Use of a Reperfusion Cannula for Acute Limb Ischemia in a Patient with Carotid Artery Extracorporeal Membrane Oxygenation Cannulation.

Acute limb ischemia is a rare but potentially devastating event in a critically ill patient. In the pediatric population, limb ischemia is usually related to iatrogenic vascular damage and arterial thrombus formation secondary to arterial catheter placement. Children who have undergone femoral artery cannulation for venoarterial extracorporeal membrane oxygenation (VA-ECMO) are particularly at risk for this complication. In these cases, there have been reports of the successful use of a percutaneous limb reperfusion cannula to prevent or treat limb ischemia. We present a case of an 18 month old female who required VA-ECMO via carotid artery cannulation for viral myocarditis and subsequently developed acute lower limb ischemia related to a thrombus from an indwelling femoral arterial catheter in place for hemodynamic monitoring. This case highlights the usage of a distal reperfusion cannula and extracorporeal membrane oxygenation (ECMO) circuit for a novel purpose, which coupled with near infrared spectroscopy (NIRS) monitoring successfully re-established blood flow to the ischemic limb.

Acute intoxication caused by a synthetic cannabinoid in two adolescents.

Illicit drug use continues to be a common problem among pediatric patients. Daily marijuana use among high school seniors is currently at a 30-year high. Marijuana use in adults has rarely been associated with cardiovascular adverse effects, including hypertension, tachycardia, arrhythmia, and myocardial infarction. Recently, abuse of synthetic cannabinoids, such as the incense "K2" or "Spice," has been increasingly reported in the lay press and medical literature. Overdose and chronic use of these substances may cause adverse effects including altered mental status, tachycardia, and loss of consciousness. Overdoses in adult patients have been described; however, limited reports in the pediatric population have been documented. A recent case series describes myocardial infarctions in pediatric patients, associated with synthetic cannabinoid use. In this report, we describe two adolescent patients admitted after they inhaled "K2," resulting in loss of consciousness, tachycardia, and diffuse pain.

Pediatric extracorporeal membrane oxygenation (ECMO): a review of the first ten years of experience at the Medical University of South Carolina.

ECMO can be life saving in pulmonary emergencies unresponsive to conventional ICU support. ECMO technology and expertise has increased immensely over the last decade. Our experience, and others, has demonstrated that the earlier the referral to an ECMO center, the better chance of survival these patients will have. Our survival results exceed the national average and we have used this therapy in a wide variety of disease processes. Long-term sequelae in survivors are infrequent, as most patients return to normal pulmonary function.

Pneumococcus-induced T-antigen activation in hemolytic uremic syndrome and anemia.

The hemolytic uremic syndrome (HUS) is most commonly associated with Escherichia coli, but has been associated with other infections such as Streptococcus pneumoniae. Pneumococcus-induced HUS carries an increased risk of mortality and renal morbidity compared with E. coli-induced HUS. The pneumococcal organism produces an enzyme, which can expose an antigen (T-antigen) present on erythrocytes, platelets, and glomeruli. Antibodies to the T-antigen, normally found in human serum, bind the exposed T-antigen, and the resultant antigen-antibody reaction (T-activation) can lead to HUS and anemia. Clinicians need to be aware to request specific testing when pneumococcus-induced HUS/anemia is suspected, as current blood banking techniques do not routinely test for the presence of the T-antigen. Once this association is documented, washing all blood products and avoiding plasma products, if possible, is recommended. Plasmapheresis can be considered for the more critically ill patient. The incidence of pneumococcus-induced HUS may be increasing. We report six cases of pneumococcus-induced HUS/anemia presenting at our hospital.