Extracorporeal membrane oxygenation support after the Fontan operation

ObjectiveExtracorporeal membrane oxygenation has been used to support children with cardiac failure after the Fontan operation. Mortality is high, and causes of mortality remain unclear. We evaluated the in-hospital mortality and factors associated with mortality in these patients.MethodsExtracorporeal Life Support Organization registry data on patients requiring extracorporeal membrane oxygenation after the Fontan operation from 1987 to 2009 were retrospectively analyzed. Demographics and extracorporeal membrane oxygenation data were compared for survivors and nonsurvivors. A multivariable logistic regression model was used to identify factors associated with mortality.ResultsOf 230 patients, 81 (35%) survived to hospital discharge. Cardiopulmonary resuscitation was more frequent (34% vs 17%, P = .04), and median fraction of inspired oxygen concentration was higher (1 [confidence interval, 0.9–1.0] vs 0.9 [confidence interval, 0.8–1.0], P = .03) before extracorporeal membrane oxygenation in nonsurvivors compared with survivors. Extracorporeal membrane oxygenation duration and incidence of complications, including surgical bleeding, neurologic injury, renal failure, inotrope use on extracorporeal membrane oxygenation, and bloodstream infection, were higher in nonsurvivors compared with survivors (P < .05 for all). In a multivariable model, neurologic injury (odds ratio, 5.18; 95% confidence interval, 1.97–13.61), surgical bleeding (odds ratio, 2.36; 95% confidence interval, 1.22–4.56), and renal failure (odds ratio, 2.81; 95% confidence interval, 1.41–5.59) increased mortality. Extracorporeal membrane oxygenation duration of more than 65 hours to 119 hours (odds ratio, 0.33; 95% confidence interval, 0.14–0.76) was associated with decreased mortality.ConclusionsCardiac failure requiring extracorporeal membrane oxygenation after the Fontan operation is associated with high mortality. Complications during extracorporeal membrane oxygenation support increase mortality odds. Prompt correction of surgical bleeding when possible may improve survival

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

États-Unis : La valeur du risque dans le service des eaux

Der Wert des Risikos in der Wasserversorgung Wie bewertet man in den USA die von den Wasserversor- gungssystemen ausgehenden Risiken ? Grobe Indizien ermö- glichen, sie zu beziffern, und helfen den Gebietskörperschaften bei der Entscheidungsfindung.Risk value in water services How can one evaluate the risks run in water conveyance in the United States ? Approximative indicators can give an idea of the figures thus helping territorial communities make their decisions.Comment évalue-t-on les risques encourus par les systèmes d'adduction d'eau aux Etats-Unis ? Des indices approximatifs permettent d'en donner une représentation chiffrée et d'aider les collectivités territoriales à prendre leurs décisions.El valor del riesgo en el servicio de aguas ¿ Cómo se evalúan los riesgos incurridos por los sistemas de conducción de agua en Estados Unidos ? Indices aproximados permiten ofrecer una representación cuantificada y ayudar a las administraciones territoriales a tomar sus decisiones.Rycus Mitchell J. États-Unis : La valeur du risque dans le service des eaux. In: Les Annales de la recherche urbaine, N°40, 1988. Risques et périls. pp. 47-52

Children watching horses photograph

Photograph showing children looking at a herd of horses on the other side of a corral fence, taken by Jeffrey Rycus of Columbus, Ohio. A sheepdog stands behind them, looking at the camera. The image won second prize in the Professional category of the Spirit of Ohio Bicentennial Photo Contest. In August 1976, the Ohio American Revolution Bicentennial Advisory Committee (OARBAC) began the Spirit of Ohio Bicentennial Photo Contest as part of a larger effort in Ohio to celebrate the 1976 American Bicentennial. The contest was meant to document "the spirit and character of the people and places which represent Ohio during [the] bicentennial year," and to create a permanent photographic archive of the year's festivity for use by future researchers. Both professional and amateur photographers submitted over 500 photographs for consideration, all taken within the state between January 1 and December 31, 1976

'Chris and Tasha' photograph

A naturalist employed at Columbus Metropolitan Parks holds a red-tailed hawk. The naturalist wears a park ranger uniform, including a badge on his hat. The image, titled "Chris and Tasha," was submitted by photographer Jeffrey A. Rycus of Columbus, Ohio, in the Professional category of the Spirit of Ohio Bicentennial Photo Contest. In August 1976, the Ohio American Revolution Bicentennial Advisory Committee (OARBAC) began the Spirit of Ohio Bicentennial Photo Contest as part of a larger effort in Ohio to celebrate the 1976 American Bicentennial. The contest was meant to document "the spirit and character of the people and places which represent Ohio during [the] bicentennial year," and to create a permanent photographic archive of the year's festivity for use by future researchers. Both professional and amateur photographers submitted over 500 photographs for consideration, all taken within the state between January 1 and December 31, 1976

Evaluating Social Consequences Associated With Planning Future Energy Policies.

PhDArea planning & developmentUrban planningUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/189608/2/7708022.pd