ABSTRACT Introduction: Extracorporeal membrane oxygenation (ECMO) for temporary cardiopulmonary support is one of the most intense and technologically complex therapies offered in medicine. It is a high-risk procedure that requires specific knowledge and technical skills to perform it with good results. Objective: The main goal of this study is to describe our extracorporeal membrane oxygenation (ECMO) training program based on the study of specialized nurses and physicians of a simulation teaching experience, conducted in a pediatric cardiac intensive care unit. The program was developed as a theoretical-practical course with final exam and annual maintenance training sessions, caring for ECMO patients, its implementation and results. Methods: A descriptive study for registered nurses, intensivists, and cardiac surgeons. A self-administered, anonymous, and voluntary survey was conducted to assess the long-term perception about the program. Demographic data to describe the population was required, and questions about satisfaction and confidence in acquired skills and competences were asked. A descriptive statistical analysis was performed; patient survival and complications were compared before and after ECMO program using chi-square test, and P<0.05 was considered statistically significant. Results: Twenty-four training courses were performed for 68 professionals. More than 88% of the professionals considered the course components to be adequate and complete; and 94% felt trained to manage the ECMO circuit. Most valued activities were workshops and clinical cases. Since the implementation of the training program, 88 patients were assisted, with a survival rate at discharge of 58%, higher than in the previous period (P=0.03). Conclusion: More than 80% of the professionals considered the workshops and simulations as the most useful components. Reliance on the circuit care was higher than in training problem scenarios. Since 2013 we assisted 88 patients on ECMO, with a survival rate at discharge of 58%, within international standards results.

Background. Unpublished research is a frequent and reported problem. Objective. To analyze factors associated to approval, development and publication of research protocols submitted to Hospital Garrahan Institutional Review Board. Method. Descriptive and observational study. The characteristics from every protocol submitted to the IRB (January/2001 to June/2006) were collected and a questionnaire was administered in order to explore the accomplishment of the study, meeting presentations, publications or mainspring for not-publication. We calculated OR and 95% CI to estimate what factors were related to the approval and the publication of the studies. Results. 190 research protocols were evaluated; 125 (66%) were approved; 84 protocols were carried out (44%) and 40 (21%) were published. The approval was related to basic research (OR 8,6 95%CI 2.3-29) and fellowship participation (OR 9.4 95%CI 4-21.7); although, experimental design (OR 0.76 95%CI 0.61-0.96) and financial support by pharmaceutical industry (OR 0.19 95%CI 0.06-0.60) decreased approval odds. The main cause for not publication was the lack of time for the writing of the article. We have not found factors related to the publication. Conclusion. From the presentation of a protocol up to its approval and publication there exists barriers that decrease progressively the possibility of completing the research.

Introducción. La falta de publicación de los trabajos de investigación atenta contra la transferencia del conocimiento a la práctica clínica. Objetivo. Analizar qué factores se asocian con la aprobación, el desarrollo y la publicación de los protocolos de investigación remitidos a la Coordinación de Investigación del Hospital de Pediatría "Prof. Dr. Juan P. Garrahan". Método. Estudio descriptivo y analítico. Se recolectaron las características de los protocolos presentados entre enero del 2001 y junio del 2006; mediante un cuestionario, se exploró sobre la realización del estudio, presentación a congresos y publicación o causa principal de no publicación. Se calcularon OR e IC 95% para estimar qué variables se relacionaban con la aprobación y la publicación de las investigaciones. Resultados. Se presentaron 190 protocolos; 125 (66%) fueron aprobados. Se ejecutaron 84 (44%) y el 21% (40) fueron publicados. La aprobación se asoció con la investigación básica (OR: 8,6 IC 95%: 2,3-29) y con tener un becario involucrado en su desarrollo (OR: 9,4 IC 95%: 4-21,7); el diseño experimental (OR: 0,68 IC 95%: 0,53-0,87) y el financiamiento de la industria farmacéutica (OR: 0,76 IC 95%: 0,61-0,96) se asociaron a menor posibilidad de aprobación. Los estudios experimentales se desarrollaron con menor frecuencia (p < 0,001). No se hallaron factores significativos relacionados con la publicación. La principal causa de no publicación comunicada por los profesionales fue la falta de tiempo para la redacción. Conclusiones. Desde la presentación de un protocolo de investigación hasta su ejecución y publicación, existen barreras que disminuyen progresivamente la posibilidad de completar el proceso de investigación en forma completa.

Serious disease by Hantavirus is characterized by hemorrhagic fever and a quick course, usually in 24 hours, to shock with severe cardiopulmonary failure. We report a patient who lived in the Gran Buenos Aires area and we emphasize the clinical and biochemical criteria that should suggest the diagnosis, especially when the patient comes from endemic zones. This is the case of a previously healthy 11 years-old girl, that had fever during four days before admission and then developed diarrhea and vomiting. She was admitted to the ICU with respiratory and hemodynamic failure requiring both high doses of inotropic agents and respiratory support. Because of the sudden course of the disease, the important and hematic characteristics of the bronchopleural secretions, the low plasma albumin levels, as well as the high levels of LDH, we suspected an uncommon infectious disease. Leptospirosis, Mycoplasma pneumoniae and common bacteria infections were ruled out. Hantavirus Andes variety was confirmed (IgG and IgM). During the first three days she was in a critical state but then recovered successfully despite the ominous initial prognosis. At present she has no sequelae.

La enfermedad grave por Hantavirus se caracteriza por fiebre hemorrágica y rápido progreso, en menos de 24 horas al shock, con grave compromiso cardiopulmonar. Presentamos una paciente que ingresó a la UCIP proveniente del Gran Buenos Aires y destacamos los elementos clínicos y bioquímicos que deben sugerir la sospecha diagnóstica especialmente cuando provenga de zonas endémicas. Se trataba de una niña de 11 años de edad, previamente sana, que había comenzado con síndrome febril progresivo 4 días antes de su ingreso, a lo que se agregaron vómitos y diarrea. Frente a la rápida descompensación respiratoria y hemodinámica ingresó a UCIP, donde se diagnosticó shock hipovolémico hemorrágico, edema pulmonar agudo e insuficiencia respiratoria aguda, que requirieron altos parámetros de asistencia respiratoria mecánica y elevadas dosis de inotrópicos. Debido a las características referidas de evolución hiperaguda, la extracción de abundante líquido por tubo endotraqueal, la hipoalbuminemia y el marcado aumento de LDH en una niña previamente sana, se sospechó etiología infecciosa de origen no habitual descartándose leptospirosis, Mycoplasma pneumoniae y gérmenes comunes. Se confirmó el diagnóstico de Hantavirus tipo Andes a través de Ig G y M. Presentó estado crítico los primeros 3 días y luego tuvo buena evolución a pesar de manifestar parámetros de mal pronóstico. En la actualidad se encuentra libre de secuelas.

Introduction. Since infant death secondary to infections and perinatal disease has decreased, congenital malformations, particularly congenital heart defects (CHD), deserve major concern. Great improvements in the surgical repair of some of these cardiac defects have been made, allowing early and complete solutions in most of them. The purpose of this presentation is to show the surgical results in congenital heart disease repair in a tertiary care public pediatric hospital between 1994 and 2001. Design. A prospective case series. Population, material and methods. Since 1994, the pediatric cardiovascular intensive care facility (PCICU) has developed a database to include every consecutivelly admitted surgical patient. Diagnosis, date and surgical procedure, and post-surgical outcome (days in PCICU, days on mechanical ventilation, morbidity and mortality) are registered in the aforementioned database. Diagnoses were stratified according to a previously designed classification. Results were extracted from this database. Results. The number of surgical patients per year increased from 341 in 1994 to 430 in 2001 (26%). Cardiopulmonary bypass was needed in more than 70% of the patients. Ventricular septal defect, tetralogy of Fallot and atrium septal defect (48%), followed by transposition of great vessels and total anomalous pulmonary venous return were the most frequently repaired congenital heart defects. Mortality has shown an important percentual decrease, overall and grouped by different pathologies too, from 12% initially to less than 5% at present. Conclusions. The early and complete repair approach in our institution has been accomplished with encouraging results and low mortality rates.

Introducción. Al disminuir la mortalidad infantil por causas perinatales e infecciosas, las muertes por malformaciones congénitas, particularmente los defectos cardíacos, adquieren mayor relevancia. En los últimos años se han realizado enormes progresos en el tratamiento quirúrgico de estas malformaciones, permitiendo la corrección completa y precoz de la mayoría de las cardiopatías. El objetivo de este trabajo fue mostrar la evolución de los resultados en la reparación quirúrgica de las cardiopatías congénitas complejas en un hospital público pediátrico de alta complejidad, entre 1994 y 2001. Diseño. Serie de casos prospectiva. Población, material y métodos. Desde 1994 la unidad de recuperación cardiovascular cuenta con una base de datos con registro consecutivo de todos los pacientes operados que ingresan a la unidad. En esta base se consignan diagnóstico, fecha y tipo de cirugía y evolución posoperatoria (tiempo de internación, ventilación mecánica, morbilidad y mortalidad). Para el diagnóstico se utilizó una clasificación propia para facilitar el procesamiento de los datos. Los resultados que aquí se presentan surgieron de la información contenida en la base de datos mencionada. Resultados. El número de pacientes operados por año se ha incrementado desde 341 casos en 1994 hasta 430 en el 2001 (26%), más del 70% con circulación extracorpórea. Las patologías más frecuentes fueron comunicación interventricular, tetralogía de Fallot y comunicación interauricular (48%), seguidas de transposición de grandes vasos y anomalía total del retorno venoso. La mortalidad global y agrupada por patologías ha mostrado un descenso porcentual muy importante, desde 12% inicial hasta menos del 5% en la actualidad. Conclusiones. En nuestra institución, ha sido posible el enfoque en la reparación anatómica y temprana de la gran mayoría de las cardiopatías congénitas, con resultados alentadores y bajas tasas de mortalidad.