Extracorporeal membrane oxygenation in children with heart disease and del22q11 syndrome: a review of the Extracorporeal Life Support Organization Registry.

The study objective was to evaluate outcomes among children with del22q11 (DiGeorge) syndrome supported on ECMO for heart disease. The ELSO registry database was queried to include all children <18 years undergoing heart surgery for either common atrio-ventricular canal, tetralogy of Fallot, truncus arteriosus or transposition of the great vessels and interrupted aortic arch and requiring ECMO, from 1998-2011. The outcomes evaluated included mortality, ECMO duration and length of hospital stay in patients with del22q11 syndrome and with no del22q11 syndrome. Eighty-eight ECMO runs occurred in children with del22q11 syndrome while 2694 ECMO runs occurred in children without del22q11 syndrome. For patients with heart defects receiving ECMO, del22q11 syndrome did not confer a significant mortality risk or an increased risk of infectious complications before or while on ECMO support. Neither the duration of ECMO nor mechanical ventilation prior to ECMO deployment were prolonged in patients with del22q11 syndrome compared to the controls.

Aspergillus infection and extracorporeal membrane oxygenation support.

BACKGROUND: The clinical characteristics of patients with Aspergillus isolation while supported on extracorporeal membrane oxygenator (ECMO) remain unclear. OBJECTIVES: We present a case report of angioinvasive Aspergillus infection on an infant supported on ECMO and also investigate outcomes among patients with Aspergillus infection reported to the Extracorporeal Life Support Organization (ELSO) registry. DESIGN: Case report and retrospective analysis of ELSO registry data set from 1985 to 2009. SETTING: One hundred and seventy ECMO centers contributing data to the ELSO registry. PATIENTS: Single case report and patients 0 to 90 years of age with Aspergillus infection requiring ECMO support as reported to the ELSO registry. METHODS: Besides presenting details of our institutional case, we compared clinical characteristics and outcomes between pediatric and adult patients with Aspergillus isolation. Risk factors for in-hospital mortality were investigated. Kaplan-Meier estimates for freedom from death on ECMO for pediatric and adult patients were investigated. MEASUREMENTS AND MAIN RESULTS: (a) we report a case with Aspergillus supported on ECMO, (b) the ELSO registry yielded 46 patients with 59% (n = 27) in the pediatric data set (≤20 years of age) and 41% (n = 19) in the adult data set (>20 years of age) with Aspergillus infection requiring ECMO support. Overall survival to hospital discharge was 30% (14/46) with 22% (6/27) in children as compared to 42% (8/18) in adults (P = .19). Table 1 shows a comparison of clinical characteristics between children and adults. The comparison between adults and pediatric groups differed significantly in age (P = .0001), more use of venoarterial ECMO in children (P = .028). The median age of pediatric group was 1.95 years (range 0-17.3 years) versus 30.2 years (range 22-60 years) among adults. CONCLUSIONS: Aspergillus infection/colonization is associated with a 70% overall mortality among patients supported on ECMO. The ELSO registry data confirms that Aspergillus infection among ECMO supported patients occurs often in hosts who do not have known immunodeficiencies. The case stresses the need for a high level of suspicion for Aspergillus infection in nonimproving lung disease in patients on ECMO support.

Trends in percutaneous endoscopic gastrostomy placement in the elderly from 1993 to 2003.

OBJECTIVES: To investigate national trends in percutaneous endoscopic gastrostomy (PEG) tube placement for hospitalized elderly patients from 1993 to 2003. METHODS: Retrospective analysis of patients ≥ 65 years of age with PEG tube placement from 1993 to 2003 from the Nationwide Inpatient Sample (NIS) database was utilized to calculate PEG placement rates per 1000 people. RESULTS: Placement of PEG tube increased by 38% in elderly patients during the study period, from 2.71 procedures during hospitalization per 1000 people to 3.75 procedures during hospitalization per 1,000 people. Placement of PEG tube in patients with Alzheimer's dementia doubled (5%-10%) over the study period. CONCLUSION: Over a 10-year period, PEG tube use in hospitalized elderly patients increased significantly. More importantly, approximately 1 in 10 PEG tube placements occurred in patients with dementia.

Inhaled nitric oxide in neurogenic cardiopulmonary dysfunction: implications for organ donation.

UNLABELLED: Many cadaveric organs for transplantation come from patients dying of sudden intracranial catastrophes. Cardiopulmonary dysfunction after such neurogenic insults is a well-recognized entity. The pulmonary dysfunction usually presents as florid pulmonary edema within minutes to hours after the initial intracranial insult and may occur in isolation or co-exist with overt or subclinical myocardial dysfunction. This may result in severe hypoxia, which threatens survival and outcomes in salvageable cases and organ preservation in patients who would be potential organ donors. Thus, rapid initiation of strategies aimed at ameliorating hypoxia after an acute neurogenic insult is paramount. Strategies aimed at improving acute hypoxia include maximizing ventilator support, diuretics, and volume resuscitation. Cardiac dysfunction may require use of ionotropes. We report the case of a 16-year-old female who developed catastrophic acute posterior fossa intracranial bleeding with resulting intractable hypoxia due to neurogenic cardiopulmonary dysfunction that responded dramatically to inhaled nitric oxide (INO). The patient went on to successfully donate organs following a non-heart-beating donor protocol. This therapy, to our knowledge, has never been described previously for use in patients with hypoxia secondary to neurogenic cardiopulmonary dysfunction. CONCLUSIONS: We document for the first time a dramatic response of hypoxia to INO in neurogenic cardiopulmonary dysfunction. This therapy ameliorates hypoxia, which may have vital implications in minimizing secondary brain injury in salvageable cases and optimizing organ preservation in potential organ donors with catastrophic intracranial insults.