Shivanand S Medar, Giles J Peek, Deepa Rastogi
Asthma is the most common chronic illness and is one of the most common medical emergencies in children. Progressive refractory near-fatal asthma requiring intubation and mechanical ventilation can lead to death. Extracorporeal membrane oxygenation (ECMO) can provide adequate gas exchange during acute respiratory failure although data on outcomes in children requiring ECMO support for status asthmaticus is sparse with one study reporting survival rates of nearly 85% with asthma being one of the best outcome subsets for patients with refractory respiratory failure requiring ECMO support...
March 30, 2020: Pediatric Pulmonology
Ilija Djordjevic, Kaveh Eghbalzadeh, Anton Sabashnikov, Antje-Christin Deppe, Elmar Kuhn, Julia Merkle, Carolyn Weber, Borko Ivanov, Ali Ghodsizad, Christian Rustenbach, Christoph Adler, Parwis Rahmanian, Navid Mader, Ferdinand Kuhn-Regnier, Mohamed Zeriouh, Thorsten Wahlers
OBJECTIVES: Central or peripheral venoarterial extracorporeal membrane oxygenation (va ECMO) is widely used in postcardiotomy cardiogenic shock (PCS). Available data suggest controversial results for both types. Our aim was to investigate PCS patients treated with either peripheral (pECMO) or central ECMO (cECMO) concerning their outcome. METHODS: Between April 2006 and October 2016, 156 consecutive patients with va ECMO therapy due to PCS were identified and included in this retrospective analysis...
March 29, 2020: Journal of Cardiac Surgery
Céline Thibault, Shavonne L Massey, Maryam Y Naim, Nicholas S Abend, Athena F Zuppa
OBJECTIVES: To develop a population pharmacokinetic model for IV phenobarbital in neonates following cardiac surgery and perform simulations to identify optimal dosing regimens. DESIGN: Retrospective single-center pharmacokinetic study. SETTING: Cardiac ICU at Children's Hospital of Philadelphia. PATIENTS: Consecutive neonates who received greater than or equal to one dose of IV phenobarbital and had greater than or equal to one phenobarbital concentration drawn per standard of care from June 15, 2012, to October 15, 2018...
March 12, 2020: Pediatric Critical Care Medicine
Mathew Thomas, Archer K Martin, Wesley L Allen, Ian A Makey, J Ross Renew, Eduardo S Rodrigues, Monica M Mordecai, Thomas E Brown, Jeremy J Foeks, James L Johnson, Kevin L Landolfo, Si M Pham
Extracorporeal circulation (ECC) support using intraoperative extracorporeal membrane oxygenation (ECMO) during lung transplantation (LTx) is now a routine practice for many high volume centers. Circuits that are dedicated to ECMO alone can be expensive and do not allow full cardiopulmonary bypass (CPB) to be performed. We describe our technique of instituting venoarterial ECMO during LTx using a less-expensive hybrid circuit that facilitates easy and immediate conversion to full CPB if needed, without interruption of ECC...
March 27, 2020: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Andrew N Rosenbaum, John K Bohman, Kent H Rehfeldt, John M Stulak, Richard C Daly, Allan M Klompas, Atta Behfar, Suraj M Yalamuri
Utilization of venoarterial extracorporeal membrane oxygenation (VA-ECMO) is expanding, but dual VA-ECMO circuits to treat cardiogenic shock with refractory hypoxemia is unreported. We describe the case of combined cardiogenic and distributive shock due to necrotizing pulmonary blastomycosis. After initial central VA-ECMO cannulation, acute respiratory distress syndrome (ARDS) with increasing shunt resulted in significant central hypoxemia due to progressive ventilation-perfusion mismatch. An additional circuit provided complete oxygenation of the high circulating volume...
April 2020: A&A Practice
Clancy W Mullan, Joshua Newman, Merideth Geib, Matthew D Pichert, Areo Saffarzadeh, Alan Hartman, Brian Lima
BACKGROUND: Pulmonary embolism is common, but the benefit of surgical embolectomy remains unclear. National trends in embolectomy were described to 2008. Recent data is lacking. We characterized the national trends in incidence, management, and outcomes of pulmonary embolisms, along with the population-level outcomes. METHODS: The National Inpatient Sample was queried by ICD-9 codes for pulmonary embolisms from 2011-2014. Saddle embolisms, shock, and interventions (systemic thrombolysis, catheter-directed therapy, extracorporeal membrane oxygenation (ECMO), and pulmonary embolectomy) were identified...
March 26, 2020: Annals of Thoracic Surgery
Reena M Ghosh, Heather M Griffis, Andrew C Glatz, Jonathan J Rome, Christopher L Smith, Matthew J Gillespie, Kevin K Whitehead, Michael L O'Byrne, David M Biko, Chitra Ravishankar, Aaron G Dewitt, Yoav Dori
Background Recent studies suggest that lymphatic congestion plays a role in development of late Fontan complications, such as protein-losing enteropathy. However, the role of the lymphatic circulation in early post-Fontan outcomes is not well defined. Methods and Results This was a retrospective, single-center study of patients undergoing first-time Fontan completion from 2012 to 2017. The primary outcome was early Fontan complication ≤6 months after surgery, a composite of death, Fontan takedown, extracorporeal membrane oxygenation, chest tube drainage >14 days, cardiac catheterization, readmission, or transplant...
April 7, 2020: Journal of the American Heart Association
Paweł Nadziakiewicz, Marek Grochla, Alena Krauchuk, Bożena Szyguła-Jurkiewicz, Marcin Cymerys, Michał O Zembala, Piotr Przybyłowski
INTRODUCTION: Recipients of nonrenal organ transplants, including the heart, are at risk for developing acute kidney injury (AKI). This situation significantly jeopardized the outcome of patients. The most effective treatment is continuous renal replacement therapy (CRRT) AIM: The goal of this project is to verify the prognostic value of preoperative serum creatinine concentration and glomerular filtration rate (GFR), calculated by the Modification of Diet in Renal Disease formula, to determine the risk of renal failure after grafting RESULTS: In the group of 39 patients, CRRT was needed in 7 patients (17...
March 25, 2020: Transplantation Proceedings
Heng-Wen Chou, Chih-Hsien Wang, Lian-Yu Lin, Nai-Hsin Chi, Nai-Kuan Chou, Hsi-Yu Yu, Yih-Sharng Chen
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is an effective support method for acute fulminant myocarditis (AFM) with cardiogenic shock. However, deciding whether to bridge to a left ventricular assist device (LVAD) or to maintain ECMO support until heart recovery is still controversial. MATERIAL AND METHODS: This was a retrospective observational study from a single center. Eighty-eight adults with AFM and ECMO support between 2006 and 2018 were included...
March 20, 2020: Journal of Critical Care
Bradley Feiger, Ajar Kochar, John Gounley, Desiree Bonadonna, Mani Daneshmand, Amanda Randles
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a mechanical system that provides rapid and short-term support for patients with cardiac failure. In many patients, pulmonary function is also impaired, resulting in poorly-oxygenated cardiac outflow competing against well-oxygenated VA-ECMO outflow, a condition known as North-South syndrome. North-South syndrome is a primary concern because of its potential to cause cerebral hypoxia, which has a critical influence on neurological complications often seen in this patient population...
March 3, 2020: Journal of Biomechanics
Cantong Zhang, Shaoying Huang, Fengping Zheng, Yong Dai
An outbreak of severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) infection has posed significant threats to international health and the economy. In the absence of specific treatment for this virus, there is an urgent need to learn from the experience and lessons in China. To reduce the case-fatality rate among COVID-19 patients, we should not ignore the complications, such as RNAaemia, acute respiratory distress syndrome, and multiple organ dysfunction. To help understand the advantages and limitations of differential treatments, we provide a timely review and discuss the complications and corresponding major treatments, especially controversial ones such as antiviral therapy (remdesivir, ribavirin, chloroquine), glucocorticoid therapy, extracorporeal support including an artificial liver system (ALS) and extracorporeal membrane oxygenation (ECMO), based on available evidence...
March 26, 2020: Journal of Medical Virology
Chenguang Shen, Zhaoqin Wang, Fang Zhao, Yang Yang, Jinxiu Li, Jing Yuan, Fuxiang Wang, Delin Li, Minghui Yang, Li Xing, Jinli Wei, Haixia Xiao, Yan Yang, Jiuxin Qu, Ling Qing, Li Chen, Zhixiang Xu, Ling Peng, Yanjie Li, Haixia Zheng, Feng Chen, Kun Huang, Yujing Jiang, Dongjing Liu, Zheng Zhang, Yingxia Liu, Lei Liu
Importance: Coronavirus disease 2019 (COVID-19) is a pandemic with no specific therapeutic agents and substantial mortality. It is critical to find new treatments. Objective: To determine whether convalescent plasma transfusion may be beneficial in the treatment of critically ill patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Design, Setting, and Participants: Case series of 5 critically ill patients with laboratory-confirmed COVID-19 and acute respiratory distress syndrome (ARDS) who met the following criteria: severe pneumonia with rapid progression and continuously high viral load despite antiviral treatment; Pao2/Fio2 <300; and mechanical ventilation...
March 27, 2020: JAMA: the Journal of the American Medical Association
Emily L Chanan, Nishan Bingham, Deane E Smith, Mark E Nunnally
Acute limb ischemia caused by peripheral venoarterial extracorporeal membrane oxygenation (ECMO) cannulation is associated with increased mortality. Early detection of limb hypoperfusion may lead to timely intervention and prevent irreversible muscle damage. Methods to determine the adequacy of tissue oxygenation in cannulated extremities include bedside physical examination, trending serum biochemical markers, and somatic near-infrared spectroscopy. To prevent ECMO-related limb ischemia events, interventions include the addition of distal antegrade perfusion catheters to the arterial ECMO canula, minimizing arterial cannula diameter, placing arterial and venous cannulae on opposite extremities, and adding a side-arm graft to the cannulated artery...
February 20, 2020: Journal of Cardiothoracic and Vascular Anesthesia
Hafize Savas, Zeliha Ozdemir Koken, Sevilay Senol Celik
BACKGROUND: Survival and discharge rates after extracorporeal membrane oxygenation are gradually increasing. More research is warranted to investigate extracorporeal membrane oxygenation patients' post-discharge experiences, problems and quality of life. OBJECTIVE: The aim of this study was to determine adult extracorporeal membrane oxygenation patients' experiences, problems and quality of life following discharge. METHODS: A mixed methods research was used...
March 23, 2020: Heart & Lung: the Journal of Critical Care
Horacio G Carvajal, Matthew W Canter, Aaron M Abarbanell, Pirooz Eghtesady
BACKGROUND: Conflicting data exists regarding the impact of ascending aorta size on outcomes following the Norwood procedure. Results from multi-institutional studies have largely relied on heterogeneous populations undergoing this surgery for different anatomic defects. Using data from the Single Ventricle Reconstruction Trial, we analyzed the impact of preoperative ascending aortic diameter on Norwood outcomes for patients with aortic atresia variants of hypoplastic left heart syndrome (HLHS)...
March 22, 2020: Annals of Thoracic Surgery
Taylor Kain, Patrick J Lindsay, Neill K J Adhikari, Yaseen M Arabi, Maria D Van Kerkhove, Robert A Fowler
Available animal and cell line models have suggested that specific therapeutics might be effective in treating Middle East respiratory syndrome (MERS). We conducted a systematic review of evidence for treatment with pharmacologic and supportive therapies. We developed a protocol and searched 5 databases for studies describing treatment of MERS and deaths in MERS patients. Risk of bias (RoB) was assessed by using ROBINS-I tool. We retrieved 3,660 unique citations; 20 observational studies met eligibility, and we studied 13 therapies...
March 26, 2020: Emerging Infectious Diseases
Sonia Marcos-Alonso, Nuria Gil, Luis García-Guereta, Dimpna Albert, María Ángeles Tejero, Félix Perez-Villa, Manuel Gómez Bueno, Teresa Blasco Peiró, Ana Cano, Beatriz Díaz Molina, Diego Rangel Sousa
Evidence on the impact of MCS on pediatric heart transplant survival is still scarce related to congenital heart disease patients including univentricular physiology as well as the risk factors for complications. We performed a retrospective review of all urgent pediatric (aged ≤16 years) HT from 2004 to 2014 in the Spanish Pediatric Heart Transplant Registry Group. Patients were stratified into two groups: urgent 0 (MCS at HT) and urgent 1 (non-MCS at HT). The primary outcome measure was post-transplant survival; secondary outcome measures were complications and absence of infections and rejection during the first post-transplant year...
March 25, 2020: Pediatric Transplantation
Danielle Pulton, Jesse Kiefer, William Vernick, Jacob T Gutsche, Jesse Raiten
No abstract text is available yet for this article.
February 25, 2020: Journal of Cardiothoracic and Vascular Anesthesia
Candice Eastman, Brian L Erstad
PURPOSE: Medication product labeling was reviewed to determine if sufficient information is available to appropriately calculate dosing regimens for special intensive care unit (ICU) populations, including patients at extremes of body habitus and patients receiving hemodialysis, continuous renal replacement therapy (CRRT), or extracorporeal membrane oxygenation (ECMO). METHODS: The labeling of the 100 most commonly used injectable medications in the adult ICUs of an academic medical center in Arizona were evaluated...
March 24, 2020: American Journal of Health-system Pharmacy: AJHP
Stavros Dimopoulos, Kostas Stefanidis, Serafim Nanas, Andreas Karabinis
No abstract text is available yet for this article.
April 2020: Critical Care Medicine
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