Background: Pediatric extracorporeal membrane oxygenation (ECMO) programs are sophisticated endeavors usually found only in high-volume cardiac surgical programs. Worldwide, many cardiology programs ...do not have on-site pediatric cardiac surgery expertise. Our single-center experience shows that an organized multidisciplinary rescue-ECMO program, in collaboration with an accepting facility, can achieve survival rates comparable to modern era on-site ECMO. Methods: A retrospective review was conducted of all patients initiated on rescue-ECMO from 2004 to 2009 in a single academic pediatric hospital without a pediatric cardiac surgery program. All aspects of ECMO were formalized using Failure Mode Effects Analysis. Results: Eight patients were initially cannulated for ECMO at our institution. Six were subsequently transported by air to the receiving facility 1,305 km away. Extracorporeal membrane oxygenation was initiated in 0.2% of our Pediatric Intensive Care Unit admissions and in 0.52% of all our pediatric cardiac patients. Mean age was 4.0 years (7 weeks to 15 years). Indications for ECMO initiations were cardiogenic shock (n = 5) and acute respiratory distress syndrome (n = 3). Six had veno-arterial- and two had veno-veno ECMO. Two patients were not transported (one death and one weaned locally). Six patients were successfully transported within 2 to 24 hours, with a survival to hospital discharge rate of 67% (four of six). Median total time on ECMO was 5.5 days. Complication rate was 50% (4/8). Conclusions: Our rescue-ECMO survival results were comparable to that of current published results from established pediatric ECMO programs. Air transport of ECMO patients can be performed safely using an organized multidisciplinary team approach.
This study explores the relationships that emerge between socioeconomic status (SES) and the prevalence of several health outcomes in children of different ages utilizing administrative data housed ...at The Manitoba Centre for Health Policy (MCHP). This research also determines the effect that family has on a child developing (or not developing) a specific health outcome. Finally, the relationship between prevalence and familial aggregation are examined.
The Johns Hopkins ACG(r) Case-Mix System grouped various physician and hospital diagnosis codes into 32 Aggregated Diagnostic Groups (ADGs). Eight of these ADGs were assessed at four age groups (0-3, 4-8, 9-13 & 14-18) for each member of the final study population. Each member was assigned to one of six SES groups, five income quintile groups and one social assistance group.
Familial aggregation was determined for eight selected ADGs using an intraclass correlation coefficient (ICC). Statistical contrasts were made for SA vs. Q1-Q5 and an overall linear trend (SA – lowest; Q5 – highest) to establish the SES differences for the prevalence and familial aggregation of a particular condition. Many of the conditions across SES had statistically significant (p<0.05) linear and SA vs. Q1-Q5 contrasts for
3
both ICCs and prevalence at all age groups. Of the eight ADGs that familial aggregation was calculated, chronic conditions related to the eye had the highest ICCs at all age groups. Injury ADGs had consistently lower ICCs for all age groups.
Factors that affected the results of ICC estimation for binary outcomes include the number of bootstrap selections, the width of the age group and the event rate for the outcome of interest. Suggested future research includes a validity review of ICC
estimates for binary outcomes, exploring the variables that may reduce or eliminate the SES gradient for ICCs and exploring the aggregation for different study samples within Manitoba.
Purpose: The novel high-sensitivity troponin T assay (hs-cTnT) has been validated for diagnosing AMI in the emergency room. However its utility in high-risk in-patient populations is unknown. ...Methods: We retrospectively reviewed admissions to a general cardiology unit that had 2 hs-cTnT measurements in the first 12 h of presentation. We assessed 8 diagnostic algorithms that used hs-cTnT concentration and changes in concentration (including the 99th percentile cut-off of 14 ng/L) for their diagnostic utility in separating AMI patients from cardiac/nonACS and non-cardiac chest-pain patients. UA was excluded. Results: There were 233 patients (mean age 67 years, 153 were males (66%)) admitted over a 2 month period, with AMI diagnosed in 118 of these patients (51%). The recommended 99th percentile cut-off had modest accuracy (65%), good sensitivity (88%), and poor specificity (25%); a higher cut-off of 75 ng/L had a better diagnostic accuracy of 73%, p < 0.05. While some hs-cTnT algorithms were either highly sensitive or specific, none were both. Conclusion: In high-risk cardiology in-patients, no hs-cTnT concentration cut-off or change more accurately diagnosed and excluded AMI, although higher cut-offs had better diagnostic utility.
Ex vivo heart perfusion (EVHP) may facilitate resuscitation of discarded donor hearts and expand the donor pool; however, a reliable means of demonstrating organ viability prior to transplantation is ...required. Therefore, we sought to identify metabolic and functional parameters that predict myocardial performance during EVHP. To evaluate the parameters over a broad spectrum of organ function, we obtained hearts from 9 normal pigs and 37 donation after circulatory death pigs and perfused them ex vivo. Functional parameters obtained from a left ventricular conductance catheter, oxygen consumption, coronary vascular resistance, and lactate concentration were measured, and linear regression analyses were performed to identify which parameters best correlated with myocardial performance (cardiac index: mL·min
–1
·g
–1
). Functional parameters exhibited excellent correlation with myocardial performance and demonstrated high sensitivity and specificity for identifying hearts at risk of poor post-transplant function (ejection fraction: R
2
= 0.80, sensitivity = 1.00, specificity = 0.85; stroke work: R
2
= 0.76, sensitivity = 1.00, specificity = 0.77; minimum dP/dt: R
2
= 0.74, sensitivity = 1.00, specificity = 0.54; tau: R
2
= 0.51, sensitivity = 1.00, specificity = 0.92), whereas metabolic parameters were limited in their ability to predict myocardial performance (oxygen consumption: R
2
= 0.28; coronary vascular resistance: R
2
= 0.20; lactate concentration: R
2
= 0.02). We concluded that evaluation of functional parameters provides the best assessment of myocardial performance during EVHP, which highlights the need for an EVHP device capable of assessing the donor heart in a physiologic working mode.
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