title: Discrepancies between autopsy and clinical findings among patients requiring extracorporeal membrane oxygenator support.
abstract: Discrepancy between clinical and autopsy diagnosis in children supported on extracorporeal membrane oxygenation (ECMO) has not been previously described. To assess the utility of autopsy examination in children supported on ECMO and assess discrepancies between premortem and postmortem diagnosis in these patients. Retrospective chart review. General pediatric and cardiac intensive care units (ICUs) in a tertiary children's hospital. The hospital's ECMO database was queried for patients supported on ECMO from 2000 through 2010 who died and underwent autopsy examination. Fifty-four autopsies were performed in 139 nonsurvivors (28%) who required ECMO support in the pediatric and cardiac ICU. Major discrepancies between premortem and postmortem diagnoses were found in 29 patients (53.7%). The commonest missed diagnosis was myocardial infarction that occurred in 16 patients, followed by adrenal hemorrhage in three patients. Five patients with a cardiac diagnosis had both major (type 1 discrepancy) and minor (type 2 discrepancy) discrepancies. Surgical complications were noted in four postmortem study with three of them being class 1 discrepancy. We report significant discrepancy between autopsy and clinical findings among ECMO-supported pediatric patients. Our findings underscore the need for enhanced premorbid surveillance in patients supported on ECMO.
authors.affiliation: From the *Department of Pediatric Cardiology, College of Medicine, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas; †Department of Pathology, College of Medicine, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas; and ‡Department of Critical Care, College of Medicine, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas.
authors.forename: Carlos
authors.initials: C
authors.lastname: Blanco
authors.forename: Carmen
authors.initials: C
authors.lastname: Steigman
authors.forename: Nathan
authors.initials: N
authors.lastname: Probst
authors.forename: Michael
authors.initials: M
authors.lastname: Stroud
authors.forename: Adnan T
authors.initials: AT
authors.lastname: Bhutta
authors.forename: Umesh
authors.initials: U
authors.lastname: Dyamenahalli
authors.forename: Michiaki
authors.initials: M
authors.lastname: Imamura
authors.forename: Parthak
authors.initials: P
authors.lastname: Prodhan
mesh_terms: D000311:Adrenal Glands / Q000473:pathology; D001344:Autopsy; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology; D012189:Retrospective Studies