Explore the vast range of titles available.

Background ECMO outcomes in COVID-19-related respiratory failure among solid organ transplant (SOT) and hematopoietic stem-cell transplant recipients (HSCT) are poorly described. We investigated: (1) whether transplant patients (SOT/HSCT) with COVID-19 have worse outcomes than non-immunocompromised (IC) COVID-19 patients, and (2) whether among transplant recipients (SOT/HSCT), those with COVID-19 have worse outcomes than those with non-COVID-19-related respiratory failure. Additionally, we aimed to identify factors independently associated with mortality among COVID-19 transplants. Methods Retrospective analyses of the Extracorporeal Life Support Organization Registry from 1/1/2017 to 31/07/2023. Two comparisons were made: (1) transplant COVID-19 versus non-IC COVID-19, and (2) transplant COVID-19 versus transplant non-COVID-19 patients. Outcomes were analyzed using propensity score (PS)-adjusted, multivariable, and PS-matched analyses, adjusting for a priori identified confounders. Primary outcome was in-hospital mortality. Results Among 38,270 runs, 146 transplant COVID-19, 12,552 non-IC-COVID-19 and 886 transplant non-COVID-19 runs were identified. In-hospital mortality in transplant COVID-19 patients was 75.3% and the risk was invariably increased compared to non-IC-COVID-19 (PS-adjusted OR: 2.36 [95%CI:1.61–3.46], p  < 0.001, multivariable OR:2.35 [95%CI:1.59–3.49], p  < 0.001, and PS-matched analysis OR: 1.89 [95%CI:1.21–2.95], p  < 0.005) and transplant non-COVID-19 patients (PS-adjusted OR: 4.20 [95%CI:2.74–6.44], p  < 0.001, multivariable OR: 3.79 [95%CI:2.51–5.74], p  < 0.001, and PS-matched analyses OR: 3.17 [95%CI:1.90–5.28], p  < 0.001). Mortality difference remained stable over time. Older age independently associated with higher mortality. This was accompanied by higher need for renal replacement therapy compared to non-IC-COVID-19 patients. Compared to transplant non-COVID-19 patients, ECMO runs and time-to-live discharge were invariably prolonged. Hemorrhagic, metabolic, pulmonary and infectious complications consistently occurred more frequently. Conclusions Mortality was high in COVID-19 transplant ECMO patients, warranting cautious use of ECMO in this population.

Background Intensive Care Unit (ICU) capacity management is essential to provide high-quality healthcare for critically ill patients. Yet, consensus on the most favorable ICU design is lacking, especially whether ICUs should deliver dedicated or non-dedicated care. The decision for dedicated or non-dedicated ICU design considers a trade-off in the degree of specialization for individual patient care and efficient use of resources for society. We aim to share insights of a model simulating capacity effects for different ICU designs. Upon request, this simulation model is available for other ICUs. Methods A discrete event simulation model was developed and used, to study the hypothetical performance of a large University Hospital ICU on occupancy, rejection, and rescheduling rates for a dedicated and non-dedicated ICU design in four different scenarios. These scenarios either simulate the base-case situation of the local ICU, varying bed capacity levels, potential effects of reduced length of stay for a dedicated design and unexpected increased inflow of unplanned patients. Results The simulation model provided insights to foresee effects of capacity choices that should be made. The non-dedicated ICU design outperformed the dedicated ICU design in terms of efficient use of scarce resources. Conclusions The choice to use dedicated ICUs does not only affect the clinical outcome, but also rejection- rescheduling and occupancy rates. Our analysis of a large university hospital demonstrates how such a model can support decision making on ICU design, in conjunction with other operation characteristics such as staffing and quality management.

In the past transfusion-related acute lung injury (TRALI) was regarded as a rare complication of transfusion medicine. Subsequently, TRALI has been shown to be one of the leading causes of transfusion-related morbidity and mortality. Insight into TRALI pathogenesis in the past decades has resulted in the development of preventive strategies [1]. The accumulation of clinical and basic science knowledge has provided the rationale for a recent update of the widely used 2004 Canadian Consensus Conference (CCC) definition of TRALI (Table 1) [2]. A panel of 10 international experts on TRALI, including two members with hemovigilance expertise, used the Delphi panel approach to develop a redefinition of TRALI by modifying the 2004 CCC definition [3].

Patients who had cardiac arrest without ST-segment elevation were assigned to undergo either immediate coronary angiography or delayed coronary angiography (after neurologic recovery). All patients underwent PCI if indicated. There was no significant between-group difference in overall survival at 90 days.

Return of spontaneous circulation occurs in less than 10% of patients with cardiac arrest undergoing cardiopulmonary resuscitation (CPR) for more than 15 minutes. Studies suggest that extracorporeal life support during cardiopulmonary resuscitation (ECPR) improves survival rate in these patients. These studies, however, are hampered by their non-randomized, observational design and are mostly single-center. A multicenter, randomized controlled trial is urgently warranted to evaluate the effectiveness of ECPR. We hypothesize that early initiation of ECPR in refractory out-of-hospital cardiac arrest (OHCA) improves the survival rate with favorable neurological status. The INCEPTION trial is an investigator-initiated, prospective, multicenter trial that will randomly allocate 110 patients to either continued CPR or ECPR in a 1:1 ratio. Patients eligible for inclusion are adults (≤ 70 years) with witnessed OHCA presenting with an initial rhythm of ventricular fibrillation (VF) or ventricular tachycardia (VT), who received bystander basic life support and who fail to achieve sustained return of spontaneous circulation within 15 minutes of cardiopulmonary resuscitation by emergency medical services. The primary endpoint of the study is 30-day survival rate with favorable neurological status, defined as 1 or 2 on the Cerebral Performance Category score. The secondary endpoints include 3, 6 and 12-month survival rate with favorable neurological status and the cost-effectiveness of ECPR compared to CCPR. The INCEPTION trial aims to determine the clinical benefit for the use of ECPR in patients with refractory OHCA presenting with VF/VT. Additionally, the feasibility and cost-effectiveness of ECPR will be evaluated.

Critically ill patients face an increased risk of both thrombotic and bleeding complications, necessitating careful administration of antithrombotic agents such as platelet aggregation inhibitors (PAI), anticoagulants and fibrinolytics for prophylactic and therapeutic purposes, but also posing challenges for reversal strategies. This survey aims to assess the current clinical practice of reversal of antithrombotics in the intensive care unit (ICU). An international online 79-item survey was performed among critical care physicians. The survey was disseminated via multiple intensive care societies. Reversal practices for PAI, vitamin K antagonists (VKA), heparins, factor Xa inhibitors, direct thrombin inhibitors (DTI) and fibrinolytics were surveyed. From June 2023 to January 2024, 477 participants started the survey, with 208 completed surveys from 49 countries. The majority (79 %) of respondents practiced ICU medicine in Europe. Only 17 % of the included participants indicated the presence of an ICU-specific antithrombotic reversal protocol in their hospital. Of those, specific protocols were present for 92 % for reversal of VKA, 75 % for unfractioned heparin, 58 % for low-molecular-weight heparin, 53 % for factor Xa inhibitors, 50 % for PAI, 44 % for DTI and 31 % for fibrinolytics. There was heterogeneity in reported reversal practice for different antithrombotics in specific scenarios and between continents. However, dosing strategies of applicable reversal agents were similar. This survey shows variability in the reported clinical approaches to reverse antithrombotic agents in the ICU. The majority of hospitals included do not have a specific protocol for antithrombotic agents reversal emphasizing the need for ICU specific guidelines. •Among ICU physicians there is heterogeneity in reported practice to reverse antithrombotic agents in critically ill patients.•The majority of hospitals included do not have a specific protocol in the ICU for the reversal of antithrombotic agents.•Dosing strategies of applicable reversal agents are similar.

A new algorithm was developed that transforms the non-invasive finger blood pressure (BP) into a radial artery BP (B̂PRad), whereas the original algorithm estimated brachial BP (B̂PBra). In this study we determined whether this new algorithm shows better agreement with invasive radial BP than the original one and whether in the operating room this algorithm can be used safely. This observational study was conducted on thirty-three non-cardiac surgery patients. Invasive radial and non-invasive finger BP were measured, of the latter B̂PRad and B̂PBra were transformed. Agreement of systolic, mean, and diastolic arterial BP (SAP, MAP, and DAP, respectively) was assessed traditionally with Bland-Altman and trend analysis and clinically safety was quantified with error grid analyses. A bias (precision) of 5 (8) mmHg or less was considered adequate. Thirty-three patients were included with an average of 676 (314) 20 s segments. For both comparisons, bias (precision) of MAP was within specified criteria, whereas for SAP, precision was higher than 8 mmHg. B̂PRad showed a better agreement than B̂PBra with BPRad for DAP values (bias (precision): 0.7 (6.0) and − 6.4 (4.3) mmHg, respectively). B̂PRad and B̂PBra both showed good concordance in following changes in BPRad (for all parameters overall degree was <7°). There were slightly more measurement pairs of MAP within the no-risk zone for B̂PRad than for B̂PBra (96 vs 77%, respectively). In this cohort of non-cardiac surgery patients, we found good agreement between BPRad and B̂PRad. Compared to B̂PBra, B̂PRad shows better agreement although clinical implications are small. This trial was registered with ClinicalTrials.gov (https://clinicaltrials.gov/ct2/show/NCT03795831). •A novel algorithm to estimate radial BP from non-invasive finger BP•Estimated radial BP showed good agreement with invasive radial BP•Estimated radial BP could be used to replace invasive BP monitoring in non-cardiac surgery patients

To identify the influence of modifiable factors in anesthesia induction strategy on post-induction hypotension (PIH), specifically the type, dosage and speed of administration of induction agents. A secondary aim was to identify patient related non-modifiable factors associated with PIH. Single-center, prospective observational cohort study. Operating room. Adult, ASA I-IV patients undergoing elective, non-cardiac surgery under general anesthesia (GA). None. Continuous non-invasive blood pressure using finger-cuff technology. PIH was defined as mean arterial pressure (MAP) <65 mmHg ≥1 min, and, separately, as a > 30 % decrease from baseline MAP ≥1 min. Study measurements were performed in 760 patients, of which 720 were suitable for analysis. A total of 238 patients (33.1 %) experienced PIH according to the 65 mmHg threshold, and 287 (39.9 %) using the 30 % decrease in MAP threshold. Remifentanil administration was associated with increased risk of PIH according to either definition (MAP <65 mmHg: OR 1.88, 95 %CI 1.31–2.69, p < 0.001, 30 % MAP decrease: OR 1.66, 95 %CI 1.15–2.40, p = 0.007). Pre-emptive vasopressor use (before or during first minute of GA) was associated with reduced risk of PIH (MAP <65 mmHg: OR 0.65, 95 %CI 0.45–0.95, p = 0.027, MAP 30 % decrease: OR 0.58, 95 %CI 0.40–0.84, p = 0.004). Speed of propofol bolus administration, propofol bolus dose, and esketamine use were not associated with PIH in multivariable analysis. Propofol bolus dose decreased with increasing age and American Society of Anesthesiologists physical status classification. PIH was common in this patient cohort, regardless of the definition used. Two of the five examined modifiable factors were associated with PIH: remifentanil infusion was associated with an increased risk, and pre-emptive vasopressor use was associated with a decreased risk of PIH. No association between propofol dose and PIH was found, most likely due dose adjustment based on clinical assessment rather than a true absence of effect. This study was registered in the Dutch Medical Research in Humans (OMON) register on 18 June 2019 (ID: NL7810). The study was approved by the Medical Ethics Committee of the Amsterdam UMC, location AMC, the Netherlands in December 2018 (NL 6748.018.18; 2018). •Hypotension during and after anesthetic induction is common.•Remifentanil increases the risk of induction hypotension whereas pre-emptive vasopressor use decreases risk.•In contrast, propofol dose and infusion speed and use of Esketamine had limited influence on induction hypotension.

PurposeThis scoping review aims to identify and describe knowledge gaps and research priorities in veno-arterial extracorporeal membrane oxygenation (VA-ECMO). MethodsAn expert panel was recruited consisting of eight international experts from different backgrounds. First, a list of priority topics was made. Second, the panel developed structured questions using population, intervention, comparison and outcomes (PICO) format. All PICOs were scored and prioritized. For every selected PICO, a structured literature search was performed.ResultsAfter an initial list of 49 topics, eight were scored as high-priority. For most of these selected topics, current literature is limited to observational studies, mainly consisting of retrospective cohorts. Only for ECPR and anticoagulation, randomized controlled trials (RCTs) have been performed or are ongoing. Per topic, a summary of the literature is stated including recommendations for further research.ConclusionsThis scoping review identifies and presents an overview of knowledge gaps and research priorities in VA-ECMO. Current literature is mostly limited to observational studies, although with increasing attention for this patient population, more RCTs are finishing or ongoing. Translational research, from preclinical trials to high-quality or randomized controlled trials, is important to improve the standard practices in this critically ill patient population.Take-home messageThis scoping review identifies and presents an overview of research gaps and priorities in VA-ECMO. Translational research, from preclinical trials to high-quality or randomized controlled trials, is important to improve the standard practices in this critically ill patient population.