Case Report: Congenital tuberculosis in a premature infant requiring extracorporeal membrane oxygenation.

Congenital tuberculosis is a rare infectious disease with less than 500 cases documented worldwide. Mortality is significant, ranging from 34 to 53%, and death without treatment is inevitable. Patients exhibit nonspecific symptoms such as fever, cough, respiratory distress, feeding intolerance, and irritability which can make appropriate diagnosis challenging in Peng et al. (2011) Pediatr Pulmonol 46(12), 1215-1224. Tuberculosis prevalence is particularly high in developing countries where access to resources can be limited in World Health Organization (2019) Global tuberculosis report 2019, Geneva. We present a 2.4-kg premature male infant with acute respiratory distress syndrome secondary to congenital tuberculosis caused by Mycobacterium bovis and tuberculosis-immune reconstitution inflammatory syndrome who was successfully supported with veno-arterial extracorporeal membrane oxygenation.

The Design and Implementation of a Convertible Extracorporeal Circuit for Lung Transplantation.

Intraoperative management for patients during orthotopic lung transplantation may be performed without mechanical circulatory support, with veno-arterial extracorporeal membrane oxygenation (VA-ECMO), or cardiopulmonary bypass (CPB). For certain patients, an intraoperative conversion from VA-ECMO to CPB may be indicated. If a VA-ECMO patient requires CPB conversion, the previous model at our institution used two separate machines and was overall inefficient. The primary aim of this project was to develop a CPB pack modification to create a circuit that easily converts from VA-ECMO to CPB if indicated. The secondary aim was to create new supportive protocols and a comprehensive education and training curriculum for our large perfusion department to enhance patient safety. The new circuit was carefully designed and evaluated to minimize changes to the current CPB circuit while allowing for the safest configuration of VA-ECMO. A new protocol was designed with multi-disciplinary collaboration. A comprehensive education and training curriculum, as well as an objective competency assessment tool, were created. The circuit was subjectively evaluated by perfusionists and outscored our previous model in the areas of ease of setup, use, and CPB conversion. It received positive feedback from cardiothoracic surgeons and anesthesiologists as well. Lastly, it provided a financial benefit to our institution.

Vacuum-Assisted Venous Drainage: A 2014 Safety Survey.

Despite the widespread use of vacuum-assisted venous drainage (VAVD) and case reports describing catastrophic incidents related to VAVD, there is a lack of data cataloging specific safety measures that individuals and institutions have incorporated into their VAVD practices for the prevention of these incidents. Therefore, the purpose of this study is to survey the perfusion community to gather data on VAVD practices, and to compare these current practices with literature recommendations and the American Society of ExtraCorporeal Technology (AmSECT) Standards and Guidelines. In September 2014, a survey was distributed via PerfList and PerfMail, and by direct e-mail to members of the New York State Society of Perfusionists, targeting certified clinical perfusionists in New York State. Survey topics pertaining to VAVD practice included 1) equipment, 2) pressure monitoring and alarms, 3) protocols, checklists, and documentation, and 4) VAVD-related incidents. Of ∼200 certified clinical perfusionists who live and/or work in New York State (NYS), 88 responded (42%). Most respondents (90.1%) report they use VAVD. Of these, 87.3% report that they monitor VAVD pressure, with 51.6% having audible and visual alarms for both positive and excessive negative pressures. At the institutional level, 61.2% of respondents reported that there is a protocol in place at for their team limiting negative pressure in the reservoir, 28.4% document VAVD pressure in the pump record, and AmSECT's three recommended VAVD checklist items are met with 53.7%, 55.1%, and 33.8% compliance. In conclusion, the results of this study reveal that the use of VAVD has increased and has become nearly universal in 2014. There is high compliance to some of the literature recommendations and AmSECT Standards and Guidelines, however, there are still some gaps between current practices and these recommendations. Continued improvement, both at the individual and institutional levels, will help to improve patient safety by preventing untoward events from occurring while using VAVD.