ASAIO journal : a peer-reviewed journal of the American Society for Artificial Internal Organs
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The use of venoarterial extracorporal membrane oxygenation and ventricular assist-devices in children with end stage heart failure is well established. The use of a bridge-to-bridge strategy leads to excellent survival rates in pediatric patients. We present an adolescent, who acquired acute respiratory failure, due to possible transfusion related lung injury, and who was successfully treated with venovenous extracorporal membrane oxygenation while on ventricular assist-device support.
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Randomized Controlled Trial
Effect of different albumin concentrations in extracorporeal circuit prime on perioperative fluid status in young children.
This study examined the effects of different dosages of albumin priming for extracorporeal circuit (ECC) on perioperative fluid status and fluid management in young children. A total of 151 consecutive pediatric patients (2-36 months old) scheduled for open heart surgery, were divided into two groups randomly, to receive either a 3% albumin solution (L group, n = 68) or a 5% albumin (H group, n = 83). Perioperative fluid intake, urine output, blood loss, diuretic dosage, the use of allogeneic blood products, ultrafiltration, and daily balance were recorded for 24 hrs in intensive care unit (ICU). ⋯ No statistically significant differences were found between the two groups in blood loss and the amount of allogenic blood products infused, length of mechanical ventilation, ICU or hospital stay, complications, or mortality. Higher concentration of albumin prime in ECC showed decreased positive fluid balances, but produced less urine output and required more diuretic usage postoperatively. Thus, no significant clinical benefit resulted from the increased dosage.
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We describe a process by which we sought to determine how the addition of intraoperative neurophysiologic monitoring (IONM) impacted the management of cardiopulmonary bypass (CPB) during pediatric cardiac surgery. While maintaining a consistent team of surgeons, anesthesiologists, nurses, and perfusionists, a multi-modal, IONM program was established consisting of Near Infrared Spectroscopy, Transcranial Doppler, and eight channel electroencephalography. ⋯ This comparative analysis of CPB management revealed a significant increase in the use of donor blood added to the CPB circuit prime as well as in the maintenance of a higher hematocrit during the bypass period after the implementation of IONM. These changes in the management of pediatric CPB correlated with recommendations of previous studies that examined postoperative neurophysiologic outcomes, suggesting that these changes were not only consistent with best practices, but that the presence of IONM data facilitated a transition to evidence-based practice.
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This study aims to compare the Jostra HL-20 roller pump to the Medos DeltaStream DP1 rotary pump in terms of pressure and flow waveforms, as well as calculated energies based on pressure/flow relationships, in a simulated pediatric cardiopulmonary perfusion system. The flow rate was set at 1,000 ml/min for each pump, under both pulsatile and nonpulsatile perfusion modes. Mean arterial pressure (MAP) was maintained at 40 mm Hg. ⋯ The total hemodynamic energy was also significantly higher in the Medos rotary pump than the Jostra roller pump, under pulsatile perfusion. This pilot study suggests that the Medos DeltaStream DP1 rotary pump may produce greater hemodynamic energy levels and higher quality physiologic pressure/flow waveforms than the Jostra roller pump. Further investigation of the Medos DeltaStream DP1 rotary pump is necessary to evaluate hemodynamic energy generation under various pump settings, in contrast to different flow rates.
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Mechanical circulatory support is gaining increased recognition as a viable treatment option for pediatric patients who suffer from congenital or acquired heart disease. Historically, the treatment options have been very limited for pediatric patients, but recent technological advances, combined with new research into circulatory support devices, are seeking alternative therapeutics options for infants and children. ⋯ The National Heart, Lung, and Blood Institute pediatric circulatory support program is discussed, in addition to the use of adult devices in pediatric applications, the Berlin Heart Excor, and several other blood pumps in development for bridge-to-transplant and bridge-to-recovery support. These devices have the potential to generate a paradigm shift in the treatment of the pediatric patients with heart failure--a shift is likely already be underway.