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Pediatric ECLS

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https://www.readbyqxmd.com/read/28301052/decreased-blood-product-usage-during-extracorporeal-life-support-with-reduced-circuit-volumes
#1
Samuel D Addison, Marcia L Buck, Gary Y Fang, James J Gangemi, David A Kaufman
BACKGROUND: Activation and consumption of platelets (PLT) and clotting factors along with hemolysis occurs when blood contacts the extracorporeal life support (ECLS) circuit and its components. STUDY DESIGN AND METHODS: The objective was to examine the effects of reducing ECLS circuit volume by decreasing tubing length and changing components on blood product usage in neonatal and pediatric patients. Blood product administration was analyzed in 40 consecutive patients who required ECLS for respiratory or cardiac failure before (PRE) and after (POST) changes in circuit design and components...
March 16, 2017: Transfusion
https://www.readbyqxmd.com/read/28289880/pediatric-morgagni-diaphragmatic-hernia-a-descriptive-study
#2
Jamie Golden, Wesley E Barry, Gene Jang, Nam Nguyen, David Bliss
INTRODUCTION: The Morgagni hernia (MH) accounts for 3-4% of congenital diaphragmatic hernias. There is a paucity of data regarding this rare defect. The purpose of this study is to describe the characteristics of children with MH, surgical approaches for repair, and patient outcomes. METHODS: Pediatric patients (ages 0-18) with a MH from 2002 to 2014 at a single, freestanding pediatric hospital were retrospectively reviewed. Patient presentation, demographics, operative methods and findings, and outcomes were evaluated...
March 13, 2017: Pediatric Surgery International
https://www.readbyqxmd.com/read/28271557/early-cardiac-catheterization-leads-to-shortened-pediatric-extracorporeal-membrane-oxygenation-run-duration
#3
Christopher R Burke, Titus Chan, Agustin E Rubio, David M McMullan
OBJECTIVE: Cardiac catheterization in patients receiving extracorporeal life support (ECLS) has previously been shown to be safe and, in many cases, therapeutic. However, the influence of cardiac catheterization on clinical outcomes in this patient population has not been clearly defined. METHODS: A single institution, retrospective review of all pediatric cardiac ECLS patients who underwent cardiac catheterization between January 2006 and September 2015 was performed...
March 8, 2017: Journal of Interventional Cardiology
https://www.readbyqxmd.com/read/28166602/managing-the-precarious-hemostatic-balance-during-extracorporeal-life-support-implications-for-coagulation-laboratories
#4
Anne M Winkler
For the past four decades, extracorporeal life support (ECLS) has been used to treat critically ill adult and pediatric patients with cardiac and/or respiratory failure unresponsive to medical management, and there are increasing numbers of centers performing ECLS for numerous indications worldwide. Despite the progress with advancing technology, hemorrhagic and thrombotic complications occur frequently and are associated with worse outcomes, but the exact cause is often elusive or multifactorial. As a result of the interaction between blood and a nonendothelialized circuit, there is activation of coagulation, fibrinolysis, as well as an increased inflammatory response; thus, anticoagulation of the patient and circuit is necessary...
February 6, 2017: Seminars in Thrombosis and Hemostasis
https://www.readbyqxmd.com/read/27925247/does-flexible-arterial-tubing-retain-more-hemodynamic-energy-during-pediatric-pulsatile-extracorporeal-life-support
#5
Shigang Wang, Allen R Kunselman, Akif Ündar
The objective of this study was to evaluate the hemodynamic performance and energy transmission of flexible arterial tubing as the arterial line in a simulated pediatric pulsatile extracorporeal life support (ECLS) system. The ECLS circuit consisted of a Medos Deltastream DP3 diagonal pump head, Medos Hilite 2400 LT oxygenator, Biomedicus arterial/venous cannula (10 Fr/14 Fr), 3 feet of polyvinyl chloride (PVC) arterial tubing or latex rubber arterial tubing, primed with lactated Ringer's solution and packed red blood cells (hematocrit 40%)...
January 2017: Artificial Organs
https://www.readbyqxmd.com/read/27916443/extracorporeal-life-support-use-in-pediatric-trauma-a-review-of-the-national-trauma-data-bank
#6
Joshua A Watson, Brian R Englum, Jina Kim, Obinna O Adibe, Henry E Rice, Mark L Shapiro, Mani A Daneshmand, Elisabeth T Tracy
PURPOSE: As the role of extracorporeal life support (ECLS) continues to evolve in the adult and pediatric populations, smaller studies and case reports have described successful use of ECLS in specific groups of pediatric trauma patients. To further define the role of ECLS in pediatric trauma, we examined indications and outcomes for use of ECLS in injured children using a large national database. METHODS: All trauma patients ≤18years old were identified from the 2007 to 2011 National Trauma Data Bank...
January 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/27862035/does-an-open-recirculation-line-affect-the-flow-rate-and-pressure-in-a-neonatal-extracorporeal-life-support-circuit-with-a-centrifugal-or-roller-pump
#7
Shigang Wang, Shannon B Spencer, Karl Woitas, Kristen Glass, Allen R Kunselman, Akif Ündar
The objective of this study is to evaluate the impact of an open or closed recirculation line on flow rate, circuit pressure, and hemodynamic energy transmission in simulated neonatal extracorporeal life support (ECLS) systems. The two neonatal ECLS circuits consisted of a Maquet HL20 roller pump (RP group) or a RotaFlow centrifugal pump (CP group), Quadrox-iD Pediatric oxygenator, and Biomedicus arterial and venous cannulae (8 Fr and 10 Fr) primed with lactated Ringer's solution and packed red blood cells (hematocrit 35%)...
January 2017: Artificial Organs
https://www.readbyqxmd.com/read/27812522/extracorporeal-life-support-for-pediatric-heart-failure
#8
REVIEW
Christopher R Burke, D Michael McMullan
Extracorporeal life support (ECLS) represents an essential component in the treatment of the pediatric patient with refractory heart failure. Defined as the use of an extracorporeal system to provide cardiopulmonary support, ECLS provides hemodynamic support to facilitate end-organ recovery and can be used as a salvage therapy during acute cardiorespiratory failure. Support strategies employed in pediatric cardiac patients include bridge to recovery, bridge to therapy, and bridge to transplant. Advances in extracorporeal technology and refinements in patient selection have allowed wider application of this therapy in pediatric heart failure patients...
2016: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/27774445/ecls-in-pediatric-cardiac-patients
#9
REVIEW
Matteo Di Nardo, Graeme MacLaren, Marco Marano, Corrado Cecchetti, Paola Bernaschi, Antonio Amodeo
Extracorporeal life support (ECLS) is an important device in the management of children with severe refractory cardiac and or pulmonary failure. Actually, two forms of ECLS are available for neonates and children: extracorporeal membrane oxygenation (ECMO) and use of a ventricular assist device (VAD). Both these techniques have their own advantages and disadvantages. The intra-aortic balloon pump is another ECLS device that has been successfully used in larger children, adolescents, and adults, but has found limited applicability in smaller children...
2016: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/27735070/in-vitro-evaluation-of-an-alternative-neonatal-extracorporeal-life-support-circuit-on-hemodynamic-performance-and-bubble-trap
#10
Shannon B Spencer, Shigang Wang, Karl Woitas, Kristen Glass, Allen R Kunselman, Akif Ündar
The objective of this study was to evaluate an alternative neonatal extracorporeal life support (ECLS) circuit with a RotaFlow centrifugal pump and Better-Bladder (BB) for hemodynamic performance and gaseous microemboli (GME) capture in a simulated neonatal ECLS system. The circuit consisted of a Maquet RotaFlow centrifugal pump, a Quadrox-iD Pediatric diffusion membrane oxygenator, 8 Fr arterial cannula, and 10 Fr venous cannula. A "Y" connector was inserted into the venous line to allow for comparison between BB and no BB...
January 2017: Artificial Organs
https://www.readbyqxmd.com/read/27543261/challenges-with-navigating-the-precarious-hemostatic-balance-during-extracorporeal-life-support-implications-for-coagulation-and-transfusion-management
#11
REVIEW
Jennifer Andrews, Anne M Winkler
For the past four decades, extracorporeal life support (ECLS) has been used to treat critically ill adult and pediatric patients with cardiac and/or respiratory failure, and there are increasingly numbers of centers worldwide performing ECLS for numerous indications. Despite the progress with advancing the technology, hemorrhagic and thrombotic complications are frequently reported and associated with worse outcomes, but the exact cause is often elusive or multifactorial. As a result of the interaction between blood and an artificial circuit, anticoagulation is necessary and there is resultant activation of coagulation, fibrinolysis, as well as, an increased inflammatory response...
October 2016: Transfusion Medicine Reviews
https://www.readbyqxmd.com/read/27446890/anticoagulation-management-and-monitoring-during-pediatric-extracorporeal-life-support-a-review-of-current-issues
#12
REVIEW
Lindsay M Ryerson, Laurence L Lequier
Anticoagulation is an imperfect science and is even more complicated in neonates and young children. The addition of the extracorporeal life support (ECLS) foreign circuit adds an additional layer of complexity. Anticoagulation goals during ECLS are to maintain a clot-free circuit and a hemostatically balanced patient. Unfractionated heparin (UFH) is the default gold standard anticoagulant as no large studies have been performed on any other anticoagulants. This review will focus on the advantages and disadvantages of the various methods to monitor UFH anticoagulation, discuss alternative anticoagulants, and examine bleeding and thrombotic complications during ECLS...
2016: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/27446889/venovenous-extracorporeal-life-support-in-single-ventricle-patients-with-acute-respiratory-distress-syndrome
#13
REVIEW
Alison B Nair, Peter Oishi
There is new and growing experience with venovenous extracorporeal life support (VV ECLS) for neonatal and pediatric patients with single-ventricle physiology and acute respiratory distress syndrome (ARDS). Outcomes in this population have been defined but could be improved; survival rates in single-ventricle patients on VV ECLS for respiratory failure are slightly higher than those in single-ventricle patients on venoarterial ECLS for cardiac failure (48 vs. 32-43%), but are lower than in patients with biventricular anatomy (58-74%)...
2016: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/27432486/the-use-of-neonatal-extracorporeal-life-support-in-pediatric-cardiac-intensive-care-unit
#14
Erkut Öztürk, Okan Yıldız, Nihat Çine, Behzat Tüzün, Selen Onan, Yakup Ergül, Alper Güzeltaş, Sertaç Haydin, Mehmet Yeniterzi, İhsan Bakır
AIM: The aim of the study is to evaluate extracorporeal life support system (ECLS) employed in neonates in pediatric cardiac intensive care unit. MATERIAL AND METHODS: Twenty-five neonates that required ECLS in between November 2010 and November 2015 were evaluated. RESULTS: The median age was 12 days (range 3-28 days) and the median body weight was 3 kg (range 2.5-5 kg). Venoarterial ECLS was performed in all of the cases. Ascendan aorta-right atrial cannulation in 22 patients and neck cannulation in three patients were performed...
August 10, 2016: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/27220493/effect-of-timing-of-cannulation-on-outcome-for-pediatric-extracorporeal-life-support
#15
Katherine W Gonzalez, Brian G A Dalton, Katrina L Weaver, Ashley K Sherman, Shawn D St Peter, Charles L Snyder
PURPOSE: Literature reports worse outcomes for operations performed during off-hours. As this has not been studied in pediatric extracorporeal life support (ECLS), we compared complications based on the timing of cannulation.. METHODS: This is a retrospective review of 176 pediatric ECLS patients between 2004 and 2015. Patients cannulated during daytime hours (7:00 A.M. to 7:00 P.M., M-F) were compared to off-hours (nighttime or weekend) using t-test and Chi-square...
July 2016: Pediatric Surgery International
https://www.readbyqxmd.com/read/27164039/pediatric-extracorporeal-life-support-using-a-third-generation-diagonal-pump
#16
Marlene Speth, Frank Münch, Ariawan Purbojo, Martin Glöckler, Okan Toka, Robert A Cesnjevar, André Rüffer
This study reports a single-centre experience of the Medos Deltastream diagonal-pump (DP3) for extracorporeal cardiac, pulmonary, or combined support in a single-center pediatric cohort. Twenty-seven consecutive patients with 28 runs of the DP3 between January 2013 and June 2014 were included for analysis. Median patient age, weight, and duration of support were 278 days (range: 0 days-14.2 years), 7.2 kg (range: 2.5-39 kg), and 8 days (range: 2-69 days). Midline sternotomy (n = 20, 71.4%) or cervical approaches (n = 8, 28...
July 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/27107689/extracorporeal-life-support-for-victims-of-drowning
#17
Christopher R Burke, Titus Chan, Thomas V Brogan, Laurance Lequier, Ravi R Thiagarajan, Peter T Rycus, D Michael McMullan
AIM: Unintentional drowning is a significant public health concern in the United States and represents a leading cause of death in the pediatric population. Extracorporeal life support (ECLS) may be used to support drowning victims, but outcomes have not been well defined. This study examined survival rates and risk factors for death in this population. METHODS: Retrospective data from the Extracorporeal Life Support Organization registry was examined to determine outcomes of ECLS and risk factors for death in drowning victims...
July 2016: Resuscitation
https://www.readbyqxmd.com/read/26235652/determining-comorbidities-and-quality-of-life-among-pediatric-survivors-of-extracorporeal-life-support
#18
Heather K Chandler, Beatriz Teppa, Khaliah A Johnson, Courtney McCracken, James D Fortenberry, Matthew L Paden
PURPOSE: The purpose of this study is to describe health-related quality of life (HRQoL) and the prevalence of comorbidities in pediatric survivors of extracorporeal life support (ECLS) and to determine risk factors for poor HRQoL. MATERIALS: The study design was a retrospective cohort and prospective follow-up study of patients who received ECLS in the pediatric intensive care unit at Egleston Children's Hospital from 2006 to 2013. Quality of life was measured using the Pediatric Quality of Life Inventory (PedsQL 4...
October 2015: Journal of Critical Care
https://www.readbyqxmd.com/read/25912740/predictors-and-outcome-of-extracorporeal-life-support-after-pediatric-heart-transplantation
#19
Jacob Simmonds, Troy Dominguez, Joanna Longman, Nitin Shastri, Maura O'Callaghan, Aparna Hoskote, Matthew Fenton, Michael Burch, Victor Tsang, Kate Brown
BACKGROUND: Extracorporeal life support (ECLS) has proven success after conventional cardiac surgery. Its use after pediatric heart transplantation is less well documented. We reviewed ECLS after pediatric heart transplantation, to understand better predisposing factors, morbidity, and mortality. METHODS: The notes of all patients at Great Ormond Street Hospital undergoing orthotopic heart transplantation from 1999 to 2009 were reviewed (202 transplants; patients aged 0...
June 2015: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/25783368/evaluating-the-introduction-of-extracorporeal-life-support-technology-to-a-tertiary-care-pediatric-institution-smoothing-the-learning-curve-through-interprofessional-simulation-training
#20
Carlos Sanchez-Glanville, Mary E Brindle, Tanya Spence, Jaime Blackwood, Tanya Drews, Steve Menzies, Steven R Lopushinsky
BACKGROUND: Extracorporeal life support (ECLS) is a life-saving technology for the critically ill child. Our objective was to evaluate the outcomes of an educational curriculum designed to introduce an ECLS program to a noncardiac pediatric surgical center. METHODS: An interdisciplinary curriculum was developed consisting of didactic courses, animal labs, simulations, and debrief sessions. We reviewed all patients requiring ECLS between October 2011 and December 2013...
May 2015: Journal of Pediatric Surgery
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