Prehospital pediatric emergencies in Austrian helicopter emergency medical service - a nationwide, population-based cohort study.

Introduction: Arguably, the most challenging emergencies encountered by emergency medical service crews involve children. Because only scant data exist about the epidemiology of pediatric emergencies in helicopter emergency medical service (HEMS) on a population level, we sought to determine the epidemiological characteristics stratified by responding area in a large nationwide sample.

Methods: This was a retrospective cohort study including all pediatric patients (0-14 years of age) who were treated by HEMS in Austria from January 2006 to June 2007 (18 months).

Haemodynamic changes and stress responses of piglets to surgery during total intravenous anaesthesia with propofol and fentanyl.

The purpose of the study was to assess the haemodynamic (blood pressure and heart rate) changes and stress responses (serum cortisol and serum amyloid A [SAA] concentrations) to surgery in piglets during total intravenous anaesthesia (TIVA) with propofol and fentanyl. After preanaesthetic medication with intramuscular midazolam (0.5 mg/kg body mass), ketamine (10 mg/kg) and butorphanol (0.

Bridging to transplantation in acute liver failure in a 7-month-old infant.

Background: Acute liver failure (ALF) in children is a rare but often fatal event. At present, liver transplantation is the only successful therapy in most cases. In the face of deteriorating hepatic encephalopathy in these children, some bridging therapy using artificial detoxification can be necessary to enable successful transplantation.

Quantitative electroencephalography values of neonates during and after venoarterial extracorporeal membrane oxygenation and permanent ligation of right common carotid artery.

Venoarterial extracorporeal membrane oxygenation (ECMO) in neonates commonly needs neck vessel cannulation leading to ligation of right common carotid artery (RCCA) in some cases. Quantitative electroencephalography (EEG) measurements provide reproducible data of cerebral function. The aim of this case-control study was to test whether ligation of the RCCA results in EEG changes after ECMO weaning.

Surfactant application during extracorporeal membrane oxygenation improves lung volume and pulmonary mechanics in children with respiratory failure.

Introduction: This study was performed to determine whether surfactant application during extracorporeal membrane oxygenation (ECMO) improves lung volume, pulmonary mechanics, and chest radiographic findings in children with respiratory failure or after cardiac surgery.

Methods: This was a retrospective chart review study in a pediatric intensive care unit (PICU). Seven patients received surfactant before weaning from ECMO was started (group S).

Testing of extracorporeal membrane oxygenation circuit related hemolysis using long-term stored packed red cells and fresh frozen plasma.

Background: The resistance of blood used in these studies to hemolysis differs markedly from that used in neonatal extracorporeal circulation under clinical circumstances. In this study, the possibility of using expired packed red cells to determine hemolysis caused by mechanical and/or environmental factors was investigated.

Methods: Packed red blood cells stored for 42 days were mixed with fresh frozen plasma and the resultant mixture was divided into three groups, two study groups and a control.

Acute hemorrhagic respiratory failure caused by Wegener's granulomatosis successfully treated by bronchoalveolar lavage with diluted surfactant.

Wegener's granulomatosis (WG) is an idiopathic inflammatory systemic disease that can occasionally cause an acute respiratory distress syndrome. We report on a 17-year-old girl with Wegener's granulomatosis and acute hemorrhagic respiratory failure successfully treated using bronchoalveolar lavage with diluted porcine surfactant (Curosurf; 4.8 mg/mL) followed by a low-dose bolus of surfactant.

Predictors of mortality at initiation of peritoneal dialysis in children after cardiac surgery.

Background: The development of renal dysfunction in the postoperative course of cardiac surgery is still associated with high mortality in pediatric patients. In particular for small infants peritoneal dialysis offers a secure and useful treatment option. The aim of the present study was to investigate if routinely used laboratory and clinical variables could help predict mortality at initiation of peritoneal dialysis.

Early postoperative prediction of cerebral damage after pediatric cardiac surgery.

Background: Cerebral damage is a serious complication of pediatric cardiac surgery. Early prediction of actual risk can be useful in counseling of parents, and in early diagnosis and rehabilitation therapy. Also, if all children at risk could be identified therapeutic strategies to limit perioperative cerebral damage might be developed.

Impact of extracorporeal membrane oxygenation modality on cytokine release during rescue from infant hypoxia.

The treatment of acute respiratory failure in infants by means of extracorporeal membrane oxygenation (ECMO) is thought to be associated with a treatment-related inflammatory reaction, which may deteriorate the underlying disease process. The aim of this study was to compare the venoarterial (VA) and venovenous (VV) modality of ECMO with regard to their pulmonary and serological cytokine release during rescue from acute hypoxia. The inflammatory response was measured in piglets undergoing hypoxic ventilation with a gas mixture of 92% N2 and 8% O2, which were then rescued through VA- (n = 5) or VV-ECMO (n = 5).

Monitoring of cerebral oxygen saturation with a jugular bulb catheter after near-drowning and respiratory failure.

We report on monitoring oxygen saturation with a jugular bulb fiber-optical catheter in an 18-month-old girl after fresh water near-drowning followed by acute respiratory failure. The first measured cerebral oxygen saturation was 22% despite normal values for arterial and central venous oxygen saturation. After conventional therapy had failed to improve cerebral oxygen saturation, we started veno-venous extracorporeal membrane oxygenation.

Peritoneal dialysis for continuing renal support after cardiac ECMO and hemofiltration.

Postoperative acute renal insufficiency after cardiac surgery in neonates is associated with increased mortality and is usually treated (while using ECMO, extracorporeal membrane oxygenation) with hemofiltration. Renal support has to be continued after weaning from ECMO when oliguria persists. When using hemofiltration, prolonged anticoagulation and a vascular access is needed, which, however, carries the risk of hemorrhagic as well as thromboembolic complications.

Methemoglobin formation in children with congenital heart disease treated with inhaled nitric oxide after cardiac surgery.

Objective: Inhaled nitric oxide (NO) is used as a therapy of pulmonary hypertension in children after cardiac surgery. Hemoglobin binds to NO with great affinity and forms methemoglobin by oxidation in the erythrocyte. Once produced, methemoglobin is unable to transport and unload oxygen in the tissues.

The immediate haemodynamic response to the initiation of extracorporeal membrane oxygenation in a piglet model of infant hypoxic respiratory failure.

There is evidence that haemodynamic fluctuations on extracorporeal membrane oxygenation (ECMO) increase the risk of cerebral damage. We hypothesized that initiation of venovenous (VV) or venoarterial (VA) ECMO itself causes haemodynamic fluctuations and, thus, established an infant animal ECMO model in order to discuss this hypothesis. Five piglets were cannulated using the jugular and femoral veins (VV group) and five using the jugular vein and carotid artery (VA group).

Low-volume peritoneal dialysis in 116 neonatal and paediatric critical care patients.

Unlabelled: Acute renal insufficiency accounts for high mortality in paediatric intensive care patients, particularly in infants. Peritoneal dialysis, usually carried out with dialysate volumes of >20 ml/kg body weight, increases pulmonary artery pressure, which may compromise myocardial function in critical illness. In this paper we report our experiences with the use of lower dialysate volumes in the treatment of critically ill children with renal impairments.

Osteomyelitis at the injection site of adrenalin through an intraosseous needle in a 3-month-old infant.

Intraosseous (IO) puncture is considered for the administration of drugs and fluids when vascular access cannot be achieved rapidly. Adrenaline/epinephrine, adenosine, crystalloids, colloids and blood products can be applied and administered effectively using this route during resuscitation of children. This technique is relatively simple with complications of <1%.

Surfactant therapy in infants and children: three years experience in a pediatric intensive care unit.

Despite the established success of surfactant application in neonates, the use of surfactant in older children is still a matter of discussion. We hypothesized that surfactant application in children with acute respiratory distress syndrome (ARDS) secondary to a pulmonary or systemic disease or after cardiac surgery improves pulmonary function. We also asked whether repeated treatment could further improve pulmonary function.

Severe respiratory failure following charcoal application in a toddler.

Charcoal has been commonly used for enteral detoxication with few adverse effects. In toddlers charcoal can often be simply applied via a gastric tube. Regurgitation and aspiration is considered a rare event.

Life threatening cardiopulmonary failure in an infant following protamine reversal of heparin after cardiopulmonary bypass.

Life threatening cardiopulmonary failure following protamine reversal of heparin after cardiopulmonary bypass (CPB) was reported to occur in adults but rarely in children. Atrial septal defect closure was performed in a 6-week-old infant erroneously suspected to suffer from right atrial thrombosis in addition. Protamine administration after CPB led to critical pulmonary hypertension and severe haemorrhagic pulmonary oedema resulting in severe hypoxia.

A pulsatile pneumatically driven neonatal extracorporeal membrane oxygenation system using neck vessel cannulas tested with neonatal mock circulation.

In posthypoxic circulatory failure, pulsatility of flow generated by mechanical support devices significantly influences outcome. Pneumatically driven assist devices can create highly pulsatile flow, but need large graft cannulas implanted by thoracotomy in children and neonates. Emergency application is therefore hindered.

Permissive hypoxemia permitted postoperative weaning from artificial ventilation after repair of pulmonary atresia.

Survival after corrective surgery of pulmonary atresia was associated with low right ventricular pressure, indicating normal pulmonary vascular resistance. Therefore increased fractional inspiratory oxygen concentration, inhaled nitric oxide and intravenous prostacyclin were considered to be effective measures during postoperative intensive care. In a 20-year-old female, conduit repair and unifocalisation of pulmonary atresia with ventricular septal defect and systemic to pulmonary arterial collaterals were performed despite preexisting one-sided pulmonary hypertension.

Extracorporeal membrane oxygenation discontinuation despite technically successful reoperation: A case report.

Death remains a probable outcome of pediatric cardiac extracorporeal membrane oxygenation (ECMO) despite increasing efforts to improve the results. On venoarterial ECMO, in an obviously hopeless situation, the decision to withdraw a life supporting measure resulting in the sudden death of a child places a heavy burden on the team. After valvulotomy of critical aortic stenosis in a prenatally diagnosed term neonate, ECMO had to be installed during postoperative resuscitation.