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Agasthya N, Froehlich CD, Golecki M, Meyer M, Ogino MT, Froehlich K, Beaty C, McCants S, Maul TM, Dirnberger DR. Single-Center Experience Using the Cardiohelp System for Neonatal and Pediatric Extracorporeal Membrane Oxygenation. Pediatr Crit Care Med 2023; 24:e190-e195. [PMID: 36571494 DOI: 10.1097/pcc.0000000000003154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Extracorporeal membrane oxygenation (ECMO) systems have continued to evolve and improve with the development of smaller and portable systems. The Cardiohelp (Maquet Getinge Cardiopulmonary AG, Rastatt, Germany) portable life support device is a compact ECMO system used widely in adults and for ECMO transport. Reports of its use in neonatal and pediatric centers remain limited. In this single-center retrospective review, we describe our institutional experience with the Cardiohelp. DESIGN Single-center retrospective review. SETTING Neonatal ICUs and PICUs in a tertiary-care children's hospital. PATIENTS Seventeen pediatric patients on ECMO. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Median (interquartile range, IQR) of patient age was 0.5 years (0-7 yr). Eleven of 17 patients were on veno-arterial ECMO, five on veno-venous ECMO, and one on veno-venoarterial ECMO. All veno-venous and veno-venoarterial runs ( n = 6) were accomplished with bicaval, dual-lumen cannulae. Median duration on Cardiohelp was 113 hours (IQR 50-140 hr). Median anti-Xa level for patients was 0.43 IU/mL (IQR 0.35-0.47 IU/mL), with median heparin dose of 23.6 U/kg/hr (IQR 17.6-28.1 U/kg/hr). Median plasma-free hemoglobin was 41.4 mg/dL (IQR 30-60 mg/dL). Circuit change was required in three cases. Fourteen patients survived ECMO, with 13 patients surviving to discharge. CONCLUSIONS We have used the Cardiohelp system to support 17 neonatal and pediatric ECMO patients, without complications. Further studies are warranted to compare complications, outcomes, and overall cost with other institutions and other existing ECMO systems.
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Affiliation(s)
- Nisha Agasthya
- Department of Pediatrics, Kansas University School of Medicine, Wichita, KS
| | - Curtis D Froehlich
- Department of Pediatrics, Nemours Children's Hospital-Delaware, Wilmington, DE
| | - Michael Golecki
- Department of Nursing, Nemours Children's Hospital-Delaware, Wilmington, DE
| | - Marisa Meyer
- Department of Pediatrics, Nemours Children's Hospital-Delaware, Wilmington, DE
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Mark T Ogino
- Department of Pediatrics, Nemours Children's Hospital-Delaware, Wilmington, DE
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Kendra Froehlich
- Department of Pediatrics, Nemours Children's Hospital-Delaware, Wilmington, DE
| | - Christopher Beaty
- Department of Pediatrics, Nemours Children's Hospital-Delaware, Wilmington, DE
| | - Sharon McCants
- Department of Pediatrics, Nemours Children's Hospital-Delaware, Wilmington, DE
| | - Timothy M Maul
- Department of Cardiothoracic Surgery, Nemours Children's Hospital-Florida, Orlando, FL
- University of Pittsburgh, Pittsburgh, PA
| | - Daniel R Dirnberger
- Department of Pediatrics, Nemours Children's Hospital-Delaware, Wilmington, DE
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Sleasman JR, Hijawi U, Alsalemi A, Rabie M, Noorizadeh M, Stead A, Cooley C, Donnelly C, Haft JW, Abrams D, Stead C, Ryan KR, Rycus P, Fox AD, Ogino MT, Alexander PM. Foundations of a Life Support Equipment Exchange Platform: ELSO Supplies. J Extra Corpor Technol 2023; 55:39-43. [PMID: 37034103 PMCID: PMC10071502 DOI: 10.1051/ject/2023001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 12/12/2022] [Indexed: 02/05/2023]
Abstract
The ELSO Supplies Platform (Supplies.ELSO.org) was created out of Extracorporeal Membrane Oxygenation (ECMO) disposable product deficiency prior to and during the Coronavirus Disease 2019 (COVID-19) pandemic. This novel Platform supports Centers in obtaining disposables when alternative avenues are exhausted. Driven by the opportunity for increased patient care by using the product availability of the 962 ELSO centers worldwide was the motivation to form an efficient online supply sharing platform. The pandemic created by COVID-19, became a catalyst to further recognize the magnitude of the supply disruption on a global scale, impacting allocations and guidelines for institutions, practice, and patient care. Records kept on the platform website are helpful to industry by providing insights where difficulties exist in the supply chain for needed equipment. Yet, the common thread is awareness, how critical situations can stretch resources and challenge our resolve for best patient care. ELSO is proud to support member centers in these situations, by providing a means of attaining needed ECMO life support products to cover supply deficiencies.
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Affiliation(s)
- Justin R. Sleasman
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Lead Perfusionist, Stanford Medicine Children’s Health 725 Welch Road Palo Alto CA 94304 USA
- Corresponding author:
| | - Ula Hijawi
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Researcher and Project Team Leader, Qatar University Doha Qatar
| | | | - Mohamed Rabie
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Researcher and Project Team Leader, Qatar University Doha Qatar
| | | | - Aidan Stead
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Interns, Extracorporeal Life Support Organization Ann Arbor MI 48103 USA
| | - Christopher Cooley
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Interns, Extracorporeal Life Support Organization Ann Arbor MI 48103 USA
| | - Conor Donnelly
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Interns, Extracorporeal Life Support Organization Ann Arbor MI 48103 USA
| | - Jonathan W. Haft
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Department of Cardiac Surgery, University of Michigan Ann Arbor MI 48109 USA
| | - Darryl Abrams
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Division of Pulmonary and Critical Care Medicine, Columbia University Irving Medical Center New York NY 10032 USA
| | - Christine Stead
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CEO, Extracorporeal Life Support Organization and Adjunct Faculty, University of Michigan School of Public Health, Health Management and Policy Ann Arbor MI 48103 USA
| | - Kathleen R. Ryan
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Department of Pediatrics, Division of Cardiology, Stanford Medicine Children’s Health and Stanford University School of Medicine Palo Alto CA 94304 USA
| | - Peter Rycus
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Executive Director, Extracorporeal Life Support Organization Ann Arbor MI 48103 USA
| | - Alexander D. Fox
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Project Manager, Extracorporeal Life support Organization Ann Arbor MI 48103 USA
| | - Mark T. Ogino
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Pediatric Neonatal-Perinatal, Critical Care Service, Division of Neonatology Nemours/Alfred I. du Pont Hospital for Children Wilmington DE 19803 USA
| | - Peta M.A. Alexander
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Lead Perfusionist, Stanford Medicine Children’s Health 725 Welch Road Palo Alto CA 94304 USA
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Department of Cardiology, Boston Children’s Hospital and Department of Pediatrics Harvard Medical School Boston MA 02115 USA
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3
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Badulak J, Antonini MV, Stead CM, Shekerdemian L, Raman L, Paden ML, Agerstrand C, Bartlett RH, Barrett N, Combes A, Lorusso R, Mueller T, Ogino MT, Peek G, Pellegrino V, Rabie AA, Salazar L, Schmidt M, Shekar K, MacLaren G, Brodie D. Extracorporeal Membrane Oxygenation for COVID-19: Updated 2021 Guidelines from the Extracorporeal Life Support Organization. ASAIO J 2021; 67:485-495. [PMID: 33657573 PMCID: PMC8078022 DOI: 10.1097/mat.0000000000001422] [Citation(s) in RCA: 229] [Impact Index Per Article: 76.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
DISCLAIMER This is an updated guideline from the Extracorporeal Life Support Organization (ELSO) for the role of extracorporeal membrane oxygenation (ECMO) for patients with severe cardiopulmonary failure due to coronavirus disease 2019 (COVID-19). The great majority of COVID-19 patients (>90%) requiring ECMO have been supported using venovenous (V-V) ECMO for acute respiratory distress syndrome (ARDS). While COVID-19 ECMO run duration may be longer than in non-COVID-19 ECMO patients, published mortality appears to be similar between the two groups. However, data collection is ongoing, and there is a signal that overall mortality may be increasing. Conventional selection criteria for COVID-19-related ECMO should be used; however, when resources become more constrained during a pandemic, more stringent contraindications should be implemented. Formation of regional ECMO referral networks may facilitate communication, resource sharing, expedited patient referral, and mobile ECMO retrieval. There are no data to suggest deviation from conventional ECMO device or patient management when applying ECMO for COVID-19 patients. Rarely, children may require ECMO support for COVID-19-related ARDS, myocarditis, or multisystem inflammatory syndrome in children (MIS-C); conventional selection criteria and management practices should be the standard. We strongly encourage participation in data submission to investigate the optimal use of ECMO for COVID-19.
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Affiliation(s)
- Jenelle Badulak
- From the Department of Emergency Medicine, University of Washington, Seattle, Washington
- Division of Pulmonary Critical Care and Sleep Medicine, University of Washington, Seattle, Washington
| | - M. Velia Antonini
- General ICU, University Hospital of Parma, Parma, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy
| | | | - Lara Shekerdemian
- Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
| | - Lakshmi Raman
- Children’s Medical Center of Dallas, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Matthew L. Paden
- Emory University, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Cara Agerstrand
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
- Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, New York
| | | | - Nicholas Barrett
- Department of Critical Care, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
- Centre for Human and Applied Physiological Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Alain Combes
- Institute of Cardiometabolism and Nutrition, INSERM, Sorbonne Université, Paris, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, Paris, France
| | - Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Thomas Mueller
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Mark T. Ogino
- Nemours Children’s Health System, Wilmington, Delaware
| | - Giles Peek
- Congenital Heart Center, Departments of Surgery and Pediatrics, University of Florida, Gainesville, Florida
| | | | - Ahmed A. Rabie
- Critical Care ECMO Service, King Saud Medical City, Ministry Of Health (MOH), Riyadh, Saudi Arabia
| | - Leonardo Salazar
- Fundación Cardiovascular de Colombia, Floridablanca, Santander, Colombia
| | - Matthieu Schmidt
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, AP-HP, Sorbonne Université Hôpital Pitié-Salpêtrière, Paris, France
- Sorbonne Université, GRC n°30, GRC RESPIRE, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Kiran Shekar
- Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | | | - Daniel Brodie
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
- Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, New York
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4
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Cho HJ, Ogino MT, Jeong IS, Paden ML, Antonini VM, Marwali EM, Fraser JF, MacLaren G, Belohlavek J, Di Nardo M. Pediatric intensive care preparedness and ECMO availability in children with COVID-19: An international survey. Perfusion 2020; 36:637-639. [PMID: 33342366 DOI: 10.1177/0267659120981810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Hwa-Jin Cho
- Department of Pediatrics, Chonnam National University Children's Hospital, and Medical School, Gwangju, South Korea.,Critical Care Research Group, The Prince Charles Hospital and Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Mark T Ogino
- Division of Neonatology, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - In-Seok Jeong
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital and Medical School, Gwangju, South Korea
| | | | | | - Eva M Marwali
- Pediatric Cardiac ICU, National Cardiovascular Harapan Kita, Jakarta, Indonesia
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital and Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Graeme MacLaren
- Cardiothoracic Intensive Care Unit, National University Health System, Singapore.,Paediatric Intensive Care Unit, Department of Paediatrics, The Royal Children's Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Jan Belohlavek
- Internal Medicine and Cardiology Unit, Charles University Prague, Praha, Czech Republic
| | - Matteo Di Nardo
- Pediatric Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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5
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Brogan TV, Thiagarajan RR, Lorusso R, McMullan DM, Di Nardo M, Ogino MT, Dalton HJ, Burke CR, Capatos G. The use of extracorporeal membrane oxygenation in human immunodeficiency virus-positive patients: a review of a multicenter database. Perfusion 2020; 35:772-777. [PMID: 32141382 DOI: 10.1177/0267659120906966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM We chose to evaluate the survival of extracorporeal membrane oxygenation among patients with human immunodeficiency virus in a multicenter registry. METHODS Retrospective case review of the Extracorporeal Life Support Organization Registry respiratory failure of all patients with human immunodeficiency virus supported with extracorporeal membrane oxygenation. RESULTS A total of 126 patients were included. Survival to discharge was 36%. Eight infants were supported with extracorporeal membrane oxygenation and three (37.5%) survived to discharge. Respiratory extracorporeal membrane oxygenation was the primary indication (78%) with a 39% survival, while cardiac and extracorporeal cardiopulmonary resuscitation indications accounted for 16% and 6% of patients with survivals of 30% and 12.5%, respectively. These differences did not reach significance. There were no significant differences between survivors and non-survivors in demographic data, but non-survivors had significantly more non-human immunodeficiency virus pre-extracorporeal membrane oxygenation infections than survivors. There were no differences in other pre-extracorporeal membrane oxygenation supportive therapies, mechanical ventilator settings, or arterial blood gas results between survivors and non-survivors. The median duration of mechanical ventilation prior to cannulation was 52 (interquartile range: 13-140) hours, while the median duration of the extracorporeal membrane oxygenation exposure was 237 (interquartile range: 125-622) hours. Ventilator settings were significantly lower after 24 hours compared to pre-extracorporeal membrane oxygenation settings. Complications during extracorporeal membrane oxygenation exposure including receipt of renal replacement therapy, inotropic infusions, and cardiopulmonary resuscitation were more common among non-survivors compared to survivors. Central nervous system complications were rare. CONCLUSION Survival among patients with human immunodeficiency virus infection who receive extracorporeal membrane oxygenation was less than 40%. Infections before extracorporeal membrane oxygenation cannulation occurred more often in non-survivors. The receipt of renal replacement therapy, inotropic infusions, or cardiopulmonary resuscitation during extracorporeal membrane oxygenation was associated with worse outcome.
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Affiliation(s)
- Thomas V Brogan
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Ravi R Thiagarajan
- Department of Cardiology, Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Roberto Lorusso
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - D Michael McMullan
- Division of Cardiothoracic Surgery, Seattle Children's Hospital, Seattle, WA, USA
| | - Matteo Di Nardo
- Pediatric Intensive Care Unit, Children's Hospital Bambino Gesù, Rome, Italy
| | - Mark T Ogino
- Nemours/Alfred I. duPont Hospital for Children, Sidney Kimmel Medical College, Thomas Jefferson University, Wilmington, DE, USA
| | | | - Christopher R Burke
- Department of Thoracic Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Gerry Capatos
- Mediclinic Parkview Hospital, Dubai, United Arab Emirates
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6
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Shekar K, Badulak J, Peek G, Boeken U, Dalton HJ, Arora L, Zakhary B, Ramanathan K, Starr J, Akkanti B, Antonini MV, Ogino MT, Raman L, Barret N, Brodie D, Combes A, Lorusso R, MacLaren G, Müller T, Paden M, Pellegrino V. Extracorporeal Life Support Organization Coronavirus Disease 2019 Interim Guidelines: A Consensus Document from an International Group of Interdisciplinary Extracorporeal Membrane Oxygenation Providers. ASAIO J 2020; 66:707-721. [PMID: 32604322 DOI: 10.1097/mat.000000000000119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Disclaimer: The Extracorporeal Life Support Organization (ELSO) Coronavirus Disease 2019 (COVID-19) Guidelines have been developed to assist existing extracorporeal membrane oxygenation (ECMO) centers to prepare and plan provision of ECMO during the ongoing pandemic. The recommendations have been put together by a team of interdisciplinary ECMO providers from around the world. Recommendations are based on available evidence, existing best practice guidelines, ethical principles, and expert opinion. This is a living document and will be regularly updated when new information becomes available. ELSO is not liable for the accuracy or completeness of the information in this document. These guidelines are not meant to replace sound clinical judgment or specialist consultation but rather to strengthen provision and clinical management of ECMO specifically, in the context of the COVID-19 pandemic.
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Affiliation(s)
- Kiran Shekar
- From Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | | | - Giles Peek
- University of Florida, Shands Hospital for Children, Gainesville, Florida
| | - Udo Boeken
- Department of Cardiac Surgery, University Hospital, Duesseldorf, Germany
| | | | - Lovkesh Arora
- University of Iowa Hospital & Clinics, Iowa City, Iowa
| | | | | | | | | | - M Velia Antonini
- 1st Intensive Care Unit, University Hospital of Parma, Parma, Italy
| | - Mark T Ogino
- Department of Paediatrics, Division of Neonatology, Nemours Alfred I duPont Hospital for Children, Wilmington, Delaware
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Lakshmi Raman
- University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Daniel Brodie
- Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York
| | - Alain Combes
- Assitance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | - Roberto Lorusso
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | | | - Matthew Paden
- Department of Pediatrics, Emory University, Atlanta, Georgia
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7
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Phillips MR, Priest M, Beaty C, Parker R, Meyer M, Dunn S, Froehlich CD, Dirnberger DR, Martin AE, Ogino MT. Extracorporeal Membrane Oxygenation in a Pediatric Patient with Hepatopulmonary Syndrome and Interrupted Inferior Vena Cava After Living Related Liver Donation. ASAIO J 2019; 65:e27-e29. [DOI: 10.1097/mat.0000000000000792] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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8
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Capatos G, Burke CR, Ogino MT, Lorusso RR, Brogan TV, McMullan DM, Dalton HJ. Venovenous extracorporeal life support in patients with HIV infection and Pneumocystis jirovecii pneumonia. Perfusion 2018. [PMID: 29528776 DOI: 10.1177/0267659118765595] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM As experience with extracorporeal life support (ECLS) increases, indications for its use have expanded to diverse patient populations, including those with HIV infection. Pneumocystis jirovecii pneumonia (PJP) is a particularly devastating complication of HIV infections. The objective of this study was to review ECLS use in HIV-positive patients, with particular emphasis on those with concomitant PJP infection. METHODS All patients were treated by the same ECLS team, consisting of an ECLS specialist intensivist, cardiothoracic surgeon and allied medical professionals at three healthcare institutions. The same ECLS protocol was utilized for all patients during the study period. A retrospective review was performed for all HIV-positive patients placed on ECLS from May 2011 to October 2014. Demographic, clinical, ECLS and complication data were reviewed to identify risk factors for death. RESULTS A total of 22 HIV-positive patients received ECLS therapy during the study period. All patients were supported with venovenous ECLS and overall survival to hospital discharge was 68%. Survival amongst the PJP positive cohort was 60%. Non-survivors were more likely to require inotropic medications on ECLS (100% non-survivors vs. 46.7% survivors, p=0.022) and had a longer total duration of ECLS (13 days non-survivors vs. 7 days survivors, p=0.011). No difference was observed between PJP-positive and PJP-negative patients with regard to demographic data, complication rates or survival. CONCLUSION ECLS is a viable treatment option in carefully selected HIV-positive patients, including those with severe disease as manifested by PJP infection.
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Affiliation(s)
- Gerry Capatos
- 1 Arwyp Medical and ECMO Centre, Johannesburg, South Africa
| | - Christopher R Burke
- 2 Division of Cardiac Surgery, Seattle Children's Hospital, Seattle, Washington, USA
| | - Mark T Ogino
- 3 Division of Neonatology, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, Delaware, USA
| | - Roberto R Lorusso
- 4 Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Thomas V Brogan
- 5 Division of Critical Care Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - D Michael McMullan
- 2 Division of Cardiac Surgery, Seattle Children's Hospital, Seattle, Washington, USA
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9
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Ogino MT. The small circuit pump, oxygenator, and surface coating. Qatar Med J 2017. [PMCID: PMC5474645 DOI: 10.5339/qmj.2017.swacelso.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Mark T. Ogino
- Nemours Alfred I DuPont Hospital for Children, Neonatology, Wilmington, DE, USA
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10
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Tabak B, Elliott CL, Mahnke CB, Tanaka LY, Ogino MT. Transthoracic echocardiography visualization of bicaval dual lumen catheters for veno-venous extracorporeal membrane oxygenation. J Clin Ultrasound 2012; 40:183-186. [PMID: 22238069 DOI: 10.1002/jcu.21873] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Accepted: 11/14/2011] [Indexed: 05/31/2023]
Abstract
Bicaval dual lumen catheters improve the efficiency of veno-venous extracorporeal membrane oxygenation by minimizing recirculation with an innovative design, which requires precise placement of three catheter ports in the superior vena cava, right atrium, and inferior vena cava, respectively. However, the exact position of these catheter ports is usually not known during placement because they cannot be visualized with conventional radiography. We performed a retrospective review of our experience over the past year using transthoracic echocardiography to evaluate the position of the catheter ports. From a subcostal, sagittal imaging approach, we were able to identify all three catheter ports in 11 of 11 studies. At least one of the catheter ports was incorrectly positioned in 5 of 11 studies. Further prospective evaluation is necessary to determine if catheter repositioning based on transthoracic echocardiography findings can further improve the clinical efficiency of veno-venous extracorporeal membrane oxygenation.
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Affiliation(s)
- Benjamin Tabak
- Department of General Surgery, Tripler Army Medical Center, Honolulu, HI 96859, USA
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11
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Uzark K, Frederick C, Lamberti JJ, Worthen HM, Ogino MT, Mainwaring RD, Moore JW. Changing practice patterns for children with heart disease: a clinical pathway approach. Am J Crit Care 1998. [DOI: 10.4037/ajcc1998.7.2.101] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND: Pediatric cardiac care is costly and requires extensive resources. We studied the effect of clinical pathways on practice patterns and patient care outcomes in infants and children hospitalized for cardiac surgery. METHODS: In consecutive patients admitted for selected cardiac surgical procedures before (n = 69) and after (n = 173) implementation of clinical pathways, outcomes including hospital length of stay, days in the ICU, time to extubation, ordering of blood studies, costs, and readmissions were compared. Data were analyzed for each of five cardiac surgical procedures: repair of an atrial septal defect, repair of a ventricular septal defect, division of a patent ductus arteriosus, repair of tetralogy of Fallot, and neonatal arterial switch operation to correct transposition of the great arteries. RESULTS: A significant reduction in length of hospital stay, including days in the ICU (decreased 1 to 2 days per admission), was achieved after the clinical pathway was implemented. Reductions in average duration of mechanical ventilation ranged from 28% for repair of a ventricular septal defect to 63% for repair of tetralogy of Fallot. The number of blood studies ordered decreased 20% to 30%. A significant reduction in hospital costs for each procedure, ranging from 16% to 29%, was also achieved with no adverse effects on patients' outcomes. CONCLUSIONS: Use of clinical pathways with children hospitalized for cardiac surgery can shorten length of stay in the hospital, reduce use of resources, and improve cost-effectiveness with beneficial outcomes for patients.
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12
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Uzark K, Frederick C, Lamberti JJ, Worthen HM, Ogino MT, Mainwaring RD, Moore JW. Changing practice patterns for children with heart disease: a clinical pathway approach. Am J Crit Care 1998; 7:101-5. [PMID: 9509223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pediatric cardiac care is costly and requires extensive resources. We studied the effect of clinical pathways on practice patterns and patient care outcomes in infants and children hospitalized for cardiac surgery. METHODS In consecutive patients admitted for selected cardiac surgical procedures before (n = 69) and after (n = 173) implementation of clinical pathways, outcomes including hospital length of stay, days in the ICU, time to extubation, ordering of blood studies, costs, and readmissions were compared. Data were analyzed for each of five cardiac surgical procedures: repair of an atrial septal defect, repair of a ventricular septal defect, division of a patent ductus arteriosus, repair of tetralogy of Fallot, and neonatal arterial switch operation to correct transposition of the great arteries. RESULTS A significant reduction in length of hospital stay, including days in the ICU (decreased 1 to 2 days per admission), was achieved after the clinical pathway was implemented. Reductions in average duration of mechanical ventilation ranged from 28% for repair of a ventricular septal defect to 63% for repair of tetralogy of Fallot. The number of blood studies ordered decreased 20% to 30%. A significant reduction in hospital costs for each procedure, ranging from 16% to 29%, was also achieved with no adverse effects on patients' outcomes. CONCLUSIONS Use of clinical pathways with children hospitalized for cardiac surgery can shorten length of stay in the hospital, reduce use of resources, and improve cost-effectiveness with beneficial outcomes for patients.
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Affiliation(s)
- K Uzark
- Children's Heart Institute, San Diego, Calif., USA
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13
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Abstract
Human immunodeficiency virus type 1 (HIV-1) isolates from perinatally infected infants and children were examined for syncytium-inducing (SI) capacity. All isolates from 14 infants < 1 year old had non-syncytium-inducing (NSI) HIV-1 phenotypes. Within their first year, 10 infants progressed to AIDS and 3 died. Of isolates from 26 children > 2 years old, 13 had SI HIV-1 phenotypes and 13 had NSI strains. Children with SI virus had significantly lower CD4+ cell counts standardized for age and were significantly older than those with NSI strains (P = .008 and .001, respectively); the effect of viral phenotype on CD4+ lymphocytes could not be detected independent of age. In another group, children with SI strains were more likely to show in vitro zidovudine resistance. Results suggest a biphasic response to HIV infection in children. Progression to AIDS may occur rapidly in infants with NSI HIV-1, but older children tend to have SI phenotypes and lower CD4+ lymphocyte counts and more often show zidovudine resistance.
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Affiliation(s)
- L T Spencer
- Department of Pediatrics, University of California, San Diego
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14
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Tabbutt S, Griswold WR, Ogino MT, Mendoza AE, Allen JB, Reznik VM. Multiple thromboses in a premature infant associated with maternal phospholipid antibody syndrome. J Perinatol 1994; 14:66-70. [PMID: 8169680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Phospholipid antibodies (lupus anticoagulant, cardiolipin) are associated with a syndrome of repeated fetal loss. Mothers with phospholipid antibodies are currently being treated with either prednisone, aspirin, or heparin to prevent fetal death. We describe a neonate whose mother had cardiolipin antibody and recurrent fetal loss and was treated with prednisone and aspirin. Thrombosis was noted in placental fetal vessels. Thromboses developed in the infant's aorta, left renal artery, middle cerebral artery, and superior sagittal sinus. Infants of phospholipid-positive mothers may have vascular thrombosis and should be carefully monitored for signs of thromboembolism.
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Affiliation(s)
- S Tabbutt
- Department of Pediatrics, University of California School of Medicine, Children's Hospital and Health Center, San Diego
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15
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Abstract
Decreasing susceptibility to zidovudine (ZDV) has been described in persons infected with human immunodeficiency virus (HIV) type 1 who are receiving ZDV therapy. However, the clinical significance of decreased ZDV susceptibility remains unclear. In this study, HIV isolates obtained from children with symptomatic HIV infection treated with ZDV were monitored for their susceptibility to the antiretroviral agent and correlated with disease progression. Using a peripheral blood mononuclear cell-based assay to measure ZDV susceptibility, we evaluated HIV isolates from 19 children (mean age, 6.8 years; range, 5 months to 12 years) during ZDV therapy for susceptibility to ZDV. Of the 19 children studied, 10 continued to have susceptible HIV strains during ZDV treatment, and 9 acquired resistant viruses. All eight isolates from children without previous exposure to ZDV were initially susceptible. After a median of 11 months of ZDV therapy, three (38%) of these eight children had acquired resistant HIV strains (defined as ZDV susceptibility > or = 10 mumol/L). Children with resistant strains had worse clinical outcomes than children whose viruses remained susceptible, as determined by a 50% decline in absolute CD4+ cell counts after 1 year of treatment, failure to thrive, or death. Children with resistant viruses who were given alternative antiretroviral therapy frequently responded to the new treatment with improved growth and stabilization of their HIV-related disease. These data suggest that, in HIV-infected children, ZDV-resistant HIV strains are associated with diminished drug efficacy and more rapid disease progression.
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Affiliation(s)
- M T Ogino
- Department of Pediatrics, University of California, San Diego, La Jolla 92093-0672
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16
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Mattrey RF, Brown JJ, Shelton RE, Ogino MT, Johnson KK, Mitten RM. Use of perfluorooctylbromide (PFOB) to detect liver abscesses with computed tomography. Safety and efficacy. Invest Radiol 1991; 26:792-8. [PMID: 1938289 DOI: 10.1097/00004424-199109000-00003] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Although perfluorooctylbromide (PFOB) is known to stimulate macrophages, particulates given intravenously (IV) can inhibit the body's response to infection by blocking the reticuloendothelial system. Since PFOB enhances abscesses on computed tomography (CT), the authors evaluated its safety and efficacy by assessing the mortality and abscess volume in 104 rabbits with intrahepatic abscesses given either PFOB or lactated Ringer's (LR), and by comparing its efficacy to that of 76% meglumine sodium diatrizoate (MSD76). Abscesses were produced by injecting a virulent strain of E. coli into the liver. Two days later, five of the rabbits had died. Of the remaining rabbits, 50 were given 5 g/kg PFOB IV, and 49 were given an equal volume of LR. All rabbits had a CT scan at four and at ten days after infusion. They were killed before the second CT scan. Thirty seconds before being killed, 28 rabbits given LR were given a bolus of 2 ml/kg MSD76 IV. Following CT, rabbits were frozen, sliced, and photographed. Abscess volumes were calculated by digitizing the photographs of the anatomic sections and the CT images. MSD76 enhanced the liver by 105 Hounsfield units (HU) more than the liquefied abscess center. The abscess wall enhanced to the same degree as liver, resulting in nonvisualization of three of six abscesses less than 3 mm in size, and a 30% underestimation of true abscess volume.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- R F Mattrey
- Department of Radiology, University of California, San Diego
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