RBC transfusion in pediatric patients supported with extracorporeal membrane oxygenation: is there an impact on tissue oxygenation?

Objective: To examine first the RBC transfusion practice in pediatric patients supported with extracorporeal membrane oxygenation and second the relationship between transfusion of RBCs and changes in mixed venous saturation (SvO2) and cerebral regional tissue oxygenation, as measured by near-infrared spectroscopy in patients supported with extracorporeal membrane oxygenation.

Design: Retrospective observational study.

Setting: Pediatric, cardiovascular, and neonatal ICUs of a tertiary care children's hospital.

von Willebrand factor multimers in pediatric extracorporeal membrane oxygenation support.

Acquired von Willebrand factor (vWF) disease is associated with a decrease in the amount of circulating high molecular weight (HMW) vWF multimers. vWF has not been previously investigated in children on extracorporeal membrane oxygenation (ECMO) support. We hypothesized that HMW vWF multimers and vWF activity decrease over the course of ECMO support in these patients.

Extracorporeal membrane oxygenation support among children with adenovirus infection: a review of the Extracorporeal Life Support Organization registry.

Overwhelming adenovirus infection requiring extracorporeal membrane oxygenation (ECMO) support carries a high mortality in pediatric patients. The objective of this study was to retrospectively review data from the Extracorporeal Life Support Organization (ELSO) registry for pediatric patients with adenovirus infection and define for this patient cohort: 1) clinical characteristics, 2) survival to hospital discharge, and 3) factors associated with mortality before hospital discharge. In this retrospective registry study, pediatric patients with adenovirus infection requiring ECMO support identified in an international ECMO registry from 1998 to 2009 were compared for clinical characteristics (demographics, pre-ECMO variables, and complications on ECMO) between survivors and nonsurvivors to hospital discharge.

Fungal infections and antifungal prophylaxis in pediatric cardiac extracorporeal life support.

Objective: Infections acquired by children during extracorporeal membrane oxygenation (ECMO) increase mortality. Our aim was to evaluate the effectiveness of prophylactic fluconazole on the incidence of fungal infections and to assess whether hospital-acquired fungal infection is associated with increased in-hospital mortality in pediatric cardiac patients requiring ECMO.

Methods: We retrospectively reviewed a prospectively maintained database and collected data on all hospital-acquired infections in patients supported for cardiac indications at a tertiary children's hospital from 1989 to 2008.

Impact of neutrophil recovery on oxygenation in pediatric oncology patients with acute hypoxemic respiratory failure.

Neutrophil recovery has been implicated in deterioration of oxygenation and exacerbation of lung injury in pediatric oncology patients. Our objectives were to determine the impact of neutrophil recovery on oxygenation in pediatric oncology patients with acute hypoxemic respiratory failure (AHRF) and to identify risk factors that result in oxygenation worsening. A cohort of 24 neutropenic pediatric oncology patients with AHRF in whom neutrophil recovery occurred during a course of mechanical ventilation was evaluated.

Interhospital transport of children requiring extracorporeal membrane oxygenation support for cardiac dysfunction.

Objective: Many centers are able to emergently deploy extracorporeal membrane oxygenation (ECMO) as support in children with refractory hemodynamic instability, but may be limited in their ability to provide prolonged circulatory support or cardiac transplantation. Such patients may require interhospital transport while on ECMO (cardiac mobile [CM]-ECMO) for additional hemodynamic support or therapy. There are only three centers in the United States that routinely perform CM-ECMO.

Single-institution experience with interhospital extracorporeal membrane oxygenation transport: A descriptive study.

Objective: Patients with refractory cardiopulmonary failure may benefit from extracorporeal membrane oxygenation, but extracorporeal membrane oxygenation is not available in all medical centers. We report our institution's nearly 20-yr experience with interhospital extracorporeal membrane oxygenation transport.

Design: Retrospective review.

Neonatal herpes virus infection and extracorporeal life support.

Objectives: To investigate outcomes among neonates with herpes virus infection reported to the Extracorporeal Life Support Organization (ELSO) Registry and analyze factors associated with death before hospital discharge with this virus. Currently, scant data exist regarding extracorporeal membrane oxygenation support in neonates with herpes virus infection.

Design: Retrospective analysis of ELSO Registry data set from 1985 to 2005.

Outcomes after extracorporeal cardiopulmonary resuscitation (ECPR) following refractory pediatric cardiac arrest in the intensive care unit.

Aim: To describe our experience using extracorporeal cardiopulmonary resuscitation (ECPR) in resuscitating children with refractory cardiac arrest in the intensive care unit (ICU) and to describe hospital survival and neurologic outcomes after ECPR.

Methods: A retrospective chart review of a consecutive case series of patients requiring ECPR from 2001 to 2006 at Arkansas Children's Hospital. Data from medical records was abstracted and reviewed.

Intrahospital transport of children on extracorporeal membrane oxygenation: indications, process, interventions, and effectiveness.

Objective: To evaluate indications, process, interventions, and effectiveness of patients undergoing intrahospital transport. Critically ill patients supported with extracorporeal membrane oxygenation are transported within the hospital to the radiology suite, cardiac catheterization suite, operating room, and from one intensive care unit to another. No studies to date have systematically evaluated intrahospital transport for patients on extracorporeal membrane oxygenation.

Extracorporeal cardiopulmonary resuscitation in refractory pediatric cardiac arrest.

The purpose of this article is to discuss the indications for extracorporeal cardiopulmonary resuscitation (ECPR), physiologic and mechanical issues that arise in patients managed with ECPR, and optimal patient selection for ECPR. ECPR can provide very good outcomes for some children who, in all likelihood, would otherwise have died. Having the capability to routinely offer ECPR represents an enormous institutional commitment of people and resources.

Changes in outcomes (1996-2004) for pediatric oncology and hematopoietic stem cell transplant patients requiring invasive mechanical ventilation.

Objective: To assess the following hypotheses regarding mechanically ventilated pediatric oncology patients, including those receiving hematopoietic stem cell transplant (HSCT) and those not receiving HSCT: 1) outcomes are more favorable for nontransplant oncology patients than for those requiring HSCT; 2) outcomes have improved for both populations over time; and 3) there are factors available during the time of mechanical ventilation that identify patients with a higher likelihood of dying.

Design: Retrospective review.

Setting: Free-standing, tertiary care, pediatric hematology oncology hospital.

Successful use of extracorporeal membrane oxygenation in severe necrotizing pneumonia caused by Staphylococcus aureus.

Objective: To report the successful use of extracorporeal membrane oxygenation (ECMO) as rescue therapy for severe necrotizing pneumonia secondary to infection by the Staphylococcus aureus species.

Design: Case series.

Setting: Pediatric intensive care unit at a freestanding tertiary care children's hospital.

Ruptured tricuspid valve papillary muscle: a treatable cause of neonatal cyanosis.

Severe tricuspid regurgitation resulting from a flail leaflet is a rare cause of neonatal cyanosis. We report two neonates with profound cyanosis and severe tricuspid regurgitation caused by rupture of the papillary muscle supporting the anterior leaflet, without other structural heart defects. Ductal patency could not be established.

Outcome of severe sepsis in pediatric oncology patients.

Objective: To describe survival to intensive care unit (ICU) discharge and 6-month survival in a large cohort of pediatric oncology patients with severe sepsis.

Design: Retrospective analysis.

Setting: The ICU of a single pediatric oncology center.

Munchausen syndrome by proxy in the pediatric intensive care unit: An unusual mechanism.

OBJECTIVE: To present a case of Munchausen syndrome by proxy (MSbP) by a previously unreported mechanism, discussing the occurrence of MSbP in patients in the pediatric intensive care unit (PICU) and the use of covert video surveillance in the diagnosis of MSbP. DESIGN: Report of one case of a child who was proven to be the victim of MSbP while hospitalized in a PICU. SETTING: A six-bed PICU in a military teaching hospital.

Fibrosing mediastinitis secondary to zygomycosis in a twenty-two-month-old child.

We report the case of a 22-month-old immunocompetent male child with fibrosing mediastinitis secondary to zygomycosis, an unusual presentation of a rare fungal infection. This patient was successfully treated with amphotericin B and itraconazole for 20 weeks. Stenting of the superior vena cava was helpful in relieving the patient's superior vena cava syndrome.