The incidences of bleeding and thrombosis are high during ECMO support. Laboratory sampling is a major contributor to transfusion during ECMO. Strategies to reduce the daily risk of bleeding and thrombosis, and different thresholds for transfusion, may be appropriate subjects of future trials to improve outcomes of children requiring this supportive therapy.

Objective Changes in technology and increased reports of successful extracorporeal life support (ECLS) use in patient populations such as influenza, cardiac arrest and adults are leading to expansion of ECLS. Major limitations to ECLS expansion remain bleeding and thrombosis. These complications are the most frequent causes of death and morbidity. As a pilot project to provide baseline data for a detailed evaluation of bleeding and thrombosis in the current era, ECLS patients were analyzed from eight centers in the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Collaborative Pediatric Critical Care Research Network (CPCCRN). Study design Retrospective analysis of patients (<19 years) reported to the ELSO (Extracorporeal Life Support Organization registry from eight CPCCRN centers between 2005 and 2011. Subjects The study cohort consisted of 2036 patients [13% with congenital diaphragmatic hernia (CDH)]. Interventions none Main results In the cohort of non-CDH patients (n=1773), bleeding occurred in 38% of patients while thrombosis was noted in 31%. Bleeding and thrombosis were associated with a decreased survival by 40% (RR: 0.59; 95%CI: 0.53, 0.66) and 33% (OR 0.67; 95%CI: 0.60, 0.74). Longer duration of ECLS and use of venoarterial cannulation were also associated with increased risk of bleeding and/or thrombotic complications and lower survival. The most common bleeding events included surgical site bleeding (17%; n=306), cannulation site bleeding (14%; n=256), and intracranial hemorrhage (11%; n=192). Common thrombotic events were clots in the circuit (15%; n=274) and the oxygenator (12%; n=212), and hemolysis (plasma free hemoglobin>50 mg/dL) (10%; n=177). Among patients with CDH, bleeding and thrombosis occurred in, respectively, 45% (n=118) and 60% (n=159), Bleeding events were associated with reduced survival (RR 0.62; 95%CI: 0.46, 0.86) although thrombotic events were not (RR 0.92; 95%CI: 0.67, 1.26). Conclusions Bleeding and thrombosis remain common complications in patients undergoing ECLS. Further research to reduce or eliminate bleeding and thrombosis is indicated to help improve patient outcome.

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Eighty-three episodes of osteoradionecrosis are reported. Of those episodes affecting the mandible (78), 23 (29.5%) required radical resection. The most common precipitating factors were postradiation extractions (22/83), periodontal disease (19/83), and preradiation extractions (17/83). Those episodes initially located within the zone of attached mucosa fared well with conservative measures while those initially located beyond the zone of attached mucosa fared poorly. In bone necroses where the external radiation dose to the affected bone exceeded 7,000 rad, the mandibular resection rate was high (44%). The most effective way of resolving advanced bone necroses was achieved with a course of hyperbaric oxygen therapy combined with a surgical sequestrectomy.

Microbial content was characterized and levels of three amines (histamine, cadaverine, and putrescine) were determined in Spanish mackerel (Scomberomorus macuZutus) decomposed at PC, WC, and 30°C for varying lengths of time. Correlations were shown (1) between the levels of the histamine, cadaverine, and putrescine and the time and temperature of decomposition, (2) between the ratios of cadaverine/histamine and putrescine/histamine levels and the temperature of decomposition, and (3) behveen increasing total microbial counts and rising amine levels. A total of 14 bacterial species with histidine decarboxylase activity were isolated from decomposing fish, including three species (Acinetobacter lwofi, Pseudomonas putrefaciens, and Aeromonas hydrophila)not previously reported to have the potential to produce histamine.