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Abstract

extremities. Pulmonary embolus (PE) is thought to arise from lower extremity DVT. Lower extremity DVT surveillance is commonly used in trauma patients considered at risk for DVT. Methods: A 23 year, comprehensive DVT surveillance literature review was performed to assess the effect of surveillance on DVT and PE rates, the efficacy of chemoprophylaxis (CP) and mechanical prophylaxis (MP), and the relationship between DVT and PE. Twenty-four publications with >13,000 patients were reviewed. Results: DVT rates are significantly higher when surveillance is used, 8.5% (n=12,423) than with no surveillance, 2.6% (n=823; p<0.001). PE rate without surveillance was 1.3% (n=823), similar to 1.1% (n=12,184) with surveillance (p=0.6093). There is no association between DVT and PE rates (p=0.7574). CP administration was associated with reduced DVT rate (4.4%, n=5,801) compared to no CP (11.7%, n=4,966; p<0.0001; RR=2.7). PE rate was lower with CP (0.8%, n=5,662) than no CP (1.5%, n=4,866; p=0.00004). MP also decreased DVT rate (7.9%, n=8,827) compared to no MP (13%, n=600; p<0.0001; RR=1.7). PE rate was similar, 1.5% (n=600) not on MP compared to 1.2% (n=8,748) with MP (p=0.4340). Of 600 who received no CP and no MP, DVT rate was 13% and PE rate was 1.5%. When CP and/or MP were given, DVT rate was 7.8% (n=9,128; p<0.0001) and PE rate was 1.2% (n=8,989; p=0.4317). Conclusions: DVT surveillance of the lower extremities appears effective in diagnosing DVT; however the risk of PE is not decreased. Our data suggest that PE rates are not associated with lower extremity DVT. The historical notion that lower extremity DVT is associated with PE development is in question. New paradigms need to be developed, e.g. considering DVT in the vena cava and pelvic veins and assessing for hyper-coagulation.Learning Objectives: Trisomy 13 (T13) and Trisomy 18 (T18) are fatal chromosomal disorders associated with multiple congenital anomalies with only 5-10% of children surviving past the first year. Extracorporeal membrane oxygenation (ECMO) is an invaluable means of cardiopulmonary support in the care of patients with reversible cardiac and or pulmonary disease refractory to other medical treatment. Determination of ECMO eligibility is based on center specific guidelines, ECMO team consensus and physician opinion. Historically, patients with T13 and T18 were not considered to be candidates for ECMO. However, in the recent era more of these infants are undergoing invasive procedures including cardiac surgery. There are no multicenter studies reporting outcomes of patients with T13 and T18 on ECMO. Methods: Pediatric patients ≤18 yr of age with T13 and T18 in the Extracorporeal Life Support Organization (ELSO) Registry were included. The primary outcome of interest was death before hospital discharge. Between group comparisons (non trisomy patients (nonT) and T13 and T18 patients) were performed using t-test, chi-square and fisher's exact test. Results: Twenty-three patients with T13 and T18 were included. ECMO use in T13 and T18 patients has incr...