Outcomes in patients requiring repeat extracorporeal membrane oxygenation.

BACKGROUND: As the number of patients requiring extracorporeal membrane oxygenation (ECMO) increases nationwide, many patients may require ECMO more than once. We review our experience and outcomes in patients requiring repeat ECMO support. METHODS: The Nebraska ECMO Research Database was utilized for data analysis, and repeat ECMO patients (REPs) were compared to the overall ECMO population. RESULTS: Of 246 patients, 2.4% (6/246) were REPs. There was no statistical difference between the median days of initial support run (P = 0.670) and second support run (P = 0.813) for REPs when comparing to the non-REP population. Median hospital length of stay for REPs was 53 days (16-124) compared to the non-REPs, who had a median hospital length of stay of 22 days (1-270); P = 0.043. In-hospital mortality rate for REPs was 50% (3/6) and 50% for non-REPs (120/240). Survival 30 days postdischarge for REPs was 50% (3/6) compared to non-REPs at 48.3% (116/240); P = NS. CONCLUSIONS: Outcomes for repeat ECMO patients compare favorably to the overall ECMO population and suggest a need to explore and broaden the clinical indications for repeat ECMO.

Combined Hookwire and Methylene Blue Localization of Pulmonary Nodules: Analysis of 74 Patients.

OBJECTIVE: Because of decreased tactile sensation with thoracoscopic approaches to biopsy, localization preoperatively and intraoperatively is important for successful biopsy. Our study evaluated the technique of combined computed tomography-guided hookwire and methylene blue localization. METHODS: Seventy-five patients from November 2007 to August 2013 who underwent combined Hawkins hookwire and methylene blue localization of 76 total pulmonary nodules before video-assisted thoracic surgery-guided wedge resection were retrospectively reviewed. Multiple patient, nodule, and procedural characteristics were analyzed for correlation with successful wire localization and wire dislodgement. Successful wire localization was defined as absence of lesions requiring re-resection, wire dislodgement necessitating re-resection, or conversion to thoracotomy for localization. RESULTS: Seventy-four patients were included in the study (75 pulmonary nodules - 1 patient had 2 lesions localized) and mean ± SD patient age was 65.8 ± 12.1 years and 50% were male. The mean ± SD largest nodule diameter was 14.6 ± 7.4 mm and 29.3% of these were subcentimeter pulmonary nodules. Increased age and history of malignancy were associated with malignant diagnoses (P = 0.037 and 0.009, respectively) Successful wire localization was present in 86.4% of patients. Lesions with lower mean distance to the pleura correlated with successful localization (P = 0.002). Wire dislodgement was present in 9.3% (7 patients) with 4 (5.3%) of these necessitating need for re-resection to establish pathologic diagnosis. Albeit wire dislodgement, 57.4% (4/7) still had successful thoracoscopic localization. CONCLUSIONS: This study demonstrates that utilization of Hawkins hookwire in combination with methylene blue injection is an effective method to successfully localize pulmonary nodules for thoracoscopic wedge resection and should prompt further investigation for its utilization.

Intradiaphragmatic Bronchogenic Cysts: Case Report and Systematic Review.

Bronchogenic cysts (BC) are congenital abnormalities that occur most commonly within the mediastinum, and rarely occur within the diaphragm. We present the 21st case of an intradiaphragmatic bronchogenic cyst in the English literature, and review all previous published cases. Analysis includes presenting clinical symptoms, relevant radiologic studies, surgical approaches to resection, and management of the diaphragm, among other relevant data. These lesions should remain on the differential diagnosis in cases of unusual masses in the region of the diaphragm.