What's New in Pediatric Surgery—1989

Abstract

The recent developments in pediatric surgical research as well as new concepts and clinical applications in the specialty are emphasized in this report. There is no attempt to make this review all inclusive. Rather, it focuses on specific areas in which new data or techniques will influence future investigations or the management of patients. EXTRACORPOREAL MEMBRANE OXYGENATION No area has commanded more investigational effort than extracorporeal membrane oxygenation (ECMO). By oculopneumoplethysmography Foglia et al1 assessed the effects of right internal carotid artery ligation on cerebral perfusion in lambs during ECMO. Postnormoxic lambs had good right hemispheric perfusion after right internal carotid artery ligation, and posthypoxic animals showed marked initial depression of ipsilateral hemispheric perfusion which improved progressively and was comparable to the normoxic model at 20 hours. Foglia et al postulated a loss of autoregulation and/or intracranial edema, both of which were reversible. It is known that ECMO is associated with an early increase in inflammatory mediators. Simoni et al2 documented a second peak of complement activation and prostaglandin synthesis after 72 hours of high-flow ECMO. They reported increased levels of endotoxin, free radical activity, and tumor necrosis factor, all markers of systemic sepsis. Early weaning, meticulous technique, and periodic replacement of the ECMO circuit for the extended run are emphasized. Crombleholme and co-workers3 proposed using ECMO as a bridge to transplantation with reduced-size lung grafts. They demonstrated the technical feasibility of the procedure in immature swine recipients. The graft was ventilated preferentially and accepted the entire cardiac output. Ongoing studies by Stolar and Dillon4 demonstrated a biphasic prostanoid response in newborn lambs undergoing ECMO perfusion.