Pediatric extracorporeal life support for refractory status asthmaticus: ELSO Registry trends from the past decade.

BACKGROUND: Extracorporeal life support (ECLS) for status asthmaticus (SA) is rare. Increased safety and experience may increase utilization of ECLS for SA. METHODS: We reviewed pediatric (<18 years old) patients requiring ECLS for SA between 1998 and 2019 within the Extracorporeal Life Support Organization (ELSO) Registry and Nemours Children's Health (NCH) system. We compared patient characteristics, pre-ECLS medications, clinical data, complications, and survival to discharge between Early (1988-2008) and Late (2009-2019) eras. RESULTS: From the ELSO Registry, we identified 173 children, 53 in Early and 120 in Late eras, with primary diagnosis of SA. Pre-ECLS hypercarbic respiratory failure was similar between eras (median pH 7.0 and pCO2 111 mm Hg). Venovenous mode (79% vs. 82%), median ECLS time (116 vs. 99 h), time to extubation (53 vs. 62 h), and hospital survival (89% vs. 88%) also remained similar. Intubation to cannulation time significantly decreased (20 vs. 10 h, p = 0.01). ECLS without complication occurred more in the Late era (19% vs. 39%, p < 0.01), with decreased hemorrhagic (24% vs. 12%, p = 0.05) and noncannula-related mechanical (19% vs. 6%, p = 0.008) complications. Within NCH, we identified six Late era patients. Pre-ECLS medication favored intravenous beta agonists, bronchodilators, magnesium sulfate, and steroids. One patient died from neurological complications following pre-ECLS cardiac arrest. CONCLUSIONS: Collective experience supports ECLS as a rescue therapy for pediatric SA. Survival to discharge remains good, and complication rates have improved. Pre-ECLS cardiac arrest may potentiate neurologic injury and impact survival. Further study is needed to evaluate causal relationships between complications and outcomes.

Creation of a Virtual Reality Telesimulation Program in Response to Mandatory COVID-19 Social Distancing During the Pandemic: A Primer for Those considering VR Simulation and Application to a Group of Physicians Naive to Virtual Reality.

The COVID-19 pandemic necessitated the closure of traditional simulation centers, prompting innovative solutions for medical education. Drawing from prior studies, which advocated for telesimulation and virtual reality (VR) as alternatives, this article explores the development and implementation of VR simulation in medical training. Leveraging the Acadicus® VR platform, a VR simulation solution was created, enabling interactive scenarios simulating pediatric critical care situations. Thirty-one diverse scenarios were designed and executed over an 8-month period, involving pediatric and emergency medicine residents and fellows. The development process involved creating lifelike mannequins and dynamic cardiac waveforms, enhancing realism and spontaneity. Using VR headsets and streaming technology, participants engaged in immersive scenarios remotely. Performance evaluation used a modified version of the Tool for Resuscitation Assessment Using Computer Simulation, revealing comparable outcomes across different training levels and specialties. Participant feedback underscored the immersive nature of VR simulation, offering enhanced realism and in-depth debriefing opportunities compared with traditional mannequin-based simulation. However, limitations such as the lack of haptic feedback and the need for better integration with existing simulation center infrastructure were noted. Cost-effectiveness emerged as a significant advantage of VR simulation, with lower upfront costs compared with traditional simulation centers. VR simulation also demonstrated versatility in staging training across various hospital settings, offering a more comprehensive learning experience. Although acknowledging the need for further research to measure skill acquisition and retention, this study highlights the potential of VR simulation as an adjunctive modality in medical education.

Treatment of pain with intranasal fentanyl in pediatric patients in an acute care setting: a systematic review.

AIM: The primary objective of this review is to provide an updated, comprehensive overview on the efficacy of intranasal fentanyl (INF) for acute pain relief in the pediatric population. METHODS: Utilizing the Preferred Reporting Instructions for Systematic Reviews and Meta-Analyses (PRISMA), we were able to screen articles based on key words to reach a final number of 10 studies. RESULTS: All but one study showed that INF was efficacious for pain relief in this select pediatric population. CONCLUSION: It is evident that INF is efficacious for analgesia, but other agents should also be considered in this patient population. As a result, further research is needed to investigate the clinically efficacy of INF in an acute care setting for pediatric patients.