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Introduction: Extracorporeal membrane oxygenation (ECMO) circuits may be changed during the run for multiple reasons; however, these circuit changes may be associated with adverse events. Predictors for undergoing a circuit change (CC) and their outcomes remain unclear. We hypothesized that neonatal and pediatric CC correlates with increased morbidity and mortality. Methods: Pediatric and neonatal patients who underwent one ECMO run lasting <30 days at a tertiary children's hospital from 2011 through 2017 were retrospectively reviewed. Bivariate regression analysis evaluated factors associated with ECMO mortality and morbidity. LASSO logistic regression models identified independent risk factors for undergoing a CC. p <.05 was significant. Results: One hundred 85 patients were included; 137 (74%) underwent no CC, while 48 (26%) underwent one or more. Undergoing a CC was associated with longer ECMO duration (p <.001), higher blood transfusion volumes (p <.001), increased hemorrhagic complications (p <.001) and increased mortality (p =.002). Increased platelet (p =.001) and FFP (p =.016) transfusion volumes at any time while on ECMO were independent factors associated with undergoing a CC. Conclusions: Changing the circuit during the ECMO run occurs frequently and may be associated with poorer outcomes. Understanding the outcomes and predictors for CC may guide management protocols for more efficient circuit changes given its important association with overall outcomes. [ABSTRACT FROM AUTHOR]

Background: Visceral artery pseudoaneurysms (VA-PSA) occur in necrotizing pancreatitis; however, little is known about their natural history. This study sought to evaluate the incidence and outcomes of VA-PSA in a large cohort of patients with necrotizing pancreatitis. Methods: Data for patients with necrotizing pancreatitis who were treated between 2005 and 2017 at Indiana University Health University Hospital and who developed a VA-PSA were reviewed to assess incidence, presentation, treatment and outcomes. Results: Twenty-eight of 647 patients with necrotizing pancreatitis (4.3%) developed a VA-PSA between 2005 and 2017. The artery most commonly involved was the splenic artery (36%), followed by the gastroduodenal artery (24%). The most common presenting symptom was bloody drain output (32%), followed by incidental computed tomographic findings (21%). The median time from onset of necrotizing pancreatitis to diagnosis of a VA-PSA was 63.5 days (range 1-957 d). Twenty-five of the 28 patients who developed VA-PSA (89%) were successfully treated with percutaneous angioembolization. Three patients (11%) required surgery: 1 patient rebled following embolization and required operative management, and 2 underwent upfront operative management. The mortality rate attributable to hemorrhage from a VA-PSA in the setting of necrotizing pancreatitis was 14% (4 of 28 patients). Conclusion: In this study, VA-PSA occurred in 4.3% of patients with necrotizing pancreatitis. Percutaneous angioembolization effectively treated most cases; however, mortality from VA-PSA was high (14%). A high degree of clinical suspicion remains critical for early diagnosis of this potentially fatal problem. Contexte : Les faux anevrismes des arteres viscerales (FAAV) surviennent en presence d'une pancreatite necrosante; on en sait cependant peu sur leur histoire naturelle. L'objectif de l'etude etait d'evaluer l'incidence et les issues des FAAV dans une grande cohorte de patients atteints de pancreatite necrosante. Methodes : Nous avons examine les donnees des patients atteints de pancreatite necrosante traites entre 2005 et 2017 a l'Hopital universitaire de l'Universite de l'Indiana qui ont fait un FAAV afin d'evaluer l'incidence, les premiers signes, le traitement et les issues de cette affection. Resultats : Vingt-huit (4,3 %) des 647 patients atteints de pancreatite necrosante inclus (2005-2017) ont fait un FAAV. L'artere la plus souvent touchee etait l'artere splenique (36 %), suivie de l'artere gastroduodenale (24 %). Les premiers signes les plus courants etaient la presence de sang dans les liquides evacues par drainage (32 %), puis les resultats d'une tomodensitometrie effectuee pour une autre raison (21 %). Le delai median entre l'apparition de la pancreatite necrosante et le diagnostic de FAAV etait de 63,5 jours (intervalle : 1 a 957 jours). Vingt-cinq des 28 patients ayant fait un FAAV (89 %) ont ete traites avec succes par angioembolisation percutanee. Trois patients (11 %) ont du etre operes : 2 des le debut, et le troisieme parce qu'il a recommence a saigner apres l'embolisation. Le taux de mortalite par hemorragie due a un FAAV chez les personnes atteintes d'une pancreatite necrosante etait de 14 % (4 patients sur 28). Conclusion : Dans cette etude, 4,3 % des patients atteints de pancreatite necrosante ont connu un FAAV. L'angioembolisation percutanee s'est averee efficace dans la plupart des cas; cependant, la mortalite associee aux FAAV etait elevee (14 %). Il est crucial de faire preuve d'une grande suspicion clinique afin de diagnostiquer tot cette affection potentiellement mortelle., Avisceral artery pseudoaneurysm (VA-PSA) is a known complication following pancreatic surgery as well as in the setting of acute and chronic pancreatitis. A VA-PSA formation can lead to massive hemorrhage [...]