No abstract

The vagal nerve is the tenth cranial nerve (CN) and is the only CN to extend through the neck into the thorax and abdomen. As a component of the autonomic nervous system, the vagal nerve innervates the visceral organs, including the lung. The majority of the bronchopulmonary sensory nerves are unmyelinated (C-fiber) afferents of the vagal nerve. The cell bodies of the visceral afferent fibers of the vagus nerve are located bilaterally in the inferior ganglion-also termed the nodose ganglia (NG). More recently, transient receptor potential vanilloid type 1 (TRPV1) channels have been identified and are expressed on the vagal C-fiber afferents, which play an important role in the cholinergic reflex pathway [1][2][3]. TRPV1 channels are nonselective cation channels and polymodal transducers that are known to be activated by increasing temperature, acidity (hydrogen ion), and endogenous inflammatory mediators [1][2][3].Although differences exist between swine and human anatomy, the patterns of the vagal nerve are largely similar and closer in size than standard rodent models [4]. Data are limited on identifying autonomic neurons and associated cell bodies, including the NG in swine [5,6]. The importance and study of pulmonary neurobiology in acute lung injury is gaining momentum and often requires the use of large animal models, including swine. With no previous reports of the identification and subsequent histopathologic confirmation of the NG and TRPV1 in swine, we provide our experiences in identifying the NG in common crossbred piglets used in an acute lung injury model investigating the

Placement of a bicaval dual-lumen (BCDL) catheter demands sophisticated visualization in patients to assure proper positioning in order to administer single-site venovenous extracorporeal membrane oxygenation (VV ECMO). Large animal models are needed and thus appropriate procedures to assure anatomic and functional cannula placement would assist in experimental design and procedures. This report describes the use of agitated blood and saline transthoracic contrast echocardiography to confirm appropriate placement and function of the BCDL catheter in a swine model of VV ECMO. Five consecutive common crossbred piglets had confirmation using this technique with assurances of cannulation while not significantly altering experimental time and procedures. Researchers studying VV ECMO in large animal models may want to consider this method of confirmation of BCDL catheter placement.

Outcomes for extracorporeal membrane oxygenation (ECMO) have been described for patients with single ventricle physiology (SVP) undergoing cavopulmonary connection (Glenn procedure). An alternative surgical pathway for patients with SVP consists of an initial hybrid procedure followed by a comprehensive Stage II procedure. No data exist describing the outcomes of patients requiring ECMO after the comprehensive Stage II procedure. The goal of this study is to describe the outcomes for patients who required ECMO after the comprehensive Stage II procedure. Data from the Extracorporeal Life Support Organization (ELSO) registry from 2001 to 2015 for children undergoing the comprehensive Stage II procedure older than 3 months of age were retrospectively analyzed. Demographics and ECMO characteristics were recorded. A total of six children required ECMO support after the comprehensive Stage II procedure (2 males, 4 females). Four patients had the diagnosis of hypoplastic left heart syndrome and two patients had the diagnosis of an unbalanced atrioventricular septal defect. Bypass time was 242.8 ± 110.9 min and cross-clamp time was 91.2 ± 46.2 min for the surgical procedure. Weight was 5.8 ± 1.3 kg and age was 150.2 + 37.9 days at time of ECMO. ECMO duration was 276.0 ± 218.1 h. Complications during the ECMO run included hemorrhage in four patients (67%), renal dysfunction in two patients (33%), and neurologic injury in two patients (33%). Four patients (67%) were discharged alive after ECMO decannulation. Despite being a much more extensive surgical procedure, the morbidity and mortality after ECMO in patients undergoing the comprehensive Stage II procedure are similar to those in patients undergoing the Glenn procedure. If needed, ECMO support is reasonable for patients after the comprehensive Stage II procedure.

Using anatomical landmarks for the placement of the BCDL catheter was rapid and effective in a swine model of VV ECMO, resulting in improved time efficiency for research.