinator

  • Mr. Alem Demoz

University of Padua Team (Italy) (project Elias) Since 2004

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Padova Cardiac Team composition

  • Paediatric cardiologist

2/1

  • Anaesthesiologists

2

  • Pediatric cardiac surgeon

2

  • OR nurses

2/1

  • Perfusionist

2/1

  • Intensivist

2

  • PICU nurse

6/4 Total 13/18

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Objectives of the Mission

  • Correct CHDs
  • Training of local people
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The International Operation Center for Children in Asmara/Eritrea (IOCCA) (Former ‘‘Ospedale Regina Elena‘‘)

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The hospital

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The Operating Room

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Postoperative ICU

4 equiped beds (sometimes more…)

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Subintensive ICU

5 beds

…sometimes more..

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Italian Equipement Supply

  • Echocardiographers

4

  • Heart-lung machine

1

  • Heat exchange blanket

2

  • Portable x-ray machine

1

  • Electrocardiographer

1

  • Pediatric ventilator

1

  • Portable monitors

4

  • Infusion pumps

4

  • External Pacemakers

4

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Hospital renovation and supply

(ArchMed, Germany)

  • Medical gases

– Modular oxygen producer

  • Electricity

– Photovoltaic unit at the roof – Uninterrupted power supply (UPS)

  • Hygiene

– Floor, windows, doors enlarged

  • Water

– At the moment supplied by tank trucks; process of creating independent water supply

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Hospital renovation and supply

(ArchMed, Germany)

  • Operating room
  • Anaesthesia room
  • Cardiac surgical I.C.U.
  • Cardiac surgical intermediate care
  • Cath lab ?
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Patients’ management

  • A forward team of pediatric cardiologists will screen

patients with local cardiologists and select candidates for surgery

  • Selected pts are further discussed among surgeons,

cardiologists, anesthetists before surgery

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Screening: clinical assessment + 2D-echo

Pediatric cardiologists

(Prof. Ornella Milanesi + 1 younger pediatric cardiologist, rotating)

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Anesthesia team

TEE Echo

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CRITERIA for Patients’ selection (I)

  • Single ventricle malformations are not usually treated
  • Down syndrome patients are accepted, upon patients’

request

  • No selection is made in according to age, body

weight and/or CHD complexity

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CRITERIA for Patients, selection (II)

  • CHDs with associated severe pulmonary

hypertension (i.e. large VSDs, CAVC) are selected for palliation (PA banding) and corrected 12 months later

  • Arterial switches for TGA are performed when a

large VSD is present and the LV is not deconditioned

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Surgical activity

Needs to be adapted to the local availability for

  • Prosthetic material
  • ICU efficiency and quality of care
  • Drugs availability
  • ICU beds
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Pre operative patients’ status

Nearly all of them have:

  • Hypoalbuminemia
  • Anemia
  • Recurrent pulmonary infections
  • Malnutrition
  • Long-standing cardiac diseases (cyanosis, left-to-right

shunt with CHF and PAH)

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The OR team

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Results (CT-Operations 2003-2016 all teams)

20 40 60 80 100 120 Number of cases Year NO CPB CPB

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Procedures

PDA coarct.

  • thers

Op‘s without CPB Op‘s with CPB

ASD VSD

valves

complex

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Results

(2003-2017 all teams)

  • Cardiac-Procedures

n = 1076

  • With CPB

n = 716

  • No CPB

n = 360

  • Early + late mortality

20 + 1 (2%)

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Cost-Effectiveness

For the expense of one neonatal heart operation in Europe i.e. € 50.000,- A team of 16 people including doctors, nurses and technicians can travel to, diagnose, operate and treat 20 children with CHD in Eritrea

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Results at last follow-up

  • All patients have been followed by Dr. Tsagareda

(local pediatric cardiologist)

  • Late death 1 pt

14 year-old patient after mitral valve plasty

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MAIN GOAL: Training the local people

  • Dr. Yoseph

Tewolde Ghidei

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Continuing education

Multi-disciplinary teaching sessions included:

  • In-job training
  • Clinical lectures

For doctors in-training, medical student and personnel, at different levels

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Funding

  • Donations
  • Government support
  • Industrial sponsorship
  • Charitable foundations
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Summary

The goal of developing a Pediatric Cardiac Surgical program in Eritrea has been achieved by a European multi-institutional cooperation of 4 different surgical teams Early and long term results can be compared with those of the best cardiac surgical units in Europe and US

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Future goals

  • Catheterization Laboratory (nearly operating)
  • Continue medical and surgical education
  • Develop a totally indipendent Eritrean team
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Conclusions

  • A conjoint international multi-institutional

cardio-thoracic team approach is feasible

  • It could serve as a model for providing a

sustained humantiarian Paediatric Cardiac- Service in a poor no-resource countries

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The Eritreans are very thankful to us for saving their children‘s lives We are very grateful to the Eritrean people for the great value in humanitarian experience which helps us in our daily work