ABSTRACT
BACKGROUND: There are very sparse data on the outcomes of children receiving prolonged extracorporeal membrane oxygenation (ECMO) after cardiac surgery. This study was aimed to evaluate the association of ECMO duration with outcomes in children undergoing surgery for congenital heart disease using the Pediatric Health Information System (PHIS) database. METHODS: Patients aged ≤18 years receiving ECMO after pediatric cardiac surgery (with or without cardiopulmonary bypass) at a PHIS-participating hospital (2004-2013) were included. De-identified data obtained from retrospective, observational dataset included demographic information, baseline characteristics, pre-ECMO risk factors, operation details, patient diagnoses, and center data. Outcomes evaluated included in-hospital mortality, length of mechanical ventilation, length of ICU stay, length of hospital stay, and hospital charges. Cox proportional hazards models were fitted to study the probability of study outcomes as a function of ECMO duration. RESULTS: Nine hundred ninety-eight patients from 37 hospitals qualified for inclusion. The median duration of ECMO run was 4 days (IQR: 1.7). After adjusting for patient and center characteristics, there was 12% increase in the odds of mortality for every 24 hours increase in ECMO duration (OR: 1.12, 95% CI: 1.07-1.18, P<0.001). Patients receiving longer duration of ECMO were associated with longer length of mechanical ventilation, longer length of ICU stay, longer length of hospital stay, and higher hospital charges. CONCLUSION: Data from this large multicenter database suggest that longer duration of ECMO support after pediatric cardiac surgery is associated with worsening outcomes.
Subject(s)
Cardiac Surgical Procedures/methods , Extracorporeal Membrane Oxygenation/adverse effects , Adolescent , Cardiac Surgical Procedures/mortality , Child , Child, Preschool , Extracorporeal Membrane Oxygenation/methods , Female , Hospital Mortality , Humans , Infant , Infant, Newborn , Length of Stay , Male , Respiration, Artificial , Retrospective Studies , Treatment OutcomeABSTRACT
Capillary electrophoresis methodology is developed to provide a rapid, inexpensive and robust technique for screening polycyclic aromatic hydrocarbons (PAHs) in water using additive complexation. A series of conventional RPLC ion-pairing agents are investigated in three different totally non-aqueous separation solvents, and the relative role of hydrophobic interaction versus electrostatic association is evaluated. Methanol is found to provide optimal selectivity when coupled with the tetrahexylammonium cation providing total analysis times of approximately 15 min for the analysis of thirteen 2-7-ring PAH pollutants. Solid-phase microextraction is demonstrated to be an effective sample preparation technique for extraction/preconcentration of PAHs from water into methanol run buffer prior to injection.
