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Chu X, Chen W, Wang Y, Zhu L, Zhang M, Zhang S. ECMO for paediatric cardiac arrest caused by bronchial rupture and severe lung injury: a case report about life-threatening rescue at an adult ECMO centre. J Cardiothorac Surg 2022; 17:142. [PMID: 35668492 PMCID: PMC9169275 DOI: 10.1186/s13019-022-01856-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 04/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bronchial rupture in children is a rare but dangerous complication after chest trauma and is associated with increased mortality. Veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) is reported as one of the treatments for this life-threatening complication. CASE PRESENTATION A 4-year-old boy with bronchial rupture and traumatic wet lung complicated by cardiac arrest after chest trauma was admitted to an adult ECMO centre. He experienced two cardiac arrests, one before and one during the operation. The total duration of cardiac arrest was 30 min. V-V ECMO was initiated because of severe hypoxia and hypercapnia during the operation. ECMO was performed for 6 days, and mechanical ventilation lasted 11 days. On the 31st day after surgery, he had recovered completely and was discharged without neurological deficit. CONCLUSION V-V ECMO can be considered for supportive care in children with severe acute respiratory failure after bronchial rupture. In an emergency, V-V ECMO can be carried out effectively in a qualified and experienced adult ECMO centre. However, the application of ECMO in children is different from that in adults and requires more refined management.
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Affiliation(s)
- Xiaoqiong Chu
- Department of Critical Care Medicine, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, No. 150, Xi Men Street, Taizhou, 317000, China
| | - Weibiao Chen
- Department of Emergency Medicine, Tiantai County Hospital of Chinese Medicine, Taizhou, China
| | - Yafei Wang
- Department of Critical Care Medicine, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, No. 150, Xi Men Street, Taizhou, 317000, China
| | - Luqi Zhu
- Department of Critical Care Medicine, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, No. 150, Xi Men Street, Taizhou, 317000, China
| | - Mengqin Zhang
- Department of Critical Care Medicine, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, No. 150, Xi Men Street, Taizhou, 317000, China
| | - Sheng Zhang
- Department of Critical Care Medicine, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, No. 150, Xi Men Street, Taizhou, 317000, China.
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Willers A, Swol J, Kowalewski M, Raffa GM, Meani P, Jiritano F, Matteucci M, Fina D, Heuts S, Bidar E, Natour E, Sels JW, Delnoij T, Lorusso R. Extracorporeal Life Support in Hemorrhagic Conditions: A Systematic Review. ASAIO J 2021; 67:476-484. [PMID: 32657828 DOI: 10.1097/mat.0000000000001216] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Extracorporeal life support (ECLS) is indicated in refractory acute respiratory or cardiac failure. According to the need for anticoagulation, bleeding conditions (e.g., in trauma, pulmonary bleeding) have been considered a contraindication for the use of ECLS. However, there is increasing evidence for improved outcomes after ECLS support in hemorrhagic patients based on the benefits of hemodynamic support outweighing the increased risk of bleeding. We conducted a systematic literature search according to the PRISMA guidelines and reviewed publications describing ECLS support in hemorrhagic conditions. Seventy-four case reports, four case series, seven retrospective database observational studies, and one preliminary result of an ongoing study were reviewed. In total, 181 patients were identified in total of 86 manuscripts. The reports included patients suffering from bleeding caused by pulmonary hemorrhage (n = 53), trauma (n = 96), postpulmonary endarterectomy (n = 13), tracheal bleeding (n = 1), postpartum or cesarean delivery (n = 11), and intracranial hemorrhage (n = 7). Lower targeted titration of heparin infusion, heparin-free ECLS until coagulation is normalized, clamping of the endotracheal tube, and other ad hoc possibilities represent potential beneficial maneuvers in such conditions. Once the patient is cannulated and circulation restored, bleeding control surgery is performed for stabilization if indicated. The use of ECLS for temporary circulatory or respiratory support in critical patients with refractory hemorrhagic shock appears feasible considering tailored ECMO management strategies. Further investigation is needed to better elucidate the patient selection and ECLS management approaches.
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Affiliation(s)
- Anne Willers
- From the ECLS Centrum, Cardio-Thoracic Surgery Department, and Cardiology Department, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Justyna Swol
- Department of Pulmonology, Intensive Care Medicine, Paracelsus Medical University, Nuremberg, Germany
| | - Mariusz Kowalewski
- From the ECLS Centrum, Cardio-Thoracic Surgery Department, and Cardiology Department, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Giuseppe Maria Raffa
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per I Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Paolo Meani
- From the ECLS Centrum, Cardio-Thoracic Surgery Department, and Cardiology Department, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Federica Jiritano
- From the ECLS Centrum, Cardio-Thoracic Surgery Department, and Cardiology Department, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Matteo Matteucci
- From the ECLS Centrum, Cardio-Thoracic Surgery Department, and Cardiology Department, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Dario Fina
- From the ECLS Centrum, Cardio-Thoracic Surgery Department, and Cardiology Department, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Samuel Heuts
- From the ECLS Centrum, Cardio-Thoracic Surgery Department, and Cardiology Department, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Elham Bidar
- From the ECLS Centrum, Cardio-Thoracic Surgery Department, and Cardiology Department, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ehsan Natour
- From the ECLS Centrum, Cardio-Thoracic Surgery Department, and Cardiology Department, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jan Willem Sels
- Cardiology Department, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
- Intensive Care Department, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Thijs Delnoij
- Cardiology Department, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
- Intensive Care Department, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Roberto Lorusso
- From the ECLS Centrum, Cardio-Thoracic Surgery Department, and Cardiology Department, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
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Characteristics and outcomes of extracorporeal life support in pediatric trauma patients. J Trauma Acute Care Surg 2020; 89:631-635. [PMID: 32301875 DOI: 10.1097/ta.0000000000002712] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Extracorporeal life support utilizing extracorporeal membrane oxygenation (ECMO) techniques has been used in the pediatric population for numerous indications, but its use in trauma has been understudied. We sought to examine the indications, characteristics, and outcomes of children placed on ECMO for trauma and hypothesized that outcomes would be equivalent to those of patients placed on ECMO for other indications. METHODS We performed a retrospective review of all pediatric trauma patients in the Extracorporeal Life Support Organization registry from 1989 to 2018. Patient characteristics, indications for ECMO, pre- and post-ECMO ventilator settings and blood chemistry, complications, and survival rates were examined. Categories were stratified by mode: venovenous (VV), veno-arterial (VA), or conversion. Data were analyzed using SPSS software, with significance considered at p value less than 0.05. RESULTS We identified 573 patients with a median age of 4.82 years. The majority of patients (62.3%) were male and on VA support (54.5%). Drowning (38.7%) was the most common mechanism, followed by burns (21.1%) and thoracic trauma (17.8%). Complication rates were high (81.9%), with the most frequent types being cardiovascular, mechanical, and hemorrhagic. Incidences of complications (overall and by type) were similar to those reported in other Extracorporeal Life Support Organization cohorts. Overall survival was 55.3% and was significantly higher (p = 0.00) for patients on VV (74.3%) compared with those on VA (41.7%), even when controlling for mechanism. CONCLUSION Survival and complication rates of pediatric trauma patients on ECMO are comparable to those reported for other indications. Trauma should not be considered a contraindication for ECMO. LEVEL OF EVIDENCE Therapeutic, level V.
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Wang C, Zhang L, Qin T, Xi Z, Sun L, Wu H, Li D. Extracorporeal membrane oxygenation in trauma patients: a systematic review. World J Emerg Surg 2020; 15:51. [PMID: 32912280 PMCID: PMC7488245 DOI: 10.1186/s13017-020-00331-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/23/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) has evolved considerably over the past two decades and has been gradually utilized in severe trauma. However, the indications for the use of ECMO in trauma remain uncertain and the clinical outcomes are different. We performed a systematic review to provide an overall estimate of the current performance of ECMO in the treatment of trauma patients. MATERIALS AND METHODS We searched PubMed and MEDLINE databases up to the end of December 2019 for studies on ECMO in trauma. The PRISMA statement was followed. Data on demographics of the patient, mechanism of injury, injury severity scores (ISS), details of ECMO strategies, and clinical outcome were extracted. RESULTS A total of 58 articles (19 retrospective reports and 39 case reports) were deemed eligible and included. In total, 548 patients received ECMO treatment for severe trauma (adult 517; children 31; mean age of adults 34.9 ± 12.3 years). Blunt trauma (85.4%) was the primary injury mechanism, and 128 patients had traumatic brain injury (TBI). The mean ISS was 38.1 ± 15.0. A total of 71.3% of patients were initially treated with VV ECMO, and 24.5% were placed on VA ECMO. The median time on ECMO was 9.6 days, and the median time to ECMO was 5.7 days. A total of 60% of patients received initially heparin anticoagulation. Bleeding (22.9%) and thrombosis (19%) were the most common complications. Ischemia of the lower extremities occurred in 9 patients. The overall hospital mortality was 30.3%. CONCLUSIONS ECMO has been gradually utilized in a lifesaving capacity in severe trauma patients, and the feasibility and advantages of this technique are becoming widely accepted. The safety and effectiveness of ECMO in trauma require further study. Several problems with ECMO in trauma, including the role of VA-ECMO, the time to institute ECMO, and the anticoagulation strategy remain controversial and must be solved in future studies.
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Affiliation(s)
- Changtian Wang
- Department of Cardiovascular Surgery, School Medicine, Jinling Hospital, Nanjing University, Nanjing, People's Republic of China.
| | - Lei Zhang
- Department of Cardiovascular Surgery, School Medicine, Jinling Hospital, Nanjing University, Nanjing, People's Republic of China
| | - Tao Qin
- Department of Cardiovascular Surgery, School Medicine, Jinling Hospital, Nanjing University, Nanjing, People's Republic of China
| | - Zhilong Xi
- Department of Cardiovascular Surgery, School Medicine, Jinling Hospital, Nanjing University, Nanjing, People's Republic of China
| | - Lei Sun
- Department of Cardiovascular Surgery, School Medicine, Jinling Hospital, Nanjing University, Nanjing, People's Republic of China
| | - Haiwei Wu
- Department of Cardiovascular Surgery, School Medicine, Jinling Hospital, Nanjing University, Nanjing, People's Republic of China
| | - Demin Li
- Department of Cardiovascular Surgery, School Medicine, Jinling Hospital, Nanjing University, Nanjing, People's Republic of China
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Venoarterial Extracorporeal Life Support Utilization in a Pediatric Trauma Patient Following a Severe Dog Mauling. Pediatr Emerg Care 2020; 36:e99-e101. [PMID: 30893224 DOI: 10.1097/pec.0000000000001753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
According to the Centers for Disease Control and Prevention, approximately 4.5 million dog bites occur each year in the United States, and more than half of these cases affect children. An estimated 1 in 6 dog bites, representing more than 800,000 bite victims each year, requires some form of medical attention. Historically, pediatric trauma patients who suffer devastating injuries and cardiopulmonary collapse requiring heroic salvage efforts have poor outcomes. We present the first case of extracorporeal membrane oxygenation utilized in a pediatric trauma patient following a severe dog bite injury. This case is an extraordinary example of multidisciplinary care of the pediatric trauma patient. It highlights the public health burden of dog bite injuries and the scant literature on extracorporeal membrane oxygenation in pediatric trauma patients.
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Medar SS, Villacres S, Kaushik S, Eisenberg R, Stone ME. Pediatric Acute Respiratory Distress Syndrome (PARDS) in Children With Pulmonary Contusion. J Intensive Care Med 2019; 36:107-114. [PMID: 31711367 DOI: 10.1177/0885066619887666] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE There is paucity of data about prevalence of pediatric acute respiratory distress syndrome (PARDS) in children with pulmonary contusion (PC). We intend to evaluate PC in children with chest trauma and the association between PC and PARDS. DESIGN Retrospective review of Institutional Trauma Registry for patients with trauma. SETTING Level 1 trauma center. PATIENTS Age 18 years and younger with a diagnosis of PC. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Of the 1916 children with trauma, 50 (2.6%) had PC. Patients with PC and PARDS had lower Glasgow Coma Scale (GCS) score (7 [3-15] vs 15 [15-15], P = .0003), higher Injury Severity Scale (ISS) score (29 [22-34] vs 19 [14-22], P = .004), lower oxygen saturations (96 [93-99] days vs 99 [98-100] days, P = .0009), higher FiO2 (1 [1-1] vs 0.21 [0.21-0.40], P < .0001), lower oxygen saturation/FiO2 (S/F) ratios (97 [90-99] vs 457 [280-471], P < .0001), need for invasive mechanical ventilation (IMV; 86% vs 23%, P < .0001), and mortality (28% vs 0%, P = .006) compared to those without PARDS. Forty-two percent (21/50) of patients needed IMV, of these 61% (13/21) had PARDS. Patients who needed IMV had significantly lower GCS score (8 [3-11] vs 15 [15-15], P < .0001), higher ISS score (27 [22-34] vs 18 [14-22], P = .002), longer length of stay (LOS; 7.5 [4-14] days vs 3.3 [2-5] days, P = .003), longer hospital LOS (18 [7.0-25] vs 5 [4-11], P = .008), higher PARDS rate (62% vs 7%, P < .0001), and lower S/F ratios (99 [94-190] vs 461 [353-471], P < .0001) compared to those who did not require IMV. Lower GCS score was independently associated with both PARDS and need for IMV. CONCLUSIONS Pediatric ARDS in children with PC is independently associated with lower GCS score, and its presence significantly increased morbidity and mortality. Further larger studies are needed to explore association of lower GCS and higher injury score in children with PARDS and PC.
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Affiliation(s)
- Shivanand S Medar
- Division of Pediatric Critical Care Medicine and Pediatric Cardiology, 37292Children's Hospital at Montefiore, Bronx, NY, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
- Jacobi Medical Center, Bronx, NY, USA
| | - Sindy Villacres
- Division of Pediatric Critical Care Medicine, 25104Neumors Children's Hospital, Orlando, FL, USA
| | - Shubhi Kaushik
- Division of Pediatric Critical Care Medicine and Pediatric Cardiology, 37292Children's Hospital at Montefiore, Bronx, NY, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Melvin E Stone
- Albert Einstein College of Medicine, Bronx, NY, USA
- Jacobi Medical Center, Bronx, NY, USA
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Use of ECMO support in pediatric patients with severe thoracic trauma. J Pediatr Surg 2019; 54:2358-2362. [PMID: 30850149 DOI: 10.1016/j.jpedsurg.2019.02.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/18/2019] [Accepted: 02/03/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) has been used in the non-trauma setting for over 30 years. However, the use of ECMO in trauma remains a difficult question, as the risk of bleeding must be weighed against the benefits of cardiopulmonary support. METHODS Retrospective review of children who sustained severe thoracic trauma (chest abbreviated injury score ≥3) and required ECMO support between 2009 and 2016. RESULTS Of the 425 children who experienced severe thoracic trauma, 6 (1.4%) underwent ECMO support: 67% male, median age 4.8 years, median ISS 36, median GCS 3, and overall survival 83%. The median hospital day of ECMO initiation was 2 with a median ECMO duration of 7 days. All cannulations occurred through the right neck regardless of the size of the child. Five initially had veno-venous support with 1 requiring conversion to veno-arterial (VA) support. Both children on VA support suffered devastating cerebrovascular accidents, one of which ultimately led to withdrawal of care and death. Complications in the cohort included: paraplegia (1), neurocognitive defects/dysphonia (1), infected neck hematoma (1), deep femoral venous thrombosis (1), bilateral lower extremity spasticity (1). CONCLUSION This small cohort supports the use of ECMO in children with severe thoracic injuries as a potentially lifesaving intervention, however, not without significant complication. LEVEL OF EVIDENCE IV.
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Puzio T, Murphy P, Gazzetta J, Phillips M, Cotton BA, Hartwell JL. Extracorporeal life support in pediatric trauma: a systematic review. Trauma Surg Acute Care Open 2019; 4:e000362. [PMID: 31565679 PMCID: PMC6744255 DOI: 10.1136/tsaco-2019-000362] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/26/2019] [Accepted: 09/01/2019] [Indexed: 01/21/2023] Open
Abstract
Introduction Extracorporeal membrane oxygenation (ECMO) was once thought to be contraindicated in trauma patients, however ECMO is now used in adult patients with post-traumatic acute respiratory distress syndrome (ARDS) and multisystem trauma. Despite acceptance as a therapy for the severely injured adult, there is a paucity of evidence supporting ECMO use in pediatric trauma patients. Methods An electronic literature search of PubMed, MEDLINE, and the Cochrane Database of Collected Reviews from 1972 to 2018 was performed. Included studies reported on ECMO use after trauma in patients ≤18 years of age and reported outcome data. The Institute of Health Economics quality appraisal tool for case series was used to assess study quality. Results From 745 studies, four met inclusion criteria, reporting on 58 pediatric trauma patients. The age range was <1–18 years. Overall study quality was poor with only a single article of adequate quality. Twenty-nine percent of patients were cannulated at adult centers, the remaining at pediatric centers. Ninety-one percent were cannulated for ARDS and the remaining for cardiovascular collapse. Overall 60% of patients survived and the survival rate ranged from 50% to 100%. Seventy-seven percent underwent venoarterial cannulation and the remaining underwent veno-venous cannulation. Conclusion ECMO may be a therapeutic option in critically ill pediatric trauma patients. Consideration should be made for the expansion of ECMO utilization in pediatric trauma patients including its application for pediatric patients at adult trauma centers with ECMO capabilities.
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Affiliation(s)
- Thaddeus Puzio
- Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA
| | - Patrick Murphy
- Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Josh Gazzetta
- Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Michael Phillips
- Pediatric Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Bryan A Cotton
- Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA
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Craniectomy and Traumatic Brain Injury in Children on Extracorporeal Membrane Oxygenation Support. Pediatr Emerg Care 2018; 34:e204-e210. [PMID: 27749813 DOI: 10.1097/pec.0000000000000907] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Severe trauma may cause refractory life-threatening respiratory failure requiring extracorporeal membrane oxygenation (ECMO). Concurrent traumatic brain injury, however, complicates the use of ECMO because of the major risk of intracranial bleeding with systemic anticoagulation. Craniotomy and/or craniectomy for hematoma evacuation during ECMO are extremely high-risk procedures secondary to ongoing anticoagulation, and there are only a few such case reports in the literature. We present the case of a child with multiple thoracic injuries and life-threatening respiratory failure supported on ECMO. She developed an intracranial hemorrhage while systemically heparinized that required emergent decannulation and bedside craniectomy for hematoma extraction. She survived with an excellent neurologic outcome. We also review the relevant literature regarding the use of ECMO in patients with polytrauma and the occurrence of craniectomy on extracorporeal support, with a focus on pediatric publications. Patients with polytrauma with brain injury can be supported on ECMO, but extreme precaution must be taken regarding anticoagulation. The intracranial complications of ECMO in this population are not infrequent, but our case report and review of the literature suggest that neurosurgical intervention should be considered in life-threatening conditions when no other alternatives are available.
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Bennett EE, Aljabari S, Short S, Scaife E, Poss WB. Perioperative extracorporeal membrane oxygenation in traumatic bronchial avulsion. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2018.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Lee OJ, Cho YH, Hwang J, Yoon I, Kim YH, Cho J. Long Term Extracorporeal Membrane Oxygenation after Severe Blunt Traumatic Lung Injury in a Child. Korean J Crit Care Med 2017. [DOI: 10.4266/kjccm.2016.00472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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12
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Lee OJ, Cho YH, Hwang J, Yoon I, Kim YH, Cho J. Long-term extracorporeal membrane oxygenation after severe blunt traumatic lung injury in a child. Acute Crit Care 2017; 34:223-227. [PMID: 31723933 PMCID: PMC6849020 DOI: 10.4266/acc.2016.00472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 10/08/2016] [Accepted: 10/10/2016] [Indexed: 12/03/2022] Open
Abstract
Managing acute respiratory distress syndrome (ARDS) after severe blunt traumatic lung injury can be challenging. In cases where patients are refractory to conventional therapy, extracorporeal membrane oxygenation (ECMO) should be considered. In addition, the heparin-coated circuit can reduce hemorrhagic complications in patients with multiple traumas. Although prolonged ECMO may be necessary, excellent outcomes are frequently associated. In this study, we report long-term support with venovenous-ECMO applied in a child with severe blunt trauma in Korea. This 10-year-old and 30 kg male with severe blunt thoracic trauma after a car accident developed severe ARDS a few days later, and ECMO was administered for 33 days. Because of pulmonary hemorrhage during ECMO support, heparin was stopped for 3 days and then restarted. He was weaned from ECMO successfully and has been able to run without difficulty for the 2 years since discharge.
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Affiliation(s)
- Ok Jeong Lee
- Department of Pediatrics, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea
| | - Yang Hyun Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jinwook Hwang
- Department of Thoracic and Cardiovascular Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Inae Yoon
- Department of Pediatrics, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea
| | - Young-Ho Kim
- Department of Pediatrics, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea
| | - Joongbum Cho
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Extracorporeal life support use in pediatric trauma: a review of the National Trauma Data Bank. J Pediatr Surg 2017; 52:136-139. [PMID: 27916443 DOI: 10.1016/j.jpedsurg.2016.10.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 10/20/2016] [Indexed: 11/21/2022]
Abstract
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. We collected patient demographics, mechanism of injury, injury severity, use of ECLS, and survival to discharge. Children undergoing ECLS were compared to those who did not undergo ECLS, using a 3:1 propensity matched analysis to compare outcomes between ECLS and non-ECLS patients with similar injury patterns. RESULTS Of 589,895 pediatric trauma patients identified, 36 patients underwent ECLS. Within the ECLS cohort, 21/36 (58%) survived, and 10/36 (28%) were discharged directly home. Most ECLS patients were between 15 and 18years 20/36 (56%). Mechanisms of injury (MOI) resulting in ECLS use included: motor vehicle collision (MVC) 16/36 (44%), gunshot wound (GSW) 6/36 (17%), burns 6/36 (17%), and drowning/suffocation (D/S) 5/36 (14%). Among the ECLS cohort, survival varied by MOI from 75% in D/S to 56% in MVC and 33% in GSW and was 55% in patients with significant head injuries. Using propensity analysis for matched injury patterns, survival for ECLS and non-ECLS patients was similar (58% vs. 65%, p=0.61). CONCLUSIONS In the largest study to date of ECLS support in pediatric trauma patients, we found encouraging survival rates to discharge, comparable to patients not undergoing ECLS with similar injuries. These results support further use and focused research of ECLS in pediatric trauma, including drowning, burn, and MVC victims and those with significant head injuries. LEVEL OF EVIDENCE Level III; treatment study.
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Lequier L. Extracorporeal Life Support in Pediatric and Neonatal Critical Care: A Review. J Intensive Care Med 2016; 19:243-58. [PMID: 15358943 DOI: 10.1177/0885066604267650] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Extracorporeal life support (ECLS) is a modified form of cardiopulmonary bypass used to provide prolonged tissue oxygen delivery in patients with respiratory and/or cardiac failure. The first large-scale success of ECLS was achieved in the management of term newborns with respiratory failure. ECLS has become an accepted therapeutic modality for neonates, children, and adults who have failed conventional therapy and in whom cardiac and/or respiratory insufficiency is potentially reversible. The use of ECLS allows one to reduce other cardiopulmonary supports and apply a gentle ventilation strategy in a population of severely compromised critical care patients. ECLS has now been employed in more than 26,000 neonatal and pediatric patients with an overall survival rate of 68%. ECLS has evolved significantly over 25 years of clinical practice; patient selection for this complex and highly invasive therapy, as well as how ECLS is employed in different patient groups, is constantly changing. Generally, ECLS is used more liberally now than in the past. The number of patients requiring this support, however, is declining yearly, and those patients who receive ECLS compose a more severe subset of an intensive care population. This review provides an overview of the development of ECLS and the equipment and techniques employed. The use of ECLS for neonatal respiratory failure, pediatric respiratory failure, and cardiac support are outlined. Management of the ECLS patient is discussed in detail, and outcome of these patients is reviewed. Finally, current trends and future implications of ECLS in neonatal and pediatric critical care are addressed.
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Affiliation(s)
- Laurance Lequier
- Stollery Children's Hospital, Pediatric Critical Care, Edmonton, Alberta T6G 2B7, Canada.
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Abstract
Thoracic injury in children deserves special attention because, although it accounts for less than 10% of traumatic injuries in children, there is a significant associated morbidity and mortality. This review discusses the anatomic and physiologic factors resulting in such injury severity with blunt thoracic trauma in children. Specific organ injuries, including most common chest wall injuries, hemo- and pneumothoraces, and pulmonary parenchymal injuries, are discussed, encompassing epidemiology, presentation, diagnosis, and management. Rare injuries including tracheobronchial tree injuries, cardiovascular injuries, esophageal injuries, and diaphragmatic injuries are also briefly discussed.
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Affiliation(s)
- Hanna Alemayehu
- Department of Surgery, Children's Mercy Hospital and Clinics, Kansas City, Missouri, United States
| | - Pablo Aguayo
- Department of Surgery, Children's Mercy Hospital and Clinics, Kansas City, Missouri, United States
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Ballouhey Q, Fesseau R, Benouaich V, Lagarde S, Breinig S, Léobon B, Galinier P. Management of blunt tracheobronchial trauma in the pediatric age group. Eur J Trauma Emerg Surg 2013; 39:167-71. [PMID: 26815075 DOI: 10.1007/s00068-012-0248-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Accepted: 12/27/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Tracheobronchial rupture (TBR) due to blunt chest trauma is a rare but life-threatening injury in the pediatric age group. The aim of this study was to propose a treatment strategy including bronchoscopy, surgery and extracorporeal membrane oxygenation (ECMO) to optimize the emergency management of these patients. METHODS We reviewed a series of 27 patients with post-traumatic TBR treated since 1996 in our pediatric trauma center. RESULTS Seven cases had persistent and large volume air leaks. Flexible bronchoscopy was performed in cases of persistent or large volume air leaks. It permitted accurate visualization of the rupture and its extent. It allowed for a clear-cut positioning of the endotracheal tube. Five were managed operatively. Four cases were considered to be life-threatening because of the combination of severe respiratory distress with hemodynamic instability. One of them had severe tracheal laceration and died. Another one had bilateral bronchi disconnection. Based on clinical and endoscopic findings, surgical repair was performed using extracorporeal membrane oxygenation as a ventilatory support. It provided quick relief from the injury, which was previously expected to result in a fatal issue. CONCLUSIONS Prompt diagnosis and accurate management of surviving patients admitted to emergency rooms are necessary. Bronchoscopy remains a critical diagnosis step. Surgery is warranted for large tracheobronchial tears and ECMO could be beneficial as supportive therapy for selected cases.
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Affiliation(s)
- Q Ballouhey
- Department of Pediatric Surgery, Children's Hospital, 330 Avenue de Grande-Bretagne TSA 70034, 31059, Toulouse Cedex 9, France.
| | - R Fesseau
- Department of Pediatric Anesthesiology, Children's Hospital, 330 Avenue de Grande-Bretagne TSA 70034, 31059, Toulouse Cedex 9, France
| | - V Benouaich
- Department of Cardiac Surgery, Rangueil Hospital, 1 Av J. Poulhes, 31059, Toulouse Cedex 9, France
| | - S Lagarde
- Department of Radiology, Rangueil Hospital, 1 Av J. Poulhes, 31059, Toulouse Cedex 9, France
| | - S Breinig
- Pediatric Intensive Care Unit, Children's Hospital, 330 Avenue de Grande-Bretagne TSA 70034, 31059, Toulouse Cedex 9, France
| | - B Léobon
- Department of Pediatric Cardiac Surgery, Children's Hospital, 330 Avenue de Grande-Bretagne TSA 70034, 31059, Toulouse Cedex 9, France
| | - P Galinier
- Department of Pediatric Surgery, Children's Hospital, 330 Avenue de Grande-Bretagne TSA 70034, 31059, Toulouse Cedex 9, France
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Ballouhey Q, Fesseau R, Benouaich V, Léobon B. Benefits of extracorporeal membrane oxygenation for major blunt tracheobronchial trauma in the paediatric age group. Eur J Cardiothorac Surg 2012. [PMID: 23178817 DOI: 10.1093/ejcts/ezs607] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Tracheobronchial rupture due to blunt chest trauma is a rare but life-threatening injury among children. The severity of this condition ranges from death before hospital admission to clinical stability resulting in delayed management. Diagnosis is difficult because there is sometimes no evidence of external trauma, in spite of severe chest crush injury and consecutive rupture of airways. Here, we report the case of a 32-month-old girl whose torso was crushed by a van, resulting in bilateral bronchi disconnection. She was admitted to our hospital with cardiac and respiratory arrest. After prompt resuscitation, flexible bronchoscopy permitted the accurate visualization of the rupture and its extent. The life-saving procedure consisted of surgical repair using extracorporeal membrane oxygenation (ECMO) as ventilatory support. This provided rapid relief from the injury, which was previously expected to result in death. These data suggest that ECMO could be beneficial as supportive therapy for selected paediatric patients with major tracheobronchial traumas.
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Affiliation(s)
- Quentin Ballouhey
- Department of Pediatrc Surgery, Children's Hospital, Toulouse Cedex 9, France.
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Extracorporeal membrane oxygenation promotes survival in children with trauma related respiratory failure. Pediatr Surg Int 2012; 28:711-4. [PMID: 22581172 DOI: 10.1007/s00383-012-3102-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2012] [Indexed: 10/28/2022]
Abstract
Extracorporeal membrane oxygenation (ECMO), which is used for cardiopulmonary support in many non-trauma settings, may also be of use in pediatric patients with traumatic lung injury by allowing the lung to rest and heal. We have utilized ECMO to support three multitrauma pediatric patients with posttraumatic respiratory failure in the past 2 years. We sought to review our experience at a level 1 tertiary care children's hospital in this patient population. Our outcomes along with the limited number of pediatric trauma patients previously reported in the literature suggest that ECMO may be safely and effectively used to manage respiratory failure in this patient population.
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Contemporary extracorporeal membrane oxygenation for adult respiratory failure: life support in the new era. Intensive Care Med 2011; 38:210-20. [DOI: 10.1007/s00134-011-2439-2] [Citation(s) in RCA: 305] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Accepted: 07/06/2011] [Indexed: 11/26/2022]
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Custer JR. The evolution of patient selection criteria and indications for extracorporeal life support in pediatric cardiopulmonary failure: next time, let's not eat the bones. Organogenesis 2011; 7:13-22. [PMID: 21317556 DOI: 10.4161/org.7.1.14024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Bill James, baseball statistician and author, tells the story of hungry cavemen sitting about a campfire, waiting for tomatoes to ripen. One has the inspiration to throw an ox on the fire, and the first barbecue ensued and was endured. After eating, the conversation goes something like this. "There were some good parts." "Yeah, but there were some bad parts." And the smart one says, "This time, let's not eat the bones." The evolution of patient selection criteria for the use of extracorporeal support (ECLS) is a bit like those cavemen and their first barbecued ox. Extracorporeal life support technology and application to patient care is the unique result of a long standing history of ambitious attempt, evaluation, debate, collaboration and extension.
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Affiliation(s)
- Joseph R Custer
- Division of Pediatric Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA.
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Factors associated with survival in pediatric extracorporeal membrane oxygenation--a single-center experience. J Pediatr Surg 2010; 45:1995-2003. [PMID: 20920718 DOI: 10.1016/j.jpedsurg.2010.05.028] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Revised: 05/24/2010] [Accepted: 05/25/2010] [Indexed: 11/24/2022]
Abstract
AIM We aimed to examine outcomes of extracorporeal membrane oxygenation (ECMO) therapy in the pediatric population and identify pre-ECMO and on-ECMO characteristics that are associated with survival. METHODS We retrospectively reviewed the ECMO records at our institution between 1999 and 2008 and selected pediatric patients who were cannulated for respiratory failure or hemodynamic instability resistant to conventional interventions. We recorded details of pre-ECMO clinical characteristics, including blood gas variables and mechanical ventilatory support, and details of ECMO therapy including survival off ECMO and to hospital discharge. Predictors of survival were analyzed using logistic regression modeling and a prediction algorithm was developed. RESULTS Of the 445 ECMO runs, data from 58 consecutive patients were analyzed: 57% were successfully decannulated, and 48% survived to discharge from the hospital. The cohort included 32 (55%) female patients, 22 postoperative patients (38%), and 15 (26%) with an immunosuppressive condition, with a median age of 5 years and weight 19.5 kg, The mean duration of pre-ECMO respiratory support was 3 days, in the form of high-frequency oscillatory ventilation (n = 28, 48%) and conventional mechanical ventilation (n = 13, 22%). The median duration (interquartile range) of ECMO support was 142 hours (60, 321) or 5.9 days. Pre-ECMO pH above 7.2 (P < .001) and oxygenation index below 35 (P = .021) were associated with the highest survival rates. Pre-ECMO PaCO(2) and duration of mechanical ventilation were not associated with survival. CONCLUSIONS Based on our results, ECMO therapy should be considered early in children with oxygenation index greater than 35 with worsening metabolic status. The restriction of ECMO based on ventilator days alone needs to be revisited in this era of lung protective ventilation.
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Kissoon N, Rimensberger PC, Bohn D. Ventilation strategies and adjunctive therapy in severe lung disease. Pediatr Clin North Am 2008; 55:709-33, xii. [PMID: 18501762 DOI: 10.1016/j.pcl.2008.02.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Respiratory failure caused by severe lung disease is a common reason for admission to the pediatric and neonatal intensive care units. Efforts to decrease morbidity and mortality have fueled investigations into innovative methods of ventilation, kinder gentler ventilation techniques, pharmacotherapeutic adjuncts, and extracorporeal life support modalities. This article discusses the rationale for and experience with some of these techniques.
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Affiliation(s)
- Niranjan Kissoon
- Department of Pediatrics, University of British Columbia, Children's Hospital, Room K4-105, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada.
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DeBerry BB, Lynch JE, Chernin JM, Zwischenberger JB, Chung DH. Successful management of pediatric cardiac contusion with extracorporeal membrane oxygenation. ACTA ACUST UNITED AC 2008; 63:1380-2. [PMID: 17429326 DOI: 10.1097/01.ta.0000224888.49964.4e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Brittany B DeBerry
- Department of Surgery, The University of Texas Medical Branch, Galveston, Texas, USA
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Chiu KM, Li SJ, Hung FM, Chu SH. Right Heart Bypass for Acute Traumatic Respiratory Distress Syndrome. ASAIO J 2005; 51:826-8. [PMID: 16340376 DOI: 10.1097/01.mat.0000183688.96065.0d] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Kuan-Ming Chiu
- Department of Cardiovascular Surgery, Far-Eastern Memorial Hospital, Taipei, Taiwan
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Agarwal HS, Taylor MB, Grzeszczak MJ, Lovvorn HN, Hunley TE, Jabs K, Shankar V. Extra corporeal membrane oxygenation and plasmapheresis for pulmonary hemorrhage in microscopic polyangiitis. Pediatr Nephrol 2005; 20:526-8. [PMID: 15714314 DOI: 10.1007/s00467-004-1724-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2004] [Revised: 08/31/2004] [Accepted: 09/14/2004] [Indexed: 10/25/2022]
Abstract
Early initiation of extracorporeal membrane oxygenation to treat acute hypoxemic respiratory failure secondary to massive pulmonary hemorrhage in microscopic polyangiitis in children can be life-saving while awaiting control of the autoimmune disease process by plasmapheresis and immunosuppression.
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Affiliation(s)
- Hemant Shyam Agarwal
- Division of Pediatric Critical Care, Vanderbilt Children's Hospital, Nashville, TN 37212, USA.
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Abstract
Since its beginnings in 1989, the Extracorporeal Life Support Organization (ELSO) Registry has collated and reported data on over 30,000 patients. The majority of patients entered into the Registry have been neonates with respiratory failure from meconium aspiration, persistent pulmonary hypertension, or congenital diaphragmatic hernia. These patients suffer from refractory hypoxemia; thus, this supportive technique came to be called "Extracorporeal Membrane Oxygenation (ECMO)" for its ability to provide excellent gas exchange. With advances in prevention, diagnosis, and treatment measures for neonatal respiratory failure, need for ECMO support has fallen from the peak of 1500 cases in the early 1990s to 800 cases annually. Sixty-six percent (over 19,000) of patients in the Registry are under the category of neonatal respiratory failure, with a 77% overall survival reported to discharge. The success of neonatal ECMO has led to expansion of the field to pediatric, cardiac, and adult patients. An average of 200 pediatric patients receive ECMO for respiratory failure per year with an overall survival of 55%. Adult respiratory failure patients form a smaller group, with less than 100 cases reported to the ELSO registry per year. Survival mirrors that noted in the pediatric ECMO population. The application of ECMO or related techniques continues to increase for cardiac failure across all age groups. Overall survival in cardiac patients ranges from 33% to 43%. A novel form of extracorporeal support is "ECPR" or ECMO during cardiac arrest. Bypass circuits and equipment can be set up and instituted within a very short period of time in this circumstance, thus the name "rapid deployment ECMO" has become associated with this form of support. Overall survival in the near-600 patients placed on ECMO during resuscitation is 40%.
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Affiliation(s)
- Heidi J Dalton
- Pediatric Intensive Care Unit, Children's National Medical Center, 111 Michigan Ave NW, Suite 100, 3 W, Washington, DC 20010, USA.
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Abstract
Thoracic trauma remains a major source of morbidity and mortality in injured children, and is second only to brain injuries as a cause of death. The presence of a chest injury increases an injured child's mortality by 20-fold. Greater than 80% of chest injuries in children are secondary to blunt trauma. The compliant chest wall in children makes pulmonary contusions and rib fractures the most common chest injuries in children. Injuries to the great vessels, esophagus, and diaphragm are rare. Failure to promptly diagnose and treat these injuries results in increased morbidity and mortality.
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Affiliation(s)
- Kennith H Sartorelli
- From the Department of Surgery, Division of Pediatric Surgery, University of Vermont, Burlington, VT 05401, USA
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