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Pediatric Granulomatosis with Polyangiitis: Treatment With ECMO

In May 2022, researchers from the Maria Fareri Children’s Hospital, Departments of Pediatrics, Rheumatology, Critical Care Medicine, and Pediatric Nephrology, and New York Medical College Department of Pediatrics presented the case of granulomatosis with polyangiitis (GPA) vasculitis in a pediatric patient treated with extracorporeal membrane oxygenation (ECMO). The complete study by Rachel Finkel, Jesse Honig, Chun P. Chao, Erin Rescoe, and Sonia Solomon can be found in Pediatric Rheumatology. The manuscript is summarized below.

Antineutrophil cytoplasmic antibody (ANCA) vasculitis is a disease that often results in necrotizing arteritis with deposits found in small and medium-sized vessels. These deposits are primarily observed in adults, but the most commonly observed subtype in the pediatric population is granulomatosis with polyangiitis (GPA) vasculitis. This disease is most often associated with respiratory tract and renal involvement.


Crystalloid Fluid Choice in Adults with Sepsis

In April 2022, researchers from the University of Toledo, Departments of Internal Medicine, Neurology, Critical Care Medicine, and Rheumatology compared the effect of balanced crystalloids (BC) vs. normal saline (NS) in adults with sepsis. The full manuscript by Azizullah Beran, Nehaya Altorok, Omar Srour, Saif-Eddin Malhas, Waleed Khokher, Mohammed Mhanna, Hazem Ayesh, Nameer Aladamat, Ziad Abuhelwa, Khaled Srour, Asif Mahmood, Nezam Altorok, Mohammad Taleb, and Ragheb Assaly can be found in the Journal of Clinical Medicine. The study’s findings are detailed below.

Sepsis is a life-threatening organ dysfunction resulting from a dysregulated host response to infection. Initial management of sepsis involves early resuscitation with intravenous fluids, with crystalloid fluids one of the preferred fluids for septic patients. There are two classifications for crystalloid fluids: non-balanced fluids (e.g., normal saline) or balanced fluids. When comparing the two, balanced fluids have a physiologic electrolyte composition that is more similar to plasma than NS. Additionally, NS has been shown to induce hyperchloremic metabolic acidosis and is associated with acute kidney injury (AKI).


Cervical Cancer with Peritoneal Carcinomatosis Management With HIPEC

In February 2022, scientists from the Beth Israel Deaconess Medical Center, Departments of Internal Medicine, Clinical Pathology, Gynecologic Oncology, and Oncology, and Tufts University School of Medicine, Department of Surgical Oncology presented two patients who had recurrent cervical adenocarcinoma with peritoneal carcinomatosis and were treated with hyperthermic intraperitoneal chemotherapy (HIPEC). The full manuscript by Taliya Lantsman, Marcos Lepe, Leslie Garrett, Martin Goodman, and Meghan Shea can be found in Gynecologic Oncology Reports. Its key findings are detailed below.

Cervical cancer is currently the fourth most common cancer found in women. Squamous cell carcinomas comprise 80% of cervical cancers and are decreasing with adequate screening, yet cervical adenocarcinomas have increased in the past three decades. This is likely because cancer cell screenings are less effective in identifying adenocarcinomas than squamous cell carcinomas.


Managing A Fungal-Infected Prosthetic Aortic Graft with Robotic-Assisted Closed-Chest Techniques

In May 2022, researchers from Lenox Hill Hospital Department of Cardiovascular and Thoracic Surgery provided a case report on the treatment of a fungal prosthetic graft infection using a robotic-assisted debridement of the aortic graft within a closed chest. The complete report by Ashley T. Giammarino, Iam Claire Sarmiento, SJacob Scheinerman, John Winalski, Richard S. Lazzaro, Derek R. Brinster, and Jonathan M. Hemli can be found in the Journal of Medical Case Reports. The case report is summarized below.

Although prosthetic vascular graft infections are uncommon, they are associated with high mortality. Traditional management usually involves graft excision and radical removal of damaged tissue through an open approach. Still, the high morbidity associated with these procedures has led to a search for alternative treatment options.


Evaluating Interfacility ECMO Transfer Outcomes by Cannulation Location and Mode of Transport

A study published in March 2022 evaluated complications and in-hospital mortality in patients treated with Venovenous (VV) ECMO based on cannula locations and transport mode. The manuscript, written by Jillian K. Wothe, Zachary R. Bergman, Krystina R. Kalland, Logan G. Peter, Elizabeth R. Lusczek, and Melissa E. Brunsvold at the University of Minnesota, can be found in Critical Care Explorations. The results of the study are detailed below.

Extracorporeal membrane oxygenation (ECMO) is a lifesaving measure for critical respiratory and cardiac failure. Unfortunately, the volume of adult patients requiring ECMO continues to increase, increasing the number of patients transported to an ECMO center. While previous studies have reported overall survival rates in patients transported on ECMO, this is one of only a few studies examining complication rates after interfacility ECMO transport and mode of transport comparison.