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2. Postoperative Respiratory Complications in SARS-CoV-2 Positive Pediatric Patients Across 20 United States Hospitals: A Cohort Study

Author

Reiter, Audra J, Ingram, Martha-Conley E, Raval, Mehul V, Garcia, Elisa, Hill, Madelyn, Aranda, Arturo, Chandler, Nicole M, Gonzalez, Raquel, Born, Kristen, Mack, Shale, Lamoshi, Abdulraouf, Lipskar, Aaron M, Han, Xiao-Yue, Fialkowski, Elizabeth, Spencer, Brianna, Kulaylat, Afif N, Barde, Amrene, Shah, Ami N, Adoumie, Maeva, Gross, Erica, Mehl, Steven C, Lopez, Monica E, Polcz, Valerie, Mustafa, Moiz M, Gander, Jeffrey W, Sullivan, Travis M, Sulkowski, Jason P, Ghani, Owais, Huang, Eunice Y, Rothstein, David, Muenks, E Peter, St Peter, Shawn D, Fisher, Jason C, Levy-Lambert, Dina, Reichl, Allison, Ignacio, Romeo C, Slater, Bethany J, Tsao, KuoJen, and Berman, Loren

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Lung, Pneumonia, Clinical Research, Pediatric, Infectious Diseases, Pneumonia & Influenza, Patient Safety, Respiratory, Good Health and Well Being, Humans, Male, Child, United States, Female, COVID-19, SARS-CoV-2, Cohort Studies, Retrospective Studies, Hospitals, Postoperative Complications, Pediatric surgery, Respiratory complications, Paediatrics and Reproductive Medicine, Pediatrics, Clinical sciences, Paediatrics
Abstract

IntroductionData examining rates of postoperative complications among SARS-CoV-2 positive children are limited. The purpose of this study was to evaluate the impact of symptomatic and asymptomatic SARS-CoV-2 positive status on postoperative respiratory outcomes for children.MethodsThis retrospective cohort study included SARS-CoV-2 positive pediatric patients across 20 hospitals who underwent general anesthesia from March to October 2020. The primary outcome was frequency of postoperative respiratory complications, including: high-flow nasal cannula/non invasive ventilation, reintubation, pneumonia, Extracorporeal Membrane Oxygenation (ECMO), and 30-day respiratory-related readmissions or emergency department (ED) visits. Univariate analyses were used to evaluate associations between patient and procedure characteristics and stratified analyses by symptoms were performed examining incidence of complications.ResultsOf 266 SARS-CoV-2 positive patients, 163 (61.7%) were male, and the median age was 10 years (interquartile range 4-14). The majority of procedures were emergent or urgent (n = 214, 80.5%). The most common procedures were appendectomies (n = 78, 29.3%) and fracture repairs (n = 40,15.0%). 13 patients (4.9%) had preoperative symptoms including cough or dyspnea. 26 patients (9.8%) had postoperative respiratory complications, including 15 requiring high-flow oxygen, 8 with pneumonia, 4 requiring non invasive ventilation, 3 respiratory ED visits, and 2 respiratory readmissions. Respiratory complications were more common among symptomatic patients than asymptomatic patients (30.8% vs. 8.7%, p = 0.01). Higher ASA class and comorbidities were also associated with postoperative respiratory complications.ConclusionsPostoperative respiratory complications are less common in asymptomatic versus symptomatic SARS-COV-2 positive children. Relaxation of COVID-19-related restrictions for time-sensitive, non urgent procedures in selected asymptomatic patients may be reasonably considered. Additionally, further research is needed to evaluate the costs and benefits of routine testing for asymptomatic patients.Level of evidenceIii, Respiratory complications.

Published
2023

14. Outcomes of Extracorporeal Life Support Utilization for Pediatric Patients With COVID-19 Infections

Author

Jacobson, Jillian C., Ryan, Mark L., Vogel, Adam M., Mehl, Steven C., Acker, Shannon N., Prendergast, Connor, Padilla, Benjamin E., Lee, Justin, Chao, Stephanie D., Martin, Nolan R., Russell, Katie W., Larsen, Kezlyn, Harting, Matthew T., Linden, Allison F., Ignacio, Romeo C., Jr, Slater, Bethany J., Juang, David, Jensen, Aaron R., Melhado, Caroline G., Pelayo, Juan Carlos, Zhong, Allen, Spencer, Brianna L., Gadepalli, Samir K., Maamari, Mia, Jimenez Valencia, Maria, Qureshi, Faisal G., and Pandya, Samir R.

Published
2024
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16. Management of pediatric appendicitis during the COVID-19 pandemic: A nationwide multicenter cohort study

Author

Hegde, Brittany, Garcia, Elisa, Hu, Andrew, Raval, Mehul, Takirambudde, Sanyu, Wakeman, Derek, Lewit, Ruth, Gosain, Ankush, Parrado, Raphael H., Cina, Robert A., Stephenson, Krista, Dassinger, Melvin S, III, Zhang, Daniel, Mustafa, Moiz M., Koo, Donna, Lipskar, Aaron M., Scheidler, Katherine, Van Arendonk, Kyle J., Berg, Patrick, Gonzalez, Raquel, Scheese, Daniel, Haynes, Jeffrey, Mina, Alexander, Zamora, Irving J., Lopez, Monica E., Mehl, Steven C., Gilliam, Elizabeth, Lofberg, Katrina, Spencer, Brianna, Kulaylat, Afif N., Gulack, Brian C, Johnson, Matthew, Laskovy, Matthew, Brahmamdam, Pavan, Shimomura, Aoi, Blanch, Therese, Tsao, KuoJen, and Slater, Bethany J.

Published
2023
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18. Lower extremity complications in children following femoral cannulation for extracorporeal membrane oxygenation.

Author

Shah, Nikhil R, Spencer, Brianna L, Maselli, Kathryn M, Williams, Keyonna M, Sood, Vikram, Gadepalli, Samir K, and Thirumoorthi, Arul S

Subjects
*THROMBOSIS risk factors, *LEG, *EXTRACORPOREAL membrane oxygenation, *INTRAVENOUS catheterization, *FISHER exact test, *RETROSPECTIVE studies, *HEMATOMA, *DISCHARGE planning, *CHI-squared test, *DESCRIPTIVE statistics, *SURGICAL complications, *FEMORAL vein, *FALSE aneurysms, *SURGICAL site infections, *REPERFUSION, *DATA analysis software, *FEMORAL artery, *COMPARTMENT syndrome, *DISEASE risk factors, *CHILDREN
Abstract

Introduction: Extracorporeal membrane oxygenation cannulation strategies vary between adults and children. Femoral approach is common in adults and extremity morbidity is well-documented. Aside from limb ischemia, complications in children are theorized and have yet to be studied. This study aims to comprehensively evaluate implications of pediatric femoral cannulation. Methods: This is a single-center retrospective review of children <21 years, undergoing femoral venoarterial (VA) or venovenous (VV) cannulation between 2015 and 2022. The primary outcome was incidence of lower extremity complications on ECMO (groin hematoma/hemorrhage, vascular thrombosis, North-South syndrome, compartment syndrome, limb loss). Secondary outcome was incidence of post-decannulation extremity complications (pseudoaneurysm, surgical site infection, vascular thrombosis, motor/sensory deficits). Results: 29 children were cannulated via femoral approach. Most required VA support (89%). Common sites were right femoral artery (70.8%) and right femoral vein (56%). 18 patients (75%) had distal reperfusion cannulas (DPC) placed. Short-term lower extremity complication rate was 59%, most frequently groin hematoma/hemorrhage (30%) and North-South syndrome (19%). Compartment syndrome occurred in 3 patients (11%), though none suffered digit/limb loss. There were no significant differences in complications between cannulation approach (open vs percutaneous) or vessel laterality (ipsilateral vs contralateral). Of those decannulated (n = 15), median ECMO duration was 8 days. Following decannulation, 20% suffered pseudoaneurysm. Ten (63%) experienced ipsilateral motor weakness which resolved in 50% of patients at 1-month follow-up; 20% suffered sensory deficits all resolving by discharge. Conclusion: Approximately one third of children who underwent femoral cannulation suffered groin hematoma/hemorrhage and nearly 20% experienced North-South syndrome. Following decannulation, most had extremity weakness while sensory deficits were rarer. This marked risk of extremity morbidity prompts proactive inpatient monitoring and close surveillance after discharge. [ABSTRACT FROM AUTHOR]

Published
2024
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21. Neonatal peri-procedural extracorporeal membrane oxygenation in the management of tracheo-esophageal fistula/esophageal atresia and left pulmonary agenesis.

Author

Hartman, Heather A, Spencer, Brianna, Hirschl, Ronald B, Elliot, Anila B, and Thirumoorthi, Arul S

Subjects
*LUNG abnormalities, *CESAREAN section, *EXTRACORPOREAL membrane oxygenation, *THORACOTOMY, *RARE diseases, *MAGNETIC resonance imaging, *DISCHARGE planning, *LARYNGOSCOPY, *MULTIPLE human abnormalities, *TRACHEAL fistula, *DEGLUTITION disorders, *PARALYSIS, ESOPHAGEAL atresia, VOCAL cord diseases
Abstract

Congenital tracheo-esophageal fistula/esophageal atresia (TEF/EA) with concomitant pulmonary agenesis is exceedingly rare and has a high mortality rate. While there are several reported cases of successful repair, all but one patient had right-sided pulmonary agenesis. In the case of left-sided pulmonary agenesis, the patient had incomplete agenesis and underwent repair through a left thoracotomy. We present the first successful repair of TEF/EA with complete left-sided pulmonary agenesis. This patient also underwent elective pre-operative veno-venous extracorporeal membrane oxygenation (ECMO) and subsequent repair of the TEF/EA. We discuss the management, anesthesia risks, and role of periprocedural ECMO in pediatric patients who are high anesthetic risk. [ABSTRACT FROM AUTHOR]

Published
2024
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24. Outcomes of Extracorporeal Life Support Utilization for Pediatric Patients With COVID-19 Infections

Author

Jacobson, Jillian C., primary, Ryan, Mark L., additional, Vogel, Adam M., additional, Mehl, Steven C., additional, Acker, Shannon N., additional, Prendergast, Connor, additional, Padilla, Benjamin E., additional, Lee, Justin, additional, Chao, Stephanie D., additional, Martin, Nolan R., additional, Russell, Katie W., additional, Larsen, Kezlyn, additional, Harting, Matthew T., additional, Linden, Allison F., additional, Ignacio, Romeo C., additional, Slater, Bethany J., additional, Juang, David, additional, Jensen, Aaron R., additional, Melhado, Caroline G., additional, Pelayo, Juan Carlos, additional, Zhong, Allen, additional, Spencer, Brianna L., additional, Gadepalli, Samir K., additional, Maamari, Mia, additional, Jimenez Valencia, Maria, additional, Qureshi, Faisal G., additional, and Pandya, Samir R., additional

Published
2023
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26. 213.5: Evaluating cardiac viability before transplantation: 24-hour normothermic ex vivo heart perfusion of the left atrium

Author

Spencer, Brianna, primary, Wilhelm, Spencer, additional, Urrea, Kristopher, additional, Sewera, Sebastian, additional, Chakrabortty, Vikramjit, additional, Ho, Jamie, additional, Sultana, Tahmina, additional, Mazur, Daniel, additional, Bartlett, Robert H, additional, Pena, Alvaro Rojas, additional, and Drake, Daniel D, additional

Published
2023
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29. A pumpless pediatric artificial lung maintains function for 72 hours without systemic anticoagulation using the nitric oxide surface anticoagulation system

Author

Spencer, Brianna L., primary, Johnson, Matthew D., additional, Wilhelm, Spencer K., additional, Lautner-Csorba, Orsolya D., additional, Matich, Hannah, additional, Lautner, Gergely, additional, Fallon, Brian P., additional, Dann, Tyler, additional, Gudex, Leah, additional, Langley, Mark, additional, Meyerhoff, Mark, additional, Potkay, Joseph, additional, Bartlett, Robert, additional, Rojas-Pena, Alvaro, additional, and Hirschl, Ronald B., additional

Published
2023
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34. Postoperative respiratory complications in SARS-CoV-2 positive pediatric patients across 20 United States hospitals: A Cohort Study

Author

Reiter, Audra J., primary, Ingram, Martha-Conley E., additional, Raval, Mehul V., additional, Garcia, Elisa, additional, Hill, Madelyn, additional, Aranda, Arturo, additional, Chandler, Nicole M, additional, Gonzalez, Raquel, additional, Born, Kristen, additional, Mack, Shale, additional, Lamoshi, Abdulraouf, additional, Lipskar, Aaron M., additional, Han, Xiao-Yue, additional, Fialkowski, Elizabeth, additional, Spencer, Brianna, additional, Kulaylat, Afif N., additional, Barde, Amrene, additional, Shah, Ami N., additional, Adoumie, Maeva, additional, Gross, Erica, additional, Mehl, Steven C., additional, Lopez, Monica E., additional, Polcz, Valerie, additional, Mustafa, Moiz M., additional, Gander, Jeffrey W., additional, Sullivan, Travis M., additional, Sulkowski, Jason P., additional, Ghani, Owais, additional, Huang, Eunice Y., additional, Rothstein, David, additional, Muenks, E. Peter, additional, St. Peter, Shawn D., additional, Fisher, Jason C., additional, Levy-Lambert, Dina, additional, Reichl, Allison, additional, Ignacio, Romeo C., additional, Slater, Bethany J., additional, Tsao, KuoJen, additional, and Berman, Loren, additional

Published
2022
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39. Management of pediatric appendicitis during the COVID-19 pandemic: A nationwide multicenter cohort study

Author

Hegde, Brittany, primary, Garcia, Elisa, additional, Hu, Andrew, additional, Raval, Mehul, additional, Takirambudde, Sanyu, additional, Wakeman, Derek, additional, Lewit, Ruth, additional, Gosain, Ankush, additional, Parrado, Raphael H., additional, Cina, Robert A., additional, Stephenson, Krista, additional, Dassinger, Melvin S, additional, Zhang, Daniel, additional, Mustafa, Moiz M., additional, Koo, Donna, additional, Lipskar, Aaron M., additional, Scheidler, Katherine, additional, Van Arendonk, Kyle J., additional, Berg, Patrick, additional, Gonzalez, Raquel, additional, Scheese, Daniel, additional, Haynes, Jeffrey, additional, Mina, Alexander, additional, Zamora, Irving J., additional, Lopez, Monica E., additional, Mehl, Steven C., additional, Gilliam, Elizabeth, additional, Lofberg, Katrina, additional, Spencer, Brianna, additional, Kulaylat, Afif N., additional, Gulack, Brian C, additional, Johnson, Matthew, additional, Laskovy, Matthew, additional, Brahmamdam, Pavan, additional, Shimomura, Aoi, additional, Blanch, Therese, additional, Tsao, KuoJen, additional, and Slater, Bethany J., additional

Published
2022
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41. CARD18: Successful Transplantation of Porcine Hearts after 24 hr of Cold Ischemia Following Resuscitation using Ex Vivo Normothermic Perfusion

Author

Johnson, Matthew D., primary, Fallon, Brian P., additional, Langley, Mark, additional, Spencer, Brianna L., additional, Kayden, Adrianna, additional, Shenton, Hannah, additional, Toomasian, John, additional, Haft, Jonathan, additional, Drake, Daniel H., additional, Rojas-Peña, Alvaro, additional, and Bartlett, Robert, additional

Published
2022
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43. Postoperative respiratory complications in SARS-CoV-2 positive pediatric patients across 20 United States hospitals: A Cohort Study.

Author

Reiter, Audra J, Reiter, Audra J, Ingram, Martha-Conley E, Raval, Mehul V, Garcia, Elisa, Hill, Madelyn, Aranda, Arturo, Chandler, Nicole M, Gonzalez, Raquel, Born, Kristen, Mack, Shale, Lamoshi, Abdulraouf, Lipskar, Aaron M, Han, Xiao-Yue, Fialkowski, Elizabeth, Spencer, Brianna, Kulaylat, Afif N, Barde, Amrene, Shah, Ami N, Adoumie, Maeva, Gross, Erica, Mehl, Steven C, Lopez, Monica E, Polcz, Valerie, Mustafa, Moiz M, Gander, Jeffrey W, Sullivan, Travis M, Sulkowski, Jason P, Ghani, Owais, Huang, Eunice Y, Rothstein, David, Muenks, E Peter, St Peter, Shawn D, Fisher, Jason C, Levy-Lambert, Dina, Reichl, Allison, Ignacio, Romeo C, Slater, Bethany J, Tsao, KuoJen, Berman, Loren, Reiter, Audra J, Reiter, Audra J, Ingram, Martha-Conley E, Raval, Mehul V, Garcia, Elisa, Hill, Madelyn, Aranda, Arturo, Chandler, Nicole M, Gonzalez, Raquel, Born, Kristen, Mack, Shale, Lamoshi, Abdulraouf, Lipskar, Aaron M, Han, Xiao-Yue, Fialkowski, Elizabeth, Spencer, Brianna, Kulaylat, Afif N, Barde, Amrene, Shah, Ami N, Adoumie, Maeva, Gross, Erica, Mehl, Steven C, Lopez, Monica E, Polcz, Valerie, Mustafa, Moiz M, Gander, Jeffrey W, Sullivan, Travis M, Sulkowski, Jason P, Ghani, Owais, Huang, Eunice Y, Rothstein, David, Muenks, E Peter, St Peter, Shawn D, Fisher, Jason C, Levy-Lambert, Dina, Reichl, Allison, Ignacio, Romeo C, Slater, Bethany J, Tsao, KuoJen, and Berman, Loren

Abstract

IntroductionData examining rates of postoperative complications among SARS-CoV-2 positive children are limited. The purpose of this study was to evaluate the impact of symptomatic and asymptomatic SARS-CoV-2 positive status on postoperative respiratory outcomes for children.MethodsThis retrospective cohort study included SARS-CoV-2 positive pediatric patients across 20 hospitals who underwent general anesthesia from March to October 2020. The primary outcome was frequency of postoperative respiratory complications, including: high-flow nasal cannula/non invasive ventilation, reintubation, pneumonia, Extracorporeal Membrane Oxygenation (ECMO), and 30-day respiratory-related readmissions or emergency department (ED) visits. Univariate analyses were used to evaluate associations between patient and procedure characteristics and stratified analyses by symptoms were performed examining incidence of complications.ResultsOf 266 SARS-CoV-2 positive patients, 163 (61.7%) were male, and the median age was 10 years (interquartile range 4-14). The majority of procedures were emergent or urgent (n = 214, 80.5%). The most common procedures were appendectomies (n = 78, 29.3%) and fracture repairs (n = 40,15.0%). 13 patients (4.9%) had preoperative symptoms including cough or dyspnea. 26 patients (9.8%) had postoperative respiratory complications, including 15 requiring high-flow oxygen, 8 with pneumonia, 4 requiring non invasive ventilation, 3 respiratory ED visits, and 2 respiratory readmissions. Respiratory complications were more common among symptomatic patients than asymptomatic patients (30.8% vs. 8.7%, p = 0.01). Higher ASA class and comorbidities were also associated with postoperative respiratory complications.ConclusionsPostoperative respiratory complications are less common in asymptomatic versus symptomatic SARS-COV-2 positive children. Relaxation of COVID-19-related restrictions for time-sensitive, non urgent procedures in selec

Published
2022

44. In VivoTesting of an Ambient Air Based, Portable, and Automated CO2Removal Controller for Artificial Lungs

Author

Spencer, Brianna L., Shaikh, Navid, Gudex, Leah, Dann, Tyler, Langley, Mark, Matich, Hannah, Bartlett, Robert H., Rojas-Peña, Alvaro, and Potkay, Joseph A.

Abstract

Portable artificial lung (AL) systems are under development, but there are few technologies available that adjust the carbon dioxide (CO2) removal in response to changes in patient metabolic needs. Our work describes the second generation of a CO2-based portable servoregulation system that automatically adjusts CO2removal in ALs. Four adult sheep (68 ± 14.3 kg) were used to test the servoregulator. The servoregulator controlled air sweep flow through the lung to meet a target exhaust gas CO2(tEGCO2) level in normocapnic and hypercapnic (arterial partial pressure of CO2[PaCO2] >60 mm Hg) conditions at varying flow rates (0.5–1.5 L/min) and at tEGCO2levels of 10, 20, and 40 mm Hg. In hypercapnic sheep, average post-AL blood partial pressure of CO2(pCO2) values were 22.4 ± 3.6 mm Hg for tEGCO2of 10 mm Hg, 28.0 ± 4.1 mm Hg for tEGCO2of 20 mm Hg and 40.6 ± 4.8 mm Hg for tEGCO2of 40 mm Hg. The controller successfully and automatically adjusted the sweep gas flow to rapidly (<10 minutes) meet the tEGCO2level when challenged with changes in inlet blood flow or target EGCO2levels for all animals. These in vivodata demonstrate an important step toward portable ALs that can automatically modulate CO2removal and allow for substantial changes in patient activity or disease status in ambulatory applications.

Published
2023
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46. Routine Repeat Imaging of Pediatric Blunt Solid Organ Injuries Is Not Necessary

Author

Fletcher, Kelsey L., Meagher, Mitchell, Spencer, Brianna L., Morgan, Madison E., Safford, Shawn D., Armen, Scott B., Hazelton, Joshua P., and Perea, Lindsey L.

Abstract

Introduction Nonoperative management of hemodynamically stable patients with blunt splenic and/or hepatic injury has been widely accepted in the pediatric population. However, variability exists in the utilization and timing of repeat imaging to assess for delayed complications during index hospitalization. Recent level-IV evidence suggests that repeat imaging in children should be performed based on a patient’s clinical status rather than on a routine basis. The aim of this study is to examine the rate of delayed complications and interventions in pediatric trauma patients with blunt splenic and/or hepatic injuries who undergo repeat imaging prompted either by a clinical change (CC) or non-clinical change (NCC).Methods A 9-year (2011-2019), retrospective, dual-institution study was performed of children (0-17 years) with blunt splenic and/or hepatic injuries. Patients were grouped based on reason for repeat imaging: CC or NCC. The rate of organ-specific delayed complications and interventions was examined by reason for scan.Results A total of 307 injuries were included in the study period (174 splenic, 113 hepatic, and 20 both). Of 194 splenic injuries, 30(15.5%) underwent repeat imaging (CC = 19; NCC = 11). Of 133 hepatic injuries, 27(20.3%) underwent repeat imaging (CC = 21; NCC = 6). There was no difference in the incidence of organ-specific delayed complications between the CC and NCC groups. Of the 4 patients with complications necessitating intervention, only one was identified based on NCC.Conclusions Our data suggest routine repeat imaging is unnecessary in children with blunt splenic and/or hepatic injuries; therefore, practitioners may rely on a patient’s clinical change.

Published
2023
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