Extracorporeal cardiopulmonary resuscitation can improve neurologic outcome after out-of-hospital cardiac arrest of cardiac origin; furthermore, pupil diameter on hospital arrival may be a key predictor to identify extracorporeal cardiopulmonary resuscitation candidates.

The findings show that children with SBDT display a characteristic facial appearance at an early age. Since the condition has an effect on growth, it needs to be prevented by controlling morphology and function at the preschool age.

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Abstract. Objectives: Advances in the field of cardiopulmonary resuscitation have led to an increasing number of patients initially surviving sudden cardiac arrest. Unfortunately, most of these patients do not recover from the resultant anoxic brain insult. Several animal and human trials have suggested that post-resuscitative brain hypothermia may improve neurologic recovery after cardiopulmonary arrest. Present cooling methods are slow, induce only brain surface cooling, or result in systemic hypothermia. The authors tested the hypothesis that unilateral hypothermic carotid bypass would induce bilateral brain cooling without evoking systemic hypothermia or hemodynamic instability. Methods: Anesthetized, ventilated common swine (n = 6, 24-37 kg) underwent right femoral and carotid artery bypass cannulation. Central and peripheral hemodynamic parameters were recorded every 2 minutes throughout the procedure. Thermodynamic parameters included bilateral frontal lobe, bilateral nasopharyngeal, pulmonary artery, and rectal temperatures. Hypothermic femoral-carotid bypass was accomplished by drawing blood from the right femoral artery, cooling it to 24ЊC, and returning it to the right carotid artery at a flow rate of 5 mL/kg/min for 30 minutes. Results: With initiation of cooling, brain temperatures dropped rapidly from baseline of 37.2ЊC to 30.6ЊC (right frontal lobe) and 33.1ЊC (left frontal lobe) at 30 minutes. Pulmonary artery and rectal temperatures also decreased, but never reached mild hypothermic levels (34ЊC). There was no significant change in any hemodynamic parameters during brain cooling. Conclusions: Femoral-carotid hypothermic bypass rapidly induced a state of selective brain hypothermia without causing systemic hypothermia or hemodynamic instability. Key words: hypothermia; brain; resuscitation; bypass; cerebral ischemia. ACADEMIC EMERGENCY MEDICINE 2001; 8:303-308 I NCREASING numbers of patients experiencing out-of-hospital cardiac arrest are surviving to hospital admission as a result of improvements in resuscitation techniques.1-3 Unfortunately, most of these patients fail to recover to their previous functional status. [4][5][6] Present therapy during the post-resuscitative period remains largely suppor- tive and directed at preventing further anoxic insult and cardiovascular instability.Recent evidence from both laboratory and human trials suggests that post-resuscitative brain hypothermia may improve functional outcome of survivors from out-of-hospital cardiac arrest. [7][8][9][10][11]

Rönning O. Craniofacial morphology in preschool children with sleep-related breathing disorder and hypertrophy of tonsils. Acta Paediatr 2002; 91: 71-77. Stockholm. ISSN 0803-5253The purpose of this study was to examine craniofacial morphology, pharyngeal airway space and hyoid bone position in preschool children with sleep-related breathing disorder associated with hypertrophy of tonsils (SBDT). Thirty-eight preschool children, mean age 4.7 y, with SBDT and with an apnoea index (AI) of 0 < AI <5, were divided into two groups. One consisted of 15 children with sleep-related breathing disorder (SBD) and more than 75% of the tonsils visible (GIII) and the other of 23 children with SBD and 25-75% of the tonsils visible (GII). The control group consisted of 31 children without ear, nose and throat disease and with GI (barely visible) tonsils. Compared with the controls, GIII children had a retrognathic mandible, a large posterior facial height, a large interincisal angle with retroclined lower incisors, a narrow pharyngeal airway space, an anterior tongue base position and a long soft palate. Compared with the controls, GII children had a large anterior lower facial height and a short nasal oor. However, like the controls, GII children did not have a retrognathic mandible. Conclusion:The ndings show that children with SBDT display a characteristic facial appearance at an early age. Since the condition has an effect on growth, it needs to be prevented by controlling morphology and function at the preschool age.