Acute and Critical Care

Case Report

Cardiology/Pediatric
Extracorporeal Membrane Oxygenation Cannula Malposition in the Azygos Vein in a Neonate with Right-Sided Congenital Diaphragmatic Hernia: Seung Jun Choi, Chun-Soo Park, Won Kyoung Jhang, Seong Jong Park; Korean J Crit Care Med. 2016;31(2):152-155. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.152

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Malposition of the extracorporeal membrane oxygenation (ECMO) venous cannula in the azygos vein is not frequently reported. We hereby present such a case, which occurred in a neonate with right-sided congenital diaphragmatic hernia. Despite ECMO application, neither adequate flow nor sufficient oxygenation was achieved. On the cross-table lateral chest radiograph, the cannula tip was identified posterior to the heart silhouette, which implied malposition of the cannula in the azygos vein. After repositioning the cannula, the target flow and oxygenation were successfully achieved. When sufficient venous flow is not achieved, as in our case, clinicians should be alerted so they can identify the cannula tip location on lateral chest radiograph and confirm whether malposition in the azygos vein is the cause of the ineffective ECMO.

Citations

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Inadvertent cannulation of the azygos vein during eCPR
Shelina M. Jamal, Deborah S. Fruitman, Kevin M. Lichtenstein, Darren H. Freed, Natalie L. Yanchar
Journal of Pediatric Surgery Case Reports.2021; 71: 101941. CrossRef
Identification of Inadvertent Azygous Vein Cannulation Using Transthoracic Echocardiography During Venoarterial Extracorporeal Membrane Oxygenation Initiation
Bethany G. Runkel, Jason D. Fraser, John M. Daniel, Karina M. Carlson
CASE.2019; 3(2): 67. CrossRef
Successful Extracorporeal Membrane Oxygenation After Incidental Azygos Vein Cannulation in a Neonate With Right-Sided Congenital Diaphragmatic Hernia Interruption of the Inferior Vena Cava and Azygos Continuation
Alessandra Mayer, Genny Raffaeli, Federico Schena, Valeria Parente, Gabriele Sorrentino, Francesco Macchini, Anna Maria Colli, Lucia Mauri, Simona Neri, Irene Borzani, Ernesto Leva, Fabio Mosca, Giacomo Cavallaro
Frontiers in Pediatrics.2019;[Epub] CrossRef
The Future of Research on Extracorporeal Membrane Oxygenation (ECMO)
Ji Young Lee
Korean Journal of Critical Care Medicine.2016; 31(2): 73. CrossRef

Original Article

PRISM III in a Pediatric Intensive Care Unit with Multiple Disease Entities: Seung Jun Choi, Cheong Jun Moon, Yoon Hong Chun, Jong Seo Yoon, Hyun Hee Kim, Jin Tack Kim, Joon Sung Lee; Korean J Crit Care Med. 2011;26(3):123-127.; DOI: https://doi.org/10.4266/kjccm.2011.26.3.123

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Abstract PDF

BACKGROUND
We applied the pediatric risk of mortality (PRISM) III score to study patients in a pediatric intensivecare unit (PICU), where children with various kinds of diseases were hospitalized. We analyzed whether this scoring system was useful to predict patient mortality in the PICU.
METHODS
We retrospectively analyzed the medical records of patients hospitalized in a 5-bed PICU at a tertiary general hospital. Children who were transferred to other hospitals and remained under pediatric intensive care were excluded from this study.
RESULTS
We studied a total of 105 children, which included 63 boys (60%) and 42 girls (40%). The mean age was 4.2 years (range 0-17 years). The children were admitted to the PICU for various conditions, including respiratory disease (31 children), neurological disease (30 children), congenital anomaly or neonatal disease (11 children), hemato-oncological disease (10 children), accident or poisoning (7 children), cardiovascular disease (5 children), sepsis (2 children), and the other miscellaneous diseases (9 children). The mean period of PICU stay was 9 days (range 2-66 days). Out of the 105 patients, 94 survived and 11 died. Thus, the mortality rate was calculated as 10.5%. PRISM III scores of the patients were between 0 and 38, with a mean +/- SD of 5.0 +/- 6.7. In comparison with previous studies on PICU patients with similar PRISM scores, the patients included in our study exhibited a higher mortality. The area under the curve for the prediction of mortality by PRISM III was 0.107. Among the variables included in PRISM III, Glasgow coma scale, pupillary light reflex, and platelet counts were associated with patient mortality.
CONCLUSIONS
In a PICU with a wide spectrum of diseases, PRISM III was not a useful predictor of patient mortality.

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Pediatric Infection & Vaccine.2020; 27(1): 45. CrossRef
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Korean Journal of Critical Care Medicine.2013; 28(2): 93. CrossRef

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