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3 results

  • Eighteen years of paediatric extracorporeal membrane oxygenation and ventricular assist devices: insight regarding late outcomes

  • Shawn M. Shah, David W. Kays, Sharon R. Ghazarian, Tom R. Karl, Plato Alexander, Nathaniel Sznycer-Taub, Jason Parker, Molly Oldeen, Melvin C. Almodovar, Gary Stapleton, James A. Quintessenza, Alfred Asante-Korang, Vyas Kartha, Jade Hanson, Ernest Amankwah, Joeli Roth, Jeffrey P. Jacobs
  • Journal:
    Cardiology in the Young / Volume 28 / Issue 11 / November 2018
    Published online by Cambridge University Press:
    17 September 2018, pp. 1316-1322
  • Background

    We reviewed all patients who were supported with extracorporeal membrane oxygenation and/or ventricular assist device at our institution in order to describe diagnostic characteristics and assess mortality.

    Methods

    A retrospective cohort study was performed including all patients supported with extracorporeal membrane oxygenation and/or ventricular assist device from our first case (8 October, 1998) through 25 July, 2016. The primary outcome of interest was mortality, which was modelled by the Kaplan–Meier method.

    Results

    A total of 223 patients underwent 241 extracorporeal membrane oxygenation runs. Median support time was 4.0 days, ranging from 0.04 to 55.8 days, with a mean of 6.4±7.0 days. Mean (±SD) age at initiation was 727.4 days (±146.9 days). Indications for extracorporeal membrane oxygenation were stratified by primary indication: cardiac extracorporeal membrane oxygenation (n=175; 72.6%) or respiratory extracorporeal membrane oxygenation (n=66; 27.4%). The most frequent diagnosis for cardiac extracorporeal membrane oxygenation patients was hypoplastic left heart syndrome or hypoplastic left heart syndrome-related malformation (n=55 patients with HLHS who underwent 64 extracorporeal membrane oxygenation runs). For respiratory extracorporeal membrane oxygenation, the most frequent diagnosis was congenital diaphragmatic hernia (n=22). A total of 24 patients underwent 26 ventricular assist device runs. Median support time was 7 days, ranging from 0 to 75 days, with a mean of 15.3±18.8 days. Mean age at initiation of ventricular assist device was 2530.8±660.2 days (6.93±1.81 years). Cardiomyopathy/myocarditis was the most frequent indication for ventricular assist device placement (n=14; 53.8%). Survival to discharge was 42.2% for extracorporeal membrane oxygenation patients and 54.2% for ventricular assist device patients. Kaplan–Meier 1-year survival was as follows: all patients, 41.0%; extracorporeal membrane oxygenation patients, 41.0%; and ventricular assist device patients, 43.2%. Kaplan–Meier 5-year survival was as follows: all patients, 39.7%; extracorporeal membrane oxygenation patients, 39.7%; and ventricular assist device patients, 43.2%.

    Conclusions

    This single-institutional 18-year review documents the differential probability of survival for various sub-groups of patients who require support with extracorporeal membrane oxygenation or ventricular assist device. The indication for mechanical circulatory support, underlying diagnosis, age, and setting in which cannulation occurs may affect survival after extracorporeal membrane oxygenation and ventricular assist device. The Kaplan–Meier analyses in this study demonstrate that patients who survive to hospital discharge have an excellent chance of longer-term survival.

  • 10 - The Hitler Youth generation and its role in the two post-war German states

  • Mark Roseman, Keele University
  • Book:
    Generations in Conflict
    Published online:
    19 October 2009
    Print publication:
    20 April 1995, pp 210-226

  • Summary

    The term ‘Hitler Youth’ conjures up images of a paramilitary organisation turning boys into men – ‘hard as Krupp steel and quick as lightning’. And the girls, so the cliché would have it, were educated to be good German mothers, happy within their domain of home and hearth, a domain subordinate to the larger world of men just as the League of German Girls (BDM) was a subdivision of the larger organisation of the Hitler Youth (HJ). That, at any rate, is the conventional picture. But such a crude caricature tells us little about the real experiences of the millions of boys and girls who were members of the HJ or about the significance of those experiences for shaping social behaviour and attitudes in the two post-war German states.

    How, then, did the almost nine million boys and girls in the HJ and BDM experience the Nazi youth organisations? Accounts of the period tend to dwell on ‘camp fire romanticism’, on the appeal of a ‘youthful community’, on sport and games, sometimes on paramilitary drill or political education. Only rarely do they tell us whether the HJ was accepted or rejected by its members. Until very recently, the historiography of the Third Reich neglected such central questions as what in retrospect was seen as positive or negative in the HJ. How did the HJ generation subsequently interpret and deal with the experiences of those years? How did those experiences shape their subsequent lives and, through them, the society in which they lived?.