ciency during cardiopulmonary resuscitation associated with chest compression interruptions. The framework we created allows for the determination of significant avoidable interruption time. By further elucidating the nature of interruptions, we can design and implement targeted interventions to improve patient outcomes.OBJECTIVES Shunt thrombosis, a potential complication of aortopulmonary shunting, is associated with high mortality. Commonly used oral antiplatelet drugs such as aspirin demonstrate variable absorption and inconsistent antiplatelet effect in critically ill patients early after surgery. IV glycoprotein IIb/IIIa inhibitors are antiplatelet agents with rapid and reproducible effect that may be beneficial as a bridge to oral therapy. DESIGN Retrospective review of pediatric patients undergoing treatment with IV tirofiban. Discarded blood samples were used to determine pharmacokinetic parameters. SETTING Pediatric cardiac ICU at a single institution. PATIENTS Fifty-two pediatric patients ( less then 18 yr) undergoing surgical aortopulmonary shunt procedure who received tirofiban infusion as a bridge to oral aspirin. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Primary outcome measures were shunt thrombosis and bleeding events, whereas secondary outcomes included measurement of platelet inhibition by thromboerations should include both age and renal function. Randomized trials are warranted to establish efficacy compared with current anticoagulation practices.OBJECTIVES Extracorporeal membrane oxygenation is used to support refractory cardiorespiratory failure. Outcomes and complications when extracorporeal membrane oxygenation is used to support cardiorespiratory failure secondary to arrhythmia in pediatric patients remain poorly defined. Our purpose is to describe pediatric patients requiring extracorporeal membrane oxygenation support for supraventricular arrhythmias in the context of normal cardiac anatomy and congenital heart disease and identify patient/peri-extracorporeal membrane oxygenation variables associated with extracorporeal membrane oxygenation-related complications and survival. DESIGN Retrospective multicenter review from 1993 to 2016. SETTING Extracorporeal Life Support Organization registry. SUBJECTS Patients younger than 21 years old requiring extracorporeal membrane oxygenation support for supraventricular arrhythmias. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 342 patients were identified (weight, 3.8 kg [3.2-7.5 kg]; age athmias was associated with a 65% survival to hospital discharge. However, there was a high rate of complications, the presence of which was associated with decreased survival. Complications appeared to be related to pre-extracorporeal membrane oxygenation clinical status and whether earlier extracorporeal membrane oxygenation cannulation prior to patient deterioration would improve outcomes needs additional evaluation.OBJECTIVES To determine if a saline-filled cuff seen at the suprasternal notch on ultrasound corresponds to correct endotracheal tube depth on a chest radiograph (tip at/below clavicle AND ≥ 1 cm above carina). DESIGN Prospective observational study. SETTING Tertiary Care Pediatric hospital. PATIENTS Patients between the ages of 0-18 years requiring nonemergent cardiac catheterizations and endotracheal intubation with a cuffed endotracheal tube were included in the study. Children with anticipated or known difficult airways were excluded. INTERVENTIONS Ultrasound evaluation of the neck following saline inflation of the endotracheal tube cuff. MEASUREMENTS AND MAIN RESULTS Ultrasonography of the patient's neck was performed following intubation by a pediatric anesthesiologist.  https://www.selleckchem.com/products/hydroxychloroquine-sulfate.html  A linear probe was used in transverse axis to identify the saline-filled cuff starting at the suprasternal notch and moving cephalad. A cine-fluoroscopic image, similar to a chest radiograph, was obtained to ascertain the endotracheal tuthe endotracheal tube following endotracheal intubation.OBJECTIVES Fluid overload is common in the PICU and has been associated with increased morbidity and mortality. It remains unclear whether fluid overload is a surrogate marker for severity of illness and need for increased support, an iatrogenic modifiable risk factor, or a sign of oliguria. The proportions of various fluid intake contributing to fluid overload and its recognition have not been adequately examined. We aimed to 1) describe the types and amounts of fluid exposure in the PICU and 2) identify the clinicians' recognition of fluid overload. SETTING Noncardiac PICU in a quaternary care hospital. PATIENTS Pediatric patients admitted for more than 24 hours. DESIGN Prospective observational study over 28 days. INTERVENTIONS Data were collected on the amount and type of fluid exposure-resuscitative boluses, blood products, enteral intake, parenteral nutrition (total parenteral nutrition), or modifiable fluids (IV fluids and medications) indexed to the patients' admission body surface area on days 1 and always recognized by PICU practitioners. Further studies to correlate modifiable fluid exposure to fluid overload and explore modifiable practice improvement opportunities are needed.INTRODUCTION Chest compression (CC) quality directly impacts cardiac arrest outcomes. Provider body type can influence the quality of cardiopulmonary resuscitation (CPR); however, the magnitude of this impact while using visual feedback is not well described. The aim of the study was to determine the association between provider anthropometric variables on fatigue and CC adherence to 2015 American Heart Association CPR while receiving visual feedback. METHODS This was a planned secondary analysis of healthcare professionals from multiple hospitals performing continuous CC for 2 minutes on an adult CPR mannequin with dynamic visual feedback. Main outcome measures include compression data (depth, rate, and lean) evaluated in 30-second epochs to explore performance fatigue. Multivariable models examined the relationship of provider anthropometrics to CC quality. Binomial mixed effects models were used to characterize fatigue by examining performance for 4 epochs. RESULTS Three hundred seventy-seven 2-minute CC episodes were analyzed.