ECMO with vasopressor use during early endotoxic shock: Can it improve circulatory support and regional microcirculatory blood flow?

Introduction: While extracorporeal membrane oxygenation (ECMO) is effective in preventing further hypoxemia and maintains blood flow in endotoxin-induced shock, ECMO alone does not reverse the hypotension. In this study, we tested whether concurrent vasopressor use with ECMO would provide increased circulatory support and blood flow, and characterized regional blood flow distribution to vital organs.

Methods: Endotoxic shock was induced in piglets to achieve a 30% decrease in mean arterial pressure (MAP).

ECMO Maintains Cerebral Blood Flow During Endotoxic Shock in Piglets.

Cerebrovascular injury while on extracorporeal membrane oxygenation (ECMO) may be caused by excessive brain perfusion during hypoxemic reperfusion. Previous studies have postulated that the most vulnerable period of time for cerebrovascular injury is during the transfer period to ECMO. Therefore, our objective was to compare brain perfusion and hemodynamics in a piglet endotoxic shock ECMO model.

Continuous renal replacement therapy to reduce inflammation in a piglet hemorrhage-reperfusion extracorporeal membrane oxygenation model.

Background: During extracorporeal membrane oxygenation (ECMO), circulation of blood across synthetic surfaces triggers an inflammatory response. Therefore, we evaluated the ability of continuous renal replacement therapy (CRRT) to remove cytokines and reduce the inflammatory response in a piglet hemorrhage-reperfusion ECMO model.

Methods: Three groups were studied: (i) uninjured controls (n = 11); (ii) hemorrhage-reperfusion while on venoarterial ECMO (30% hemorrhage with subsequent blood volume replacement within 60 min) (n = 8); (iii) treatment with CRRT after hemorrhage-reperfusion while on ECMO (n = 7).

Late presentation of diaphragmatic hernia in a Pacific Island pediatric population.

Background: Congenital diaphragmatic hernia (CDH) usually presents at birth with respiratory distress syndrome (RDS) and has a high mortality rate if not promptly recognized and treated. The incidence of CDH is reported to be 0.8 - 1.

Comparison of home and clinic well-baby visits in a military population.

Patient satisfaction is an indicator of quality of care received. Home-visit programs are associated with increased satisfaction and equivalent clinical outcomes but increased cost, compared with clinic visits. We hypothesized that home visits for routine well-child care would also be associated with increased satisfaction and equivalent outcomes.