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This systematic review summarizes the major developments in extracorporeal membrane oxygenation (ECMO) circuitry in pediatrics over the past 20 years and demonstrates the impacts of those developments on clinical outcomes. This systematic review followed structured Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 1987 studies were retrieved, of which 82 were included in the final analysis. Over the past 20 years, ECMO pumps have shifted from roller pumps to centrifugal pumps. Silicone and polypropylene hollow fiber membrane oxygenators were initially used but have been replaced by polymethylpentene hollow fiber membrane oxygenators, with other ECMO components poorly reported. Considerable variability in mortality was found across studies and there was no statistical difference in mortality rates across different periods. The duration of ECMO and other outcome measures were inconsistently reported across studies. This systematic review demonstrated technological developments in pumps and oxygenators over the last two decades, although patient mortality rates remained unchanged. This could be because of ECMO support applied to patients in more critical conditions over the years. We also highlighted the limitations of methodology information disclosure and outcome measures in current ECMO studies, showing the need of reporting standardization for future ECMO studies.

Background:The NITric oxide during cardiopulmonary bypass (CPB) to improve Recovery in Infants with Congenital heart defects (NITRIC) trial, a 1320-patient, multicentre, randomised controlled trial, is aiming to improve survival free of ventilation after CPB by using nitric oxide delivered into the oxygenator of the CPB.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jtcvs.2008.07.029 Byline: Stephen Horton (a)(c), Yves d'Udekem (a)(c), Frank Shann (b), Warwick Butt (b), Martin Bennett (a), Derek Best (b), Christian Brizard (a)(c) Author Affiliation: (a) Department of Cardiac Surgery, Royal Children's Hospital, Victoria, Australia (b) Intensive Care Unit, Royal Children's Hospital, Victoria, Australia (c) University of Melbourne, Melbourne, Australia Article History: Received 19 April 2008; Accepted 10 July 2008 Article Note: (footnote) Disclosures: None.

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Geoff Sharp, reviewing the Kosovo conflict for Arena Magazine No. 41, cites the Lacanian philosopher Slavoj Zizek. In his view contemporary American military intervention is a fusion of `the new [...]

A refined model of fault structure in the active New Madrid Seismic Zone (NMSZ) is presented based on relocated hypocenters and application of a statistical clustering method to determine fault planes. Over 200 earthquakes are recorded in the NMSZ every year, but the three‐dimensional (3‐D) fault structure is difficult to determine because the zone is covered by thick, Mississippi Embayment sediment. The distribution of earthquakes in the NMSZ indicates four major arms of seismicity, suggesting the presence of a northeast‐southwest trending strike‐slip fault system with a major northwest trending, contractional stepover fault. Relocation of 4,131 earthquakes using HypoDD resulted in major improvement in the depiction of fault structure in the NMSZ including three‐dimensional structural variations along the along the Reelfoot fault (RF) and a well‐defined intersection of the Axial and RFs. Optimal Anisotropic Dynamic Clustering analysis of the relocated hypocenters produced a fault model consisting of 12, well resolved planes. The RF is continuous along strike from the northern end to the Ridgely fault, located south of the intersection with the Axial fault (AF). The crosscutting Ridgely fault may serve as a barrier to rupture propagation along the entire fault. The strike‐slip arms of seismicity are well resolved and correspond to near vertical planes. Three planes are resolved in the southern part of the AF and are associated with the Osceola igneous complex. A refined fault model is determined for the active New Madrid seismic zone using earthquakes that occurred from 2000 to 2019. The seismic zone is located in the central United States and poses a hazard to critical infrastructure and numerous population centers. The major faults are the Reelfoot thrust fault and the strike‐slip Axial fault (AF). The first step in constructing the improved fault model involved relocation of the earthquakes to decrease location error. The second step involved fitting planes to the relocated earthquakes under the assumption that the earthquakes cluster along fault segments. The resulting model provides a three‐dimensional representation of the fault structure. A major fault disrupts the southern portion of the Reelfoot fault, making it discontinuous. The northern part of the AF is very well defined. Earthquakes are more scattered along the southern part of the AF, but three fault planes are resolved that are located along the side of a major intrusion. The fault model can be used in studies involving possible rupture length and magnitude of large earthquakes. New Madrid Seismic Zone hypocenters for the years 2000–2019 are relocated and have a median relative location error of 65 mPlanes are fit to the relocated hypocenters producing a detailed three‐dimensional model of fault structureThe Reelfoot fault is segmented by the Ridgely fault New Madrid Seismic Zone hypocenters for the years 2000–2019 are relocated and have a median relative location error of 65 m Planes are fit to the relocated hypocenters producing a detailed three‐dimensional model of fault structure The Reelfoot fault is segmented by the Ridgely fault

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The extracorporeal membrane oxygenation circuit is made of a number of components that have been customized to provide adequate tissue oxygen delivery in patients with severe cardiac andor respiratory failure for a prolonged period of time (days to weeks). A standard extracorporeal membrane oxygenation circuit consists of a mechanical blood pump, gas-exchange device, and a heat exchanger all connected together with circuit tubing. Extracorporeal membrane oxygenation circuits can vary from simple to complex and may include a variety of blood flow and pressure monitors, continuous oxyhemoglobin saturation monitors, circuit access sites, and a bridge connecting the venous access and arterial infusion limbs of the circuit. Significant technical advancements have been made in the equipment available for short- and long-term extracorporeal membrane oxygenation applications. Contemporary extracorporeal membrane oxygenation circuits have greater biocompatibility and allow for more prolonged cardiopulmonary support time while minimizing the procedure-related complications of bleeding, thrombosis, and other physiologic derangements, which were so common with the early application of extracorporeal membrane oxygenation. Modern era extracorporeal membrane oxygenation circuitry and components are simpler, safer, more compact, and can be used across a wide variety of patient sizes from neonates to adults.

In recent years, there has been a trend to incorporate arterial filters into cardiopulmonary bypass (CPB) oxygenators. The FX oxygenators are the first examples of integrating a filter around the fibers of the oxygenator. To assess the efficacy of the FX05 oxygenator, in comparison with our existing CPB setup (RX05 oxygenator arterial filter), we randomly assigned 40 patients undergoing CPB, with calculated flows <1.5 L/min, to FX05 or RX05 arterial filter (19 FX and 21 RX). Embolic load was assessed using the emboli detection and classification quantifier, with sensors placed prefilter and postfilter/oxygenator at identical distances for both devices. A total of 6,270 FX readings and 6,183 RX readings were obtained. Because of the extremely skewed nature of the data, the prefilter embolic volumes were divided into deciles, and each decile was analyzed separately. Our results show that the devices perform similarly; both filter out a high percentage of the prefilter embolic load. Our data support that in the clinical setting, the FX05 is as effective at removing emboli as the RX05 with an arterial filter (CXAF02) which, in conjunction with the prime volume reduction and circuit simplification, has warranted our conversion to the FX series of oxygenators.

This study aims to evaluate the impact of a change in extracorporeal membrane oxygenation (ECMO) technology on patient and circuit outcomes. A retrospective single-centre study of all ECMO runs from 1988 to 2006 was performed. Predictors of survival to hospital discharge (primary outcome measure) were evaluated in the entire cohort by univariate and multivariate analysis. A detailed subgroup univariate and multivariate analysis was performed in the cardiac and respiratory groups to identify predictors of survival to hospital discharge. A total of 275 patients underwent 294 extracorporeal support runs at a median (interquartile range) age of 40 (3-639) days and weight of 4.0 (3.1-10) kg. The primary indications for support were respiratory (41.8%), cardiac (45.6%) and sepsis (12.6%). Between the initial (Era 1) and most recent era (Era 3), cardiac support became the predominant ECMO indication (26 of 127 vs. 59 of 107; P<0.001). Survival to decannulation, intensive care and hospital discharge for the entire cohort and Era 3 patients were 50.0%, 48.9%, 44.4% and 71.7%, 55.6%, 52.6% (P<0.003), respectively. Treatment in Era 3 was associated with increased survival to intensive care discharge (P=0.02) for all ECMO patients. Cardiac survival was associated with treatment in Era 3 (P=0.04) and a lower complexity score (P<0.001). There was a significant reduction in mechanical circuit complications in the respiratory ECMO subgroup. A significant improvement in patient survival outcomes and reduction in mechanical circuit complications was noted in the current era. This improvement was associated with a change in ECMO technology.

Background. Contact of blood with the surfaces of the cardiopulmonary bypass (CPB) circuit has been implicated as a cause of the inflammatory response. We undertook a prospective randomized trial of 200 pediatric patients, all with a calculated total bypass flow of less than 2.3 L/min (< 0.96 L/m2/min).

Twelve children aged 6 days to 12 years had left or common atrial to aortic extracorporeal support with a centrifugal pump after cardiac operations. Left ventricular assist time ranged from 38 to 190 hours. Ten patients were successfully weaned from left ventricular assist device support; four hospital deaths occurred afterward. All six survivors were discharged from the hospital with improved left ventricular function. Although the follow-up time is short and the experience limited, we consider the centrifugal pump type of left ventricular assist device to be a potentially lifesaving treatment modality for selected pediatric patients having cardiac operations.

There has been profound economic and political change in New Zealand in the last decade. It is therefore not surprising that since 1984 there have also been great changes in the urban government of New Zealand. The question posed by this essay is: what do these economic, political and administrative changes mean for urban policy?