• Journal of Chest Surgery
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• v.54 no.6
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• pp.558-558
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• 2021

• Journal of Chest Surgery
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• v.51 no.5
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• pp.328-332
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• 2018

Background: Extracorporeal life support (ECLS) can be applied in brain-dead donors for organ perfusion before donation, thereby expanding the donor pool. The aim of this study was to examine the benefits and early clinical outcomes of ECLS for organ preservation. Methods: Between June 2012 and April 2017, 9 patients received ECLS with therapeutic intent or for organ preservation. The following data were collected: demographics, purpose and duration of ECLS, cause of death, dose of vasoactive drugs, and need for temporary dialysis before organ retrieval. The early clinical outcomes of recipients were studied, as well as survival and graft function at 1 month. Results: ECLS was initiated for extracorporeal cardiopulmonary resuscitation in 5 patients. The other patients needed ECLS due to hemodynamic deterioration during the assessment of brain death. We successfully retrieved 18 kidneys, 7 livers, and 1 heart from 9 donors. All organs were transplanted and none were discarded. Only 1 case of delayed kidney graft function was noted, and all 26 recipients were discharged without any significant complications. Conclusion: The benefits of protecting the vital organs of donors is significant, and ECLS for organ preservation can be widely used in the transplantation field.

• Journal of Chest Surgery
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• v.48 no.5
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• pp.318-327
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• 2015

Background: With improvements in cardiopulmonary resuscitation (CPR) techniques, the quality and the effectiveness of CPR have been established; nevertheless, the survival rate after cardiac arrest still remains poor. Recently, many reports have shown good outcomes in cases where extracorporeal membrane oxygenation (ECMO) was used during prolonged CPR. Accordingly, we attempted to evaluate the impact of extracorporeal cardiopulmonary resuscitation (ECPR) on the survival of patients who experienced a prolonged cardiac arrest and compared it with that of conventional CPR (CCPR). Methods: Between March 2009 and April 2014, CPR, including both in-hospital and out-of-hospital CPR, was carried out in 955 patients. The ECPR group, counted from the start of the ECPR program in March 2010, included 81 patients in total, and the CCPR group consisted of 874 patients. All data were retrospectively collected from the patients' medical records. Results: The return of spontaneous circulation (ROSC) rate was 2.24 times better in CPR of in-hospital cardiac arrest (IHCA) patients than in CPR of out-of-hospital CA (OHCA) patients (p=0.0012). For every 1-minute increase in the CPR duration, the ROSC rate decreased by 1% (p=0.0228). Further, for every 10-year decrease in the age, the rate of survival discharge increased by 31%. The CPR of IHCA patients showed a 2.49 times higher survival discharge rate than the CPR of OHCA patients (p=0.03). For every 1-minute increase in the CPR duration, the rate of survival discharge was decreased by 4%. ECPR showed superiority in terms of the survival discharge in the univariate analysis, although with no statistical significance in the multivariate analysis. Conclusion: The survival discharge rate of the ECPR group was comparable to that of the CCPR group. As the CPR duration increased, the survival discharge and the ROSC rate decreased. Therefore, a continuous effort to reduce the time for the decision of ECMO initiation and ECMO team activation is necessary, particularly during the CPR of relatively young patients and IHCA patients.

• Journal of Chest Surgery
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• v.40 no.12
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• pp.874-877
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• 2007

Airway management is difficult problem in severe tracheal stenosis. A total airway obstruction during the procedure resulted in a fatal outcome. We suggest a tracheostomy assisted with an emergency bypass system as a possible method for avoiding this complication.

• Journal of Chest Surgery
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• v.32 no.7
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• pp.675-680
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• 1999

We describe here two cases of anterior tracheoplasty utilizing an autologous pericardial patch. One patient was a 9 year-old female who had a congenital long tracheal stenosis associated with major vascular anomalies including pulmonary artery sling. One-stage correction was done under the support of an extracorporeal membrane oxygenation system. She required a prolonged ventilation support for 10 days postoperatively until the implanted pericardium was fixed to the mediastinal structures. The other patient was a 8 year-old male who had acquired tracheal stenosis following a complicated tracheostomy. By applying additional support over the pericardial patch with the costal cartilage, an endotracheal tube could be removed immediately after the operation. Both patients have been doing well in a postoperative follow-up of over a year, and there have been evidences of growth in the reconstructed trachea.

• Clinical and Experimental Pediatrics
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• v.57 no.11
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• pp.489-495
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• 2014

Purpose: The aims of this study were to document our single-center experience with pediatric acute fulminant myocarditis (AFM) and to investigate its clinical features and short-term outcomes. Methods: We performed a retrospective chart review of all children <18 years old who were diagnosed with AFM between October 2008 and February 2013. Data about patient demographics, initial symptoms, investigation results, management, and outcomes between survivors and nonsurvivors were collected. Results: Seventeen of 21 patients (80.9%) with myocarditis were diagnosed with AFM. Eleven patients (64.7%) survived to discharge, and 6 (35.3%) died. Electrocardiography on admission revealed dysrhythmia in 10 patients (58.8%); of these, all 7 patients with a complete atrioventricular block survived. Fractional shortening upon admission was significantly different between the survivors (16%) and nonsurvivors (8.5%) (P=0.01). Of the serial biochemical markers, only the initial brain natriuretic peptide (P=0.03) and peak blood urea nitrogen levels (P=0.02) were significantly different. Of 17 patients, 4 (23.5%) required medical treatment only. Extracorporeal membrane oxygenation (ECMO) was performed in 13 patients (76.5%); the survival rate in these patients was 53.8%. ECMO support was initiated >24 hours after admission in 4 of the 13 patients (30.7%), and 3 of those 4 patients (75%) died. Conclusion: AFM outcomes may be associated with complete atrioventricular block upon hospital admission, left ventricular fractional shortening at admission, time from admission to the initiation of ECMO support, initial brain natriuretic peptide level, and peak blood urea nitrogen level.

• Pediatric Infection and Vaccine
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• v.25 no.2
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• pp.101-106
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• 2018

A 6-year-old boy with underlying hemolytic anemia of unknown etiology, atopic dermatitis, and recurrent urticaria visited our hospital because of acute respiratory failure induced by influenza A. Despite mechanical ventilation after endotracheal intubation along with inhalation of nitric oxide, respiratory acidosis and hypoxemia persisted. Veno-venous extracorporeal membrane oxygenation (VV ECMO) insertion was performed to provide respiratory support. After performing flexible bronchoscopy, we found that thick mucus plugs were obstructing the right bronchus intermedius and the upper lobe orifice. After bronchial washing and removal of the plugs, we were able to wean the patient off VV ECMO and transfer him to the general ward. He was discharged without any neurologic or pulmonary sequelae.

• Tuberculosis and Respiratory Diseases
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• v.69 no.2
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• pp.75-80
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• 2010

The year of 2009~2010 brought a number of concepts and new ideas were evaluated with promising results. However, some studies that challenged many beliefs. In acute respiratory distress syndrome (ARDS), recent clinical studies took into consideration of pathophysiologic changes of respiratory system compliance. Meta-analysis of positive end-expiratory pressure trials showed survival benefit of high positive end-expiratory pressure in ARDS. Until now, prone positioning did not show survival benefit in patients with ARDS. Extracorporeal membrane oxygenation (ECMO) based management improved survival in patients with severe ARDS. ECMO can be a management option in severe ARDS. Sedation is a standard practice in critically ill patients needing mechanical ventilation. However, Danish group reported less sedation of critically ill patients receiving mechanical ventilation was associated with an increase in days without ventilation. Although this single center study has some limitations, the overall results are promising. Use of maximal sterile barrier precautions (mask, sterile gown, sterile gloves, and large sterile drapes) with chlorhexidine-impregnated dressing reduced central venous catheter related infection. Selective oropharyngeal decontamination (application of topical antibiotics in the oropharynx) reduced the mortality rate of an intensive care unit (ICU) population. Normoglycemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation (NICE-SUGAR) trial reported intensive glucose control increased mortality among adults in the ICU. Some of the results of above papers are promising. However, some ideas may need for more frequent individual assessment and increase the workload of ICU staffs. Before implementation of new practice in ICU, we should take into consideration of individual hospital situation including human and material resources.

• Pediatric Infection and Vaccine
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• v.26 no.1
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• pp.71-79
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• 2019

Mycoplasma pneumoniae (MP) is the most common causative agent of community-acquired pneumonia in school-aged children. An 8-year-old boy who had been diagnosed with autism looked severely ill when he presented to our hospital due to dyspnea and lethargy. He had fever and cough 7 days prior to hospitalization. He had signs and symptoms of severe respiratory distress. The percutaneous oxygen saturation was 88% at high oxygen supply. Chest radiography showed diffusely increased opacity with moderate pleural effusion. He was intubated immediately and admitted to the intensive care unit. Under the clinical impression of mycoplasmal pneumonia, intravenous clarithromycin was started. Laboratory findings showed leukocytosis, hepatitis, decreased renal function, and presence of serum MP immunoglobulin (Ig) M (+) IgG (+) and sputum MP polymerase chain reaction (+). On hospital day 2, the patient developed multiple organ failure with acute respiratory distress syndrome (ARDS). Veno-venous extracorporeal membrane oxygenation (ECMO) was performed with continuous renal replacement therapy (CRRT) and was weaned successfully. This is the first reported case of an ARDS due to MP infection complicated by multiple organ failure that was successfully treated with ECMO and CRRT in South Korea.

• Journal of Chest Surgery
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• v.27 no.12
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• pp.977-983
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• 1994

From April 1989 to December 1993, total 39 patients who were unable to be weaned off CPB or expected fatal immediate postoperiatively, were treated with ventricular assist device [VAD] or extracorporeal membrane oxygenator[ECMO] at the Royal Children`s Hospital, Melbourne. Ages ranged from 3 day to 19.4 year old and body weights from 2.0Kg to 70Kg. Twenty-seven[69.2%] of 39 patients were weaned to be decannulated successfully and sixteen[41.0%] survived to hospital discharge and late survival rate was twelve[30.8%] of 39 patients. The total follow-up period was 4 to 56 months [32.92$\pm$20.77months] and most of the late survivals showed good myocardial recovery state. From the viewpoint of the assist modality, 29 patients were treated with VAD and among them, 23 were weaned from assist successfully, but among the 8 ECMO patients, only 3 could be weaned, and both modalities were performed to the 2 patients with one weaned. The total duration of assist was from 8 to 428 hours and there was a significant difference between hospital discharged group and hospital death group, which were 83.13$\pm$31.29 hours vs 147.52$\pm$112.03 hours[P=0.032]. Conclusively, at the critical postcardiotomy situation of the paediatrtic patients including various congenital complex disease and procedures, we can choose this VAD or ECMO treatment strategy as the reasonable life saving way except transplantation.