A Multidisciplinary Approach to Expand the Use of Pediatric ECLS Systems in Turkey

Artificial Organs, 2015

To improve the outcomes of pediatric extracorporeal life support (ECLS) and cardiopulmonary bypass (CPB) procedures in Turkey, we have established a series of conferences, called "Istanbul Symposiums." Since the first symposium in June of 2011, we have organized seven additional symposiums in Istanbul (1-3). The objective of this editorial is to share the latest results on pediatric ECLS and CPB patients with the Artificial Organs community. The eighth Istanbul Symposium was held at the Medipol University on January 10, 2015. A multidisciplinary faculty including pediatric heart surgeons, pediatric intensivists, perfusionists, cardiologists, anesthesiologists, and scientists were invited to share their latest results (Fig. 1). The symposium was opened with welcoming remarks by Dr. Halil Turkoglu, the head of the cardiovascular surgery department at Medipol University, Istanbul, Turkey (Fig. 2). Dr. Akif Ündar presented his lecture about the basic principles of scientific research and the impact of the Istanbul Symposiums on pediatric ECLS and CPB patients in Turkey, along with future suggestions and recommendations (Fig. 3) (4-6). There were three specific panels at the eighth symposium: 1 Pediatric ECLS: 2015 update; 2 Latest developments on pediatric cardiac surgery and pediatric CPB procedures; 3 Role of perfusionists during ECLS and CPB along with hands-on wet-labs. FIRST PANEL ON PEDIATRIC ECLS: 2015 UPDATE The historical development as well as the current ECLS practice in Turkey was discussed by Dr. Atif Akcevin. ECLS experience at IMAEH Dr. Sertaç Haydin presented their results and experience related to the management of complications in extracorporeal membrane oxygenation (ECMO) implementation at Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital (IMAEH). Seventy patients underwent ECMO support between March 2011 and January 2015 in this particular hospital. They changed their ECLS system from Medos Deltastream DP2 (Medos Medizintechnik AG, Stolberg, Germany) to Medos Deltastream DP3 (Medos Medizintechnik AG) after November 2012, and DP3 was used in a consecutive series of 45 patients (4.6% of all children undergoing congenital heart surgery during the same period). Their ECLS circuit consisted of a Deltastream DP3 diagonal pump head, a Hilite (Medos Medizintechnik AG) polymethylpentene diffusion membrane oxygenator, and Rheoparin (Medos Medizintechnik AG) coated tubing for both arterial and venous lines (Fig. 4). The Deltastream DP3 System can provide both nonpulsatile and pulsatile flow for pediatric ECLS. ECLS with the DP3 was performed in 45 patients. The median age and weight of the patients were 60 days (range 2-2920 days) and 3.7 kg (range 2.6-20 kg), respectively. Hemorrhage was the most common complication in patients who had successful weaning, whereas renal failure was the most common complication in unsuccessful weaning. Median ECMO duration was 5.6 days (range 4-41). ECMO was successfully discontinued (children survived and were able to maintain adequate hemodynamics more than 24 h following ECLS termination) in 31 (68.8%) patients. Nineteen (42.2%) patients survived to hospital discharge. Twelve patients (26.6%) died after successful weaning. During the study period, 13 patients received extracorporeal cardiopulmonary resuscitation (ECPR) for refractory cardiac arrest unresponsive to conventional cardiopulmonary resuscitation measures.

Journal of pediatric critical care, 2017

Extra Corporeal Life Support (ECLS) is an advanced mode of life support, which is becoming increasingly available in many countries. Though the initial investment is expensive, it can be adopted to suit the local policies as well as keep the running costs low. There are various unexplored indications for ECMO support in critically ill patients from tropical countries. Further innovations are awaited to make the technology more affordable to majority of the population. The World forum, ELSO is committed to take everyone along in spreading the knowledge and improving the ECMO practice.

Artificial Organs, 2017

TURKISH JOURNAL OF MEDICAL SCIENCES, 2014

Background/aim: To collect data from throughout Turkey in order to facilitate the organization of pediatric intensive care units (PICUs), and to develop short-term immediate action plans and draft long-term strategic plans. Materials and methods: A total of 35 specialists including 17 pediatric critical care (PCC) specialists, 9 PCC fellows in training, and 9 pediatricians working in PICUs evaluated PICUs and their infrastructures, mortality rates, appropriateness of indications for PICU admissions, PICU bed numbers, and utilization of those PICU beds. Results: PICU bed numbers, PCC specialist numbers, and PICU nurse numbers are insufficient in Turkey. The high percentage of inappropriate and inefficient use of current PICU beds is also another problem. Conclusion: In the light of this report, it is obvious that pediatric intensive care services are successful and efficient only in the presence of PCC specialists in PICUs. Studies for improving the infrastructure of PICUs and the training of PCC specialists and other health personnel should be started immediately.

Türk Pediatri Arşivi

Developments in perinatal and neonatal care have increased the survival rate of high-risk newborns but led to a rise in chronic diseases seen in these infants. A significant number of them attend primary and secondary health care centers after discharge; however, there are very few standard protocols for the long-term follow-up of these babies. Therefore, we aimed to establish a follow-up guideline that emphasizes on universal screening schemes and takes into consideration national data. The guide presented here provides brief recommendations for physicians in light of evidence-based data for the follow-up of high-risk newborn infants. The steps taken to monitor and solve the problems of all high-risk infants may vary. We hope the use of such a standard approach in evaluating each infant in daily routine will improve the life quality of these highrisk infants.

2011

The most recent and rapid changes in pediatric extracorporeal life support systems (ECLS) and cardiopulmonary bypass (CPB) procedures are remarkable in terms of not only the development of significantly improved circuit components but also new techniques that reduce morbidity and mortality in pediatric cardiac patients, particularly neonates and infants (1-14). The objective of this editorial is to present the outcomes of the two most recent ECLS symposiums held at the Swiss Hotel and the

Resuscitation, 2000

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2016

mônio de crescimento recombinante (rhGH) em pacientes pediátricos em estado de hipercatabolismo internados em unidades de terapia intensiva pediátrica (UTIP). MÉTODO: Foram pesquisados os seguintes bancos de

Pediatric Critical Care Medicine, 2009

Objective-A systematic review of weaning and extubation for pediatric patients on mechanical ventilation.

Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs, 2013

We investigated early clinical outcomes of a new extracorporeal life support (ECLS) system (Endumo 2000, Heiwa Bussan, Tokyo, Japan), which consists of a ROTAFLOW centrifugal pump, a BIOCUBE oxygenator with plasma-leakage-tight polymer fibers, and a biocompatible coating (T-NCVC coating), in pediatric patients <1 year old. From 2008 to 2011, 31 patients required ECLS. Except for 1 patient who was instituted with a transitional ECLS device, a conventional ECLS system (pediatric Emersave, TERUMO, Saitama, Japan) was initiated in 14 patients before December 2009 (6 boys, 63.4 ± 87.1 days old, 3.1 ± 1.0 kg), and the Endumo 2000 was initiated in 16 patients after December 2009 (8 boys, 43.9 ± 78.5 days old, 3.2 ± 0.7 kg). Primary reasons for the institution of ECLS were intraoperative low output syndrome in 11 patients, post-cardiotomy cardiopulmonary collapse in 9 patients, and other reasons in 10 patients. The median support period was 21.7 ± 20.7 days and the total number of circui...