39 research outputs found
Congenital diaphragmatic hernia: To repair on or off extracorporeal membrane oxygenation?
Background: Congenital diaphragmatic hernia (CDH) can be repaired on or off extracorporeal membrane oxygenation (ECMO). In many centers, operating off ECMO is advocated to prevent bleeding complications. We aimed to compare surgery-related bleeding complications between repair on or off ECMO. Methods: All patients with CDH repair and ECMO treatment between January 1, 1995, and May 31, 2008, were retrospectively reviewed. Tranexamic acid was routinely given to all patients repaired on ECMO for 24 hours perioperatively after 2003. Extra-fluid expansion, transfusion, or relaparotomy caused by postoperative bleeding were scored as surgery-related bleeding complications and were related to the Extracorporeal Life Support Organization (ELSO) registry. We used χ 2 test and t test for statistics. Results: Demographic data and surgery-related bleeding complications in the on-ECMO group were not significantly different compared with the off-ECMO group (P =.331) in our institute. In contrast, more surgery-related bleeding complications were reported by ELSO in their on-ECMO group (P <.0001). Conclusion: In contrast to the data from the ELSO registry, we did not observe significantly more surgery-related bleeding complications after CDH repair on ECMO. Using a specific perioperative hemostatic treatment enabled us to perform CDH repair on ECMO with a low frequency of bleeding complications, thereby taking advantage of having the physiologic benefits of ECMO available perioperatively
Modern microwave methods in solid state inorganic materials chemistry: from fundamentals to manufacturing
No abstract available
Dutch Prospective Observational Study on Prehospital Treatment of Severe Traumatic Brain Injury: The BRAIN-PROTECT Study Protocol
Background: Severe traumatic brain injury (TBI) is associated with a high mortality rate and those that survive
commonly have permanent disability. While there is a
broad consensus that appropriate prehospital treatment is
crucial for a favorable neurological outcome, evidence to
support currently applied treatment strategies is scarce. In
particular, the relationship between prehospital treatments
and patient outcomes is unclear. The BRAIN-PROTECT
study therefore aims to identify prehospital treatment
strategies associated with beneficial or detrimental outcomes. Here, we present the study protocol. Study
Protocol: BRAIN-PROTECT is the acronym for BRAin
INjury: Prehospital Registry of Outcome, Treatments and
Epidemiology of Cerebral Trauma. It is a prospective
observational study on the prehospital treatment of
patients with suspected severe TBI in the Netherlands.
Prehospital epidemiology, interventions, medication strategies, and nonmedical factors that may affect outcome are
studied. Multivariable regression based modeling will be
used to identify confounder-adjusted relationships
between these factors and patient outcomes, including
mortality at 30 days (primary outcome) or mortality and
functional neurological outcome at 1 year (secondary outcomes). Patients in whom severe TBI is suspected during
prehospital treatment (Glasgow Coma Scale score 8 in
combination with a trauma mechanism or clinical findings
suggestive of head injury) are identified by all four helicopter emergency medical services (HEMS) in the
Netherlands. Patients are prospectively followed up in 9
participating trauma centers for up to one year. The
manuscript reports in detail the objectives, setting, study
design, patient inclusion, and data collection process.
Ethical and juridical aspects, statistical considerations, as
well as limitations of the study design are discussed.
Discussion: Current prehospital treatment of patients
with suspected severe TBI is based on marginal evidence,
and optimal treatment is basically unknown. The BRAINPROTECT study provides an opportunity to evaluate and
compare different treatment strategies with respect to
patient outcomes. To our knowledge, this study project is
the first large-scale prospective prehospital registry of
patients with severe TBI that also collects long-term follow-up data and ma
Arterial lactate for predicting mortality in children requiring extracorporeal membrane oxygenation
Background. Dynamic arterial lactate indices predict mortality more accurately than static arterial lactate measurements in children with septic shock or congenital cardiac defects. The current study evaluates whether this also applies to children with primary respiratory disease requiring extracorporeal membrane oxygenation (ECMO). Methods. Static arterial lactate levels (LACabs) were prospectively collected before and during ECMO support for this single center, observational cohort study. Also, time-weighted arterial lactate (LAC(tw)) and lactate change over time (LACdelta) were calculated as dynamic indices for, respectively, the duration and the trend over time of lactate derangement. Intensive care mortality was the primary endpoint. Analyses were performed for neonatal and pediatric patients separately. Results. Fifty-six neonatal and 39 pediatric patients were included. Eighteen (32%) neonatal and 12 (31%) pediatric patients died. The evolution of LACabs and LACdelta differed between the pediatric survivors and the pediatric non-survivors (P <0.001, P=0.025). The hazard ratio was 1.23 (CI95=1.06-1.43, P=0.007) for LACabs and 20.64 (CI95=1.99-214.20, P=0.011) for LACdelta, indicating that higher lactate levels increase the risk for mortality. The predictive value for LACabs was 0.75 (CI95=0.57-0.93) and for LACdelta 0.69 (CI95=0.51-0.87), respectively. There were neither consistent differences for LACtw in the pediatric patients, nor for any of the static or dynamic lactate indices in the neonatal patients. Conclusion. Static arterial lactate measurements and, to a lesser extent, dynamic arterial lactate indices predict mortality in pediatric, but not neonatal ECMO patients. The magnitude and trend over time rather than the duration of lactate derangement are associated with mortalit