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The performance of viscoelastic coagulation monitor (VCM) compared with TEG 5000 (TEG) is unknown. In this multicenter study, the authors evaluated the agreement among VCM/TEG parameters and their relationship with standard coagulation tests in critically ill patients. Viscoelastic coagulation monitor, TEG, and laboratory samples were analyzed simultaneously. Viscoelastic coagulation monitor/TEG agreement was computed by Bland and Altman's plots, association with laboratory parameters was studied with Spearman's correlation coefficient and random-intercept linear models. One-hundred and twenty-seven patients enrolled, 320 paired observations: 210 (65.6%) under unfractioned heparin (UFH), 94 (29.4%) under low molecular weight heparin (LMWH), 16 (5.0%) no heparin. Under UFH prolonged clot formation times and reduced the amplitude of viscoelastic tracings on both devices, especially on TEG. The type of heparin affected the agreement between VCM/TEG homolog parameters. Reaction time (TEG-R) resulted 23.1 min longer than the homolog clotting time (VCM-CT) under UFH; maximum amplitude (TEG-MA) resulted 29.5 mm higher than maximum clot firmness (VCM-MCF) under LMWH. Weak correlation was observed between VCM-CT/TEG-R and activated partial thromboplastin time (aPTT)/anti-Xa; no correlation was found between VCM-alpha/TEG-angle and fibrinogen concentration. Viscoelastic coagulation monitor-MCF showed strong (LWMH) to moderate (UFH) correlation with platelet count, while TEG-MA only showed lower correlation. Viscoelastic coagulation monitor and TEG are differently affected by heparin. The platelet count is well represented by VCM-MCF even during UFH administration., Competing Interests: Disclosure: The authors have no conflicts of interest to report., (Copyright © ASAIO 2023.)

Background: The COVID-19 pandemic halted routine medical care, including well-child visits (WCVs) and immunizations., Purpose: Describe the development and impact of a multidisciplinary initiative on the number of WCVs and immunizations delivered in aftermath of the COVID-19 pandemic over a four week period between April 14, 2021 and May 5, 2021., Methods: Student pharmacists (SP), family medicine residents (FMRs), and nurses within a family medicine practice in a medically underserved community, developed a program to increase the number of pediatric patients up-to-date on WCVs and immunizations. "Well-child Wednesdays" used adjusted staffing to conduct visits with patients behind on vaccines. The 4-week pilot program utilized SPs to identify immunization gaps in patients less than 12 years old following chart review and to coordinate scheduling. During the visit, FMRs completed the components of the well-child visit; immunization gaps were communicated to the nurse who, after review, administered needed immunizations., Discussion: Of 193 patient charts reviewed for immunization needs, 68 were not up-to-date on routine vaccines and 29 patients (mean age 5 years old, 58.6% male) were able to be reached and agreed to schedule a visit. Of these, 20 kept their appointment and a total of 69 vaccines were administered, with DTaP as the most common with 13 doses administered followed by Hepatitis A with 10 doses given., Conclusions: An interprofessional immunization program was an effective strategy to address the decline in immunizations and WCVs as a result of COVID-19., (© 2023 Elsevier Inc. All rights reserved.)

Intraoperative allergic reactions are rare but serious events associated with increased morbidity and mortality. We report the salvage of intraoperative anaphylaxis leading to extreme hypercapnic respiratory failure by veno-venous extracorporeal membrane oxygenation (ECMO). A 38-year-old woman undergoing thyroidectomy developed intractable bronchospasm after administration of atracurium, leading to extreme hypercapnic respiratory failure (PaCO 2  > 250 mmHg, pH 6.773). After the failure of conventional medical therapy and ventilatory optimization, the patient was connected to a veno-venous ECMO circuit. PaCO 2 of 45.6 mmHg and pH of 7.25 were achieved in 1 h, by slowly increasing sweep gas flows up to 3.5 L/min and using continuous end-tidal CO 2 monitoring to gauge the procedure. After extubation and disconnection from ECMO, the patient was discharged on the 6th day without sequelae. Rapid reversal of extreme hypercapnic acidosis by ECMO was feasible, without any neurologic sequelae. Veno-venous ECMO support may be a valuable option for the salvage of intraoperative anaphylaxis.

The absorption, excretion and metabolism of a new diuretic compound, 2-phenyl-6-sulfonamido-7-chloro-1,2,3,4-tetrahydro-4-quinazolinone (M.G. 13054), after oral administration to the dog have been studied. The results can be summarized as follows: 1) M.G. 13054 given orally to dogs is quickly absorbed. 2) The maximal blood levels are reached within the 3rd hour after the administration and remain appreciable (10% of the maximal values) till the 12th hour. 3) Fecal and urinary excretion is rapid and 94% of the product administered is excreted in the first 48 hours following treatment. 4) The product does not seem to be tightly bound to plasma proteins. 5) M. G. 13054 does not seem to be metabolized to any appreciable extent.