| 1. |
- Aalbers, J., et al.
(författare)
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DARWIN : towards the ultimate dark matter detector
- 2016
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Ingår i: Journal of Cosmology and Astroparticle Physics. - : IOP Publishing. - 1475-7516. ; :11
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Tidskriftsartikel (refereegranskat)abstract
- DARk matter WImp search with liquid xenoN (DARWIN(2)) will be an experiment for the direct detection of dark matter using a multi-ton liquid xenon time projection chamber at its core. Its primary goal will be to explore the experimentally accessible parameter space for Weakly Interacting Massive Particles (WIMPs) in a wide mass-range, until neutrino interactions with the target become an irreducible background. The prompt scintillation light and the charge signals induced by particle interactions in the xenon will be observed by VUV sensitive, ultra-low background photosensors. Besides its excellent sensitivity to WIMPs above a mass of 5 GeV/c(2), such a detector with its large mass, low-energy threshold and ultra-low background level will also be sensitive to other rare interactions. It will search for solar axions,galactic axion-like particles and the neutrinoless double-beta decay of Xe-136, as well as measure the low-energy solar neutrino flux with <1% precision, observe coherent neutrino-nucleus interactions, and detect galactic supernovae. We present the concept of the DARWIN detector and discuss its physics reach, the main sources of backgrounds and the ongoing detector design and R&D efforts.
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| 2. |
- Andersson, Jacob, et al.
(författare)
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Differences in head circumference and neuroimaging characteristics : what can they tell about the aetiologies of infant subdural haematoma?
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background Acute (ASDH) and chronic subdural haematoma (CSDH) in infants have been regarded as highly specific for abuse. A recent study showed different risk factors for ASDH and CSDH, indicating that CSDH in many cases was related to external hydrocephalus. Purpose To investigate to what extent external hydrocephalus may explain findings and symptoms interpreted as signs of abusive head trauma. Material and methods Eighty-five infants with ASDH (n=16) and CSDH (n=69) were reviewed with regard to cranio-cortical- (CCW), sino-cortical- (SCW), frontal interhemispheric-(IHW), subarachnoid space width (SSW) and head circumference (HC). In infants with unilateral SDH, the correlation between the contralateral SSW and the ipsilateral CCW and SDH width was calculated. A correlation would imply that the CSDH replaces an already existing extracerebral space.Results Infants with CSDH had significantly higher CCW, SCW, IHW and SSW than infants with ASDH (p < 0.05). The ipsilateral CCW (R = 0.92, p < 0.001) and SDH width (R = 0.81, p < 0.01) were correlated to the contralateral SSW. Increased HC was more prevalent in Infants with CSDH (71%) than in infants with ASDH (14%) (p < 0.01). Forty-two infants, all with CSDH, had at least one of CCW, SCW or IHW ≥ 95th percentile. Twenty infants, all with CSDH, had CCW, SCW and IHW > 5 mm and increased HC. Conclusion A significant proportion of infants with CSDH may have external hydrocephalus as an underlying cause and that parts of the widened subarachnoid space in some infants is replaced by a CSDH.
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| 3. |
- Andersson, Jacob, et al.
(författare)
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Different vulnerability profiles in acute compared to chronic subdural haematoma amongst infants with suspected abusive head trauma
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: In a register study based on ICD 10 coding, there was a similar vulnerability profile (male sex, preterm and small for gestational age) in infants diagnosed with non-traumatic subdural haematoma (SDH) and infants having SDH with abuse diagnosis. However, ICD-10 does not separate between acute (ASDH) and chronic subdural haematoma (CSDH). Purpose: To determine the vulnerability profile in infants having CSDH and ASDH, respectively. Material and methods: A descriptive review of infants with SDH/hygroma examined by the Swedish National Board of Forensic Medicine between 1994 and 2018. Included cases (n=85) were analysed with regard to possible vulnerability factors. Results: Type of subdural fluid could be determined in 85 of 96 cases. Sixteen infants had ASDH and 69 CSDH. Infants with ASDH had the peak incidence during the first month of life, 56% were male, 6% were premature, 13% were twins and 44% died. In infants with CSDH, the peak incidence occurred during the third month of life, 69% were male, 34% were premature, 12% were twins and 4% died. Conclusion: CSDH, but not ASDH, is associated with factors suggesting non-traumatic pathogenesis, for which reason CSDH and ASDH should be analysed separately to extend the knowledge regarding the aetiology of SDH during infancy.
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| 4. |
- Andersson, Jacob, et al.
(författare)
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External Hydrocephalus as a Cause of Infant Subdural Hematoma : Epidemiological and Radiological Investigations of Infants Suspected of Being Abused
- 2022
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Ingår i: Pediatric Neurology. - : Elsevier. - 0887-8994 .- 1873-5150. ; 126, s. 26-34
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Tidskriftsartikel (refereegranskat)abstract
- Background: Acute subdural hematoma (ASDH) and chronic subdural hematoma (CSDH) in infants have been regarded as highly specific for abuse. Other causes of CSDH have not been investigated in a large population.Purpose: The purpose of this study was to investigate to what extent external hydrocephalus is present in infants with ASDH and CSDH undergoing evaluation for abuse.Material and methods: Eighty-five infants suspected of being abused, with ASDH (n = 16) or CSDH (n = 69), were reviewed regarding age, risk factor profiles, craniocortical width (CCW), sinocortical width (SCW), frontal interhemispheric width (IHW), subarachnoid space width (SSW), and head circumference (HC). In infants with unilateral subdural hematoma (SDH), correlations between contralateral SSW and ipsilateral CCW and SDH width were investigated.Results: Infants with CSDH had significantly lower mortality, were more often premature and male, and had significantly higher CCW, SCW, IHW, and SSW than infants with ASDH (P < 0.05). Ipsilateral CCW (R = 0.92, P < 0.001) and SDH width (R = 0.81, P < 0.01) correlated with contralateral SSW. Increased HC was more prevalent in infants with CSDH (71%) than in infants with ASDH (14%) (P < 0.01). Forty-two infants, all with CSDH, had at least one of CCW, SCW, or IHW ≥95th percentile. Twenty infants, all with CSDH, had CCW, SCW, and IHW >5 mm, in addition to increased HC.Conclusion: A substantial proportion of infants with CSDH who had been suspected of being abused had findings suggesting external hydrocephalus.
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| 5. |
- Fredly, Siv, et al.
(författare)
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Skin microcirculation in healthy term newborn infants - assessment of morphology, perfusion and oxygenation
- 2015
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Ingår i: Clinical hemorheology and microcirculation. - : IOS Press. - 1386-0291 .- 1875-8622. ; 59:4, s. 309-322
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Tidskriftsartikel (refereegranskat)abstract
- Despite microcirculations fundamental role, assessments of its function are limited. We explored the applicability of Computer Assisted Video Microscope (CAVM), Laser Doppler Perfusion Measurements (LDPM) and Diffuse Reflectance Spectroscopy (DRS) to study skin microvascular morphology, perfusion and oxygen saturation in twenty-five healthy newborns day 1-3 of life. Results: Day 1-3 (mean (SD)): Microvascular density (CAVM; number of microvessels crossing a grid of lines/mm line, c/mm): Chest: 11.3 (1.5), 11.0 (1.7), 10.7 (1.6). Hand: 13.2 (2.0), 13.2 (1.9), 12.4 (1.6). Capillary density was significantly higher in the hand than in the chest each day (p less than 0.001). Perfusion (LDPM; arbitrary units): Chest: 109.1 (26.0), 101.4 (24.6), 100.8 (25.3). Hand: 58.9 (17.5), 54.3 (15.8), 46.9 (14.8). Perfusion was significantly higher in the chest than in the hand each day (p less than 0.01). Microvascular oxygen saturation (DRS; %): Chest: 88.1 (5.2), 87.8 (10.0), 86.7 (9.0). Hand: 79.9 (15.2), 82.7 (11.8), 82.2 (12.1) (p less than 0.05). Capillary flow velocities (CAVM) were similar in the chest and hand: 60-70% capillaries had "continuous high flow" and 30-40% "continuous low flow". Multimodal skin microvascular assessments with CAVM, LDPM and DRS are feasible with reproducible data in newborns. The hand has lower perfusion, higher capillary density and higher oxygen extraction than the chest.
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| 6. |
- Högberg, Ulf, 1949-, et al.
(författare)
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Difficult birth is the main contributor to birthrelated fracture and accidents to other neonatal fractures
- 2020
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Ingår i: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 109:10, s. 2040-2048
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Tidskriftsartikel (refereegranskat)abstract
- AIM: Specific birthrelated fractures have been studied; underestimates might be a problem. We aimed to assess all fractures diagnosed as birthrelated as well as other neonatal fractures.METHODS: A population-based study on all infants born in Sweden 1997-2014; data was retrieved from the Swedish Health Registers (10th version of International Classification of Diseases. Outcome measures were birthrelated fractures (ICD-10 P-codes) and other neonatal fractures (ICD-10 S-codes).RESULTS: The overall fracture incidence was 2.9 per 1,000 live birth (N=5,336); 92.6% had P-codes and 7.4% (S-codes). Some birthrelated fractures were diagnosed beyond the neonatal period. Other neonatal fractures could have been birthrelated. Clavicle fracture, (88.8%) was associated with adverse maternal- and infant anthropometrics and birth complications. The few neonates with rib fractures all had concomitant clavicle fracture. For skull fractures, a minor part was birthrelated, most were associated with accidents. Half of the long bone fractures were associated with accidents. Birthrelated femur fractures were associated with bone fragility risk factors. Five infants with abuse diagnoses had fractures: skull (4), long bone (2), and rib (1).CONCLUSION: Birthrelated and other neonatal fractures are rarely diagnosed. Difficult birth is the main contributor to birthrelated fracture, and accidents to other neonatal fractures.
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| 7. |
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| 8. |
- Högberg, Ulf, 1949-, et al.
(författare)
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Epidemiology of subdural haemorrhage during infancy : A population-based register study
- 2018
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 13:10
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To analyse subdural haemorrhage (SDH) during infancy in Sweden by incidence, SDH category, diagnostic distribution, age, co-morbidity, mortality, and maternal and perinatal risk factors; and its association with accidents and diagnosis of abuse. Methods A Swedish population-based register study comprising infants born between 1997 and 2014, 0-1 years of age, diagnosed with SDH-diagnoses according to the (International Classification of Diseases, 10th version (ICD10), retrieved from the National Patient Register and linked to the Medical Birth Register and the Death Cause Register. Outcome measures were: 1) Incidence and distribution, 2) co-morbidity, 3) fall accidents by SDH category, 4) risk factors for all SDHs in the two age groups, 0-6 and 7-365 days, and for ICD10 SDH subgroups: S06.5 (traumatic SDH), I62.0 (acute nontraumatic), SDH and abuse diagnosis. Results Incidence of SDH was 16.5 per 100 000 infants (n = 306). Median age was 2.5 months. For infants older than one week, the median age was 3.5 months. Case fatality was 6.5%. Male sex was overrepresented for all SDH subgroups. Accidental falls were reported in 1/3 of the cases. One-fourth occurred within 0-6 days, having a perinatal risk profile. For infants aged 7-365 days, acute nontraumatic SDH was associated with multiple birth, preterm birth, and small-for-gestational age. Fourteen percent also had an abuse diagnosis, having increased odds of being born preterm, and being small-for-gestational age. Conclusions The incidence was in the range previously reported. SDH among newborns was associated with difficult birth and neonatal morbidity. Acute nontraumatic SDH and SDH with abuse diagnosis had similar perinatal risk profiles. The increased odds for acute nontraumatic SDH in twins, preterm births, neonatal convulsions or small-for-gestational age indicate a perinatal vulnerability for SDH beyond 1st week of life. The association between prematurity/small-for-gestational age and abuse diagnosis is intriguing and not easily understood.
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| 9. |
- Högberg, Ulf, 1949-, et al.
(författare)
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Medical diagnoses among infants at entry in out-of-home care : A Swedish population-register study
- 2019
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Ingår i: Health Science Reports. - : Wiley. - 2398-8835. ; 2:8
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Tidskriftsartikel (refereegranskat)abstract
- Background and aims: Identification of child abuse involves a medical investigation and assessment of problems related to social environment and upbringing and might necessitate out-of-home care. The objective of this study was to analyse infants placed in out-of-home care in Sweden by incidence, medical diagnoses, and perinatal factors.Methods: This was a population-based register study of infants born in Sweden 1997 to 2014. Data were retrieved from registers at the Swedish National Board of Health and Welfare and Statistics Sweden. Outcome measures were out-of-home care categories: (a) "Problems Related to Social Environment/Upbringing", (b) "Abuse diagnoses without SDH (subdural haemorrhage), RH (retinal haemorrhage), rib fracture, or long bone fracture", and (c) "SDH, RH, rib fracture, or long bone fracture." As a reference population, we randomly selected infants without medical diagnoses born the same year.Results: Overall incidence of out-of-home care was 402 per 100 000. For subcategories (a), (b), and (c), the incidences were 14.8 (n = 273), 3.77 (n = 70), and 9.83 (n = 182) per 100 000, respectively. During the study period, the first remained unchanged; the latter two have been increasing. Compared with other reasons for out-of-home care, children in category (c), "SDH, RH, rib fracture, or long bone fracture", had increased odds of being boys (adjusted odds ratio [aOR] 1.60; 95% confidence interval [CI], 1.08-2.38) and decreased odds of having a mother being single (aOR 0.49; 95% CI, 0.32-0.75) and a smoker (aOR 0.60; 95% CI, 0.37-0.96). Compared with the reference population, children in this category were more often twin born (7.7% versus 2.8%), preterm (18.5% versus 5.5%), and small-for-gestational age (5.2% versus 2.1%).Conclusion: SDH, RH, rib fracture, or long bone fracture constitute a minor part of medical diagnoses for infants entered in out-of-home care, but have been increasing, both in numbers and proportion. Overdiagnosis of abuse might be a possible reason but cannot be ascertained by this study design.
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| 10. |
- Högberg, Ulf, 1949-, et al.
(författare)
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Preventable harm and child maltreatment diagnosis (eLetter)
- 2019
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Ingår i: The BMJ. - : BMJ Publishing Group Ltd. - 1756-1833. ; 366
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To systematically quantify the prevalence, severity, and nature of preventable patient harm across a range of medical settings globally.Design: Systematic review and meta-analysis.Data sources: Medline, PubMed, PsycINFO, Cinahl and Embase, WHOLIS, Google Scholar, and SIGLE from January 2000 to January 2019. The reference lists of eligible studies and other relevant systematic reviews were also searched.Review methods: Observational studies reporting preventable patient harm in medical care. The core outcomes were the prevalence, severity, and types of preventable patient harm reported as percentages and their 95% confidence intervals. Data extraction and critical appraisal were undertaken by two reviewers working independently. Random effects meta-analysis was employed followed by univariable and multivariable meta regression. Heterogeneity was quantified by using the I2 statistic, and publication bias was evaluated.Results: Of the 7313 records identified, 70 studies involving 337 025 patients were included in the meta-analysis. The pooled prevalence for preventable patient harm was 6% (95% confidence interval 5% to 7%). A pooled proportion of 12% (9% to 15%) of preventable patient harm was severe or led to death. Incidents related to drugs (25%, 95% confidence interval 16% to 34%) and other treatments (24%, 21% to 30%) accounted for the largest proportion of preventable patient harm. Compared with general hospitals (where most evidence originated), preventable patient harm was more prevalent in advanced specialties (intensive care or surgery; regression coefficient b=0.07, 95% confidence interval 0.04 to 0.10).Conclusions: Around one in 20 patients are exposed to preventable harm in medical care. Although a focus on preventable patient harm has been encouraged by the international patient safety policy agenda, there are limited quality improvement practices specifically targeting incidents of preventable patient harm rather than overall patient harm (preventable and non-preventable). Developing and implementing evidence-based mitigation strategies specifically targeting preventable patient harm could lead to major service quality improvements in medical care which could also be more cost effective.
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| 11. |
- Stridbeck, Ulf, et al.
(författare)
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Vurdering av filleristing av barn i straffesaker for norske domstoler
- 2020
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Ingår i: Tidsskrift for rettsvitenskap. - : Scandinavian University Press / Universitetsforlaget AS. - 0040-7143 .- 1504-3096. ; 133:4, s. 423-475
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Tidskriftsartikel (refereegranskat)abstract
- Dette er en flerfaglig gjennomgang av samtlige norske straffesaker funnet på Lovdata fra 2004 fram til 2015 om «filleristing». Hver sak er gjennomgått av forfatterne; to jurister og tre medisinske eksperter på hodeskader hos barn. Materialet har bestått av straffesaksdokumentene, inkludert sakkyndige rapporter og aktuelle pasientjournaler med billeddiagnostikk av de samme barna. Rettssakene presenteres ut fra dommene, og i de aktuelle sakene er rettens vurderinger i mange saker knyttet opp mot de rettssakkyndiges vurderinger. Parallelt har de medisinske forfatterne etterprøvd hvorvidt de sakkyndiges vurderinger står seg ut fra dagens kunnskap om slike skadebilder. Særlig vekt er lagt på muligheten for at skadebildet ikke er påført ved foreldres eller andres voldsbruk, men av medisinske tilstander hos barnet selv. Det kan synes som om det er få fellende straffedommer som utelukkende er basert på sakkyndighetsvurderinger vedrørende filleristing. I flere andre saker synes det å foreligge tvil når det gjelder skadeårsak og skadepåføring. I tillegg presenteres enkelte barnevernssaker med vekt på beviskravet ved filleristing sammenliknet med straffesakene, men her uten å ha foretatt nye medisinske vurderinger.
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| 12. |
- Sundheim, Liv Kristin, et al.
(författare)
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Acute skin trauma induces hyperemia, but superficial papillary nutritive perfusion remains unchanged
- 2017
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Ingår i: Microcirculation. - : WILEY. - 1073-9688 .- 1549-8719. ; 24:7
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Superficial skin papillary capillaries with blood supply from a superficial vascular plexus and regulated by local metabolic needs supply oxygen and nutrients for epithelial cell proliferation. A deep vascular plexus regulated by autonomous nerves serves body thermoregulation. In healthy volunteers, we assessed circulatory effects of a standardized skin trauma by CAVM, DRS, and LDPM to assess the measuring depth of the three techniques and to describe the acute trauma effects on nutritive and thermoregulatory perfusion. Methods: Volunteers (n=12) were examined at baseline and after induction of a 5.0 mmx1.0 mm incision on the forearm; 30 minutes after the trauma induction, data were collected at 0-1, 2-3 and 30 mm distances. Results: LDPM showed hyperemia at 2-3 mm distance (35.8 +/- 15.2 a.u.), but not at 30 mm distance (7.4 +/- 2.5 a.u.) compared to baseline (8.8 +/- 1.8 a.u.). The DRS saturation increased at 2-3 mm (71.2 +/- 4.8%), but not at 30 mm (49.8 +/- 7.9%) compared to baseline (45.8 +/- 7.4%). Capillary density and flow velocities were unaffected at all distances. Conclusions: The results indicate that skin nutritive papillary capillary function can be assessed by CAVM and DRS, but not with LDPM because of its dependence of the deep plexus perfusion.
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| 13. |
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| 14. |
- Thiblin, Ingemar, et al.
(författare)
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Medical findings and symptoms in infants exposed to witnessed or admitted abusive shaking : A nationwide registry study
- 2020
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Ingår i: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 15:10
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Tidskriftsartikel (refereegranskat)abstract
- Background: Many physicians regard the combination of encephalopathy, subdural haemorrhage (SDH), retinal haemorrhage (RH), rib fractures, and classical metaphyseal lesions (CML) as highly specific for abusive head trauma (AHT). However, without observed abuse or other criteria that are independent of these findings, bias risk is high.Methods: Infants subjected for examination under the suspicion of maltreatment during the period 1997-2014 were identified in the National Patient Registry, International Classification of Diseases (ICD-10 SE). The medical records were scrutinized for identification of cases of witnessed or admitted physical abuse by shaking. The main outcome measures were occurrence of SDH, RH, fractures and skin lesions.Results: All identified 36 infants had been shaken, and for 6, there was information indicating blunt force impact immediately after shaking. In 30 cases, there were no findings of SDH or RH, rib fractures, or CMLs. Six infants had finding(s) suggestive of physical abuse, two with possible acute intracranial pathology. One infant with combined shaking and impact trauma had hyperdense SDH, hyperdense subarachnoid haemorrhage, suspected cortical vein thrombosis, RH, and bruises. Another infant abused by shaking had solely an acute subarachnoid haemorrhage. Both had pre-existing vulnerability. The first was born preterm and had non-specific frontal subcortical changes. The other had bilateral chronic SDH/hygroma.Conclusions: The present findings do not support the hypothesis that acute SDH or RH can be caused by isolated shaking of a healthy infant. However, they do suggest that abuse by shaking may cause acute intracranial haemorrhage with RH in infants with certain risk factors.
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| 15. |
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| 16. |
- Thiblin, Ingemar, et al.
(författare)
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Retinal haemorrhage in infants investigated for suspected maltreatment is strongly correlated with intracranial pathology
- 2022
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Ingår i: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 111:4, s. 800-808
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To test the two prevailing hypotheses regarding the aetiology of infant retinal haemorrhage: (a) traction forces exerted by the lens and/or corpus vitreum on the retina during infant shaking or (b) retinal vessel leakage secondary to intracranial pathology and raised intracranial pressure.Methods: Comparison of medical findings and reported type of trauma in infants investigated for suspected physical abuse with presence (n = 29) or non-presence of retinal haemorrhage (RH) (n = 119).Results: Intracranial pathology was recorded in 15 (13%) of the non-RH cases and in 27 (97%) of the RH cases (p < 0.0001). All 18 infants with bilateral RH had intracranial pathology. Of 27 infants subjected to witnessed or admitted shaking, two were in the group with RH. One had a single unilateral RH and no intracranial pathology. The other had bilateral RH and intracranial pathology with non-specific white matter changes, acute subdural and subarachnoid haemorrhages, and suspected cortical venous thrombosis. In 15 RH cases, there was no trauma reported and no findings other than RH and intracranial pathology. Accidental blunt head trauma was reported in 7 RH cases.Conclusion: The present study indicates that RH in infants is secondary to intracranial pathology of non-specific aetiology.
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| 17. |
- Wester, Knut, et al.
(författare)
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Re-evaluation of medical findings in alleged shaken baby syndrome and abusive head trauma in Norwegian courts fails to support abuse diagnoses
- 2022
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Ingår i: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 111:4, s. 779-792
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The criteria for diagnosing abusive head trauma (AHT) are not well defined and this condition might be diagnosed on failing premises. Our aim was to review criminal AHT cases in Norwegian courts by scrutinising the underlying medical documentation.METHODS: Cases were identified in the data registry for Norwegian courts from 2004 to 2015. Documentation was obtained from relevant health institutions. The medical co-authors first made independent evaluations of the documentation for each child, followed by a consensus evaluation.RESULTS: A total of 17 children (11 boys) were identified, all diagnosed as AHT by court appointed experts, 15 were infants (mean age 2.6 months). A high proportion (41.2%) was born to immigrant parents and 31.3% were premature. The medical findings could be explained by alternative diagnoses in 16 of the 17 children; 8 boys (7 infants - mean age 2.9 months) had clinical and radiological characteristics compatible with external hydrocephalus complicated by chronic subdural haematoma. Six children (five infants with mean age 2.1 months) had a female preponderance and findings compatible with hypoxic ischaemic insults.CONCLUSION: The medical condition in most children had not necessarily been caused by shaking or direct impact, as was originally concluded by the court experts.
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| 18. |
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| 19. |
- Wester, Torjus, et al.
(författare)
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Skin microvascular morphology and hemodynamics during treatment with veno-arterial extra-corporeal membrane oxygenation
- 2014
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Ingår i: Clinical hemorheology and microcirculation. - : IOS Press. - 1386-0291 .- 1875-8622. ; 56:2, s. 119-131
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To explore the potentials of microcirculatory assessments for predicting outcome of patients treated with extra corporeal membrane oxygenation for cardiogenic shock. Methods: Eight patients with acute cardiogenic shock treated with ECMO and eight healthy controls were examined with skin vital microscopy and laser Doppler perfusion measurements. Results: Three patients died on ECMO (group 1). Five patients were successfully weaned off ECMO (group 2). Four patients were discharged from hospital and one died after successful weaning from bleeding complications. Patients surviving ECMO (group 2) had microcirculatory findings comparable with healthy controls. Patients in group 1 showed major skin microvascular pathology: pericapillary bleedings (n = 1), pericapillary dark haloes (n = 2) and capillary micro thrombi (n = 1). As compared with survivors they had lower functional capillary density (FCD) (n = 3), higher heterogeneity of functional capillary density (n = 3) and significantly reduced capillary mean flow-categorical velocity (n = 2). Laser Doppler measurements in group 1 had non-significant lower laser Doppler flux values as compared with survivors and controls. Conclusion: Skin microvascular pathology as detected with video microscopy (pericapillary bleedings or haloes, micro-thrombi/capillaries with “no flow”, low FCD with high spatial distribution heterogeneity or low mean flow-categorial velocity seems to be associated with poor prognosis.
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| 20. |
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