Feeding intolerance is common in intensive care unit (ICU) patients, but evidence supporting prokinetic use is limited. We aimed to provide international epidemiological data on the use of prokinetic agents in adult ICU patients and to explore potential associations with patient-important outcomes. We conducted an inception cohort study between August 2024 and March 2025 in acutely admitted ICU patients in 56 ICUs across 11 countries. The primary outcome was the proportion of patients receiving prokinetic agents. Secondary outcomes included associations with baseline characteristics, serious adverse events (SAEs), days alive out of ICU/hospital, days alive without life support and 90-day mortality. Associations with SAEs, baseline characteristics and mortality were assessed using pre-specified Cox regression models, while other secondary outcomes were evaluated using adjusted linear regression. All models were adjusted for country, severity of illness, number of comorbidities, surgery and ICU admission type. Among 1440 ICU patients (median age 64 years, 56.9% male), 187 (13.0%; 95% confidence interval [CI] 11.3-14.8) received prokinetic agents during ICU stay, most commonly metoclopramide (65%). Prior abdominal surgery was associated with the initiation of prokinetic agents (hazard ratio [HR] 1.81; 95% CI 1.17-2.79). Use of prokinetic agents was statistically significantly associated with a higher hazard of experiencing a SAE (HR 1.9; 95% CI 1.3-2.8), fewer days alive out of ICU (mean difference [MD] -7.6 days; 95% CI, -13.4 to -2.2) and hospital (-13.5 days; 95% CI -18.7 to -8.4), but not with 90-day mortality (HR 0.62; 95% CI 0.3-1.2). Prokinetic agents were used in 13% of ICU patients, most commonly metoclopramide and more often in those with prior abdominal surgery. Prokinetic use was associated with a higher hazard of experiencing SAEs and fewer days alive out of hospital/ICU.

The development of a commercial space resources (SRU) industry could face a conundrum: Is it possible to finance and develop a SRU industry in the absence of an existing market? And conversely, is it possible to develop a SRU market prior to the development of a SRU industry? Various potential markets have been proposed for SRU over time. These include water sourced from the Moon or asteroids as feedstock for propellant or for the use of life support and radiation shielding, precious metals, principally platinum group metals sourced from asteroids for sale into terrestrial markets, and lunar sourced helium-3 for terrestrial nuclear fusion. However, there appears to be little critical evaluation of most of these potential markets to help determine viability. This paper reviews existing methodologies for evaluating markets and then proposes a revised methodology for evaluating potential SRU markets. The methodology takes a simplified approach using a framework that evaluates six factors: ‘product’, ‘customers & market’, ‘market growth’, ‘competition’, ‘pricing’, and ‘economics’. A practical demonstration of the framework is provided, through its use as a screening tool to evaluate the potential market for producing platinum from asteroids for return to terrestrial markets. The paper discusses how SRU markets could be segmented, in this case illustrating market segmentation by location, with potential markets proposed for three segments: the lunar surface, the terrestrial economy, and cislunar space. The paper also discusses other practical considerations important from a commercial / market perspective, in particular considerations around potential pricing and contract structure, drawing on pricing and contract practice in the terrestrial natural resources industries. Finally, the question of how SRU markets and customers could evolve is reviewed. Such markets could evolve from fixed price and term contracts with government entities, through public private partnerships with some flexibility around pricing and contract terms, to deep, liquid markets based perhaps on benchmark pricing as is currently the case in the terrestrial oil industry and to a lesser extent in markets for minerals such as iron ore. • Classic market evaluation frameworks can fail for first generation SRU. • Propose six pillar SRU screen: product, market, growth, competition, pricing, economics. • Pricing/contract structures will be key to SRU financing. • Market segmentation can focus product/market fit and financing pathways.

Effects of distinct prebriefing and debriefing on learning outcomes in advanced life support training for ward nurses: A randomized controlled trial.

One Teenager's Choice: Continue Life Support or Let Go.

Disparities in Access to Neonatal and Pediatric Extracorporeal Membrane Oxygenation Services in the United States.

Pediatric secondary transports within a regional emergency medical services system.

Incidence trends, outcomes, and factors associated with mortality in multisystem inflammatory syndrome in children: A nationwide study in Thailand during 2021-2023.

We have evaluated the complications and outcomes of venovenous multisite (VVMS) cannulation for support with extracorporeal membrane oxygenation (ECMO) using the Extracorporeal Life Support Organization (ELSO) registry of neonates (≤ 28 d old) and infants (29-364 d old). Retrospective ELSO database cohort, comparing outcomes and complications associated with VVMS and venovenous dual lumen (VVDL) cannulation. Patients younger than 1 year supported with VV ECMO. ELSO data January 1, 2013 to December 31, 2023. None. We identified 1403 neonates and 603 infants supported with VVDL, and 42 and 77, respectively, with VVMS. At 24 hours of ECMO we found median (interquartile range [IQR]) oxygen saturations (Sao2) were higher in the VVMS compared with the VVDL group: for neonates, 98% (IQR, 93-99%) vs. 94% (IQR, 89-97%); a p value of less than 0.01; and for infants, 94% (IQR, 91-97%) vs. 90% (IQR, 85-95%); a p value of less than 0.01. After adjustment for ventilatory parameters, VVMS was associated with higher mean (95% CI) Sao2 than VVDL: for neonates by 3.3% (95% CI, 1.0-5.6%); p = 0.005; and for infants by 3.3% (95% CI, 1.3-5.3%); p = 0.002. Higher Sao2 was also associated with higher flows rather than ventilator parameters. Median flows were higher in the VVMS group compared with VVDL for neonates (111 vs. 101 mL/kg/min) and infants (114 vs. 100 mL/kg/min); a p value of less than 0.01. In general, we failed to identify associations between support technique and mortality or complications. However, in infants, VVMS in comparison with VVDL was associated with fewer mechanical complications (23% vs. 37%; p = 0.02). Between 2013 and 2023, in neonatal and infant ECMO, VVMS as opposed to VVDL cannulation was associated with higher ECMO flows and Sao2 at 24-hour support. We failed to identify associations between support technique and complications or mortality, apart from lower mechanical complications in infants supported using VVMS.

Blood coagulation analysis is essential for evaluating bleeding and clotting risks, particularly in extracorporeal life support (ECLS) patients receiving preventative anticoagulant therapy, like heparin or bivalirudin. Therapy management requires continuous monitoring; however, existing methods exhibit high variability and require relatively large blood volumes, limiting their use in neonatal and pediatric care. This study assesses the ability of integrated quasistatic acoustic tweezing thromboelastometry (i-QATT), a novel noncontact technique utilizing small blood samples (6 µl), to monitor anticoagulant therapy. Integrated quasistatic acoustic tweezing thromboelastometry analysis was conducted on platelet-poor plasma samples collected from pediatric ECLS patients treated with unfractionated heparin (UFH) or bivalirudin, while heparinase was applied to neutralize the anticoagulation effect of UFH. Integrated quasistatic acoustic tweezing thromboelastometry accurately detected UFH and bivalirudin effects and UFH reversal in commercial and patient plasma samples, where clot initiation time, clotting time, and time to firm clot formation were identified as key i-QATT parameters in anticoagulant monitoring. The technique demonstrated sensitivity to anticoagulant dosage levels, effectively distinguished between different anticoagulants, and exhibited strong correlations with gold-standard plasma coagulation tests and rotational thromboelastometry. Additionally, i-QATT showed potential in assessing dynamic changes in thrombosis during the treatment period. The findings of this study highlight i-QATT's ability to monitor anticoagulant therapy in pediatric patients.

The American Heart Association (AHA) regularly updates its evidence-based practice recommendations for basic life support, advanced cardiovascular life support, pediatric life support, and neonatal life support. This article reviews the latest AHA guidelines, which were released in October 2025, highlights important changes, and demonstrates how nurses can incorporate these changes into their practice. Examples of new practice recommendations include back blows and abdominal thrusts in the management of severe foreign body obstruction in the conscious adult, use of the two thumbs encircling approach or heel of one hand when providing infant chest compressions, and the administration of an initial 200 Joule synchronized shock in the unstable patient with atrial fibrillation.

The effects of active video games on psychology among adolescents with overweight and obesity: A systematic review.

Web-based versus simulation-based refresher training in newborn life support: A randomized multicenter noninferiority controlled trial.

Regional versus National Lung Allocation for Patients Bridged to Transplant with Extracorporeal Life Support: A Comparison of Canada and France Models of Allocation

Intensive care nurses sensitive to the physical and emotional needs of their patients who are vulnerable during advanced cardiopulmonary life support may experience moral distress when they cannot act insituations they consider morally and ethically correct. This study aimed to determine the moral distress experienced by intensive care nurses during advanced cardiopulmonary life support and the contextual factors leading to this distress. A qualitative, descriptive study using semi-structured interviews was conducted. This study was conducted with 21 nurses who had worked in an adult intensive care unit for at least 1 year and had experience attending advanced cardiopulmonary life support. Data were collected between November and December 2023. Data were evaluated using the content analysis method. Consolidated Criteria for Reporting Qualitative was used for reporting this study. The following three themes and eight sub-themes were identified: (i) decisions in resuscitation, (ii) disorganization within the organization and (iii) person-centred care. Intensive care nurses sensitive to their patient's physical and emotional needs often experience moral distress for many reasons during the advanced cardiopulmonary life support process. Intensive care nurses experience moral distress during advanced cardiopulmonary life support due to lack of knowledge, legal obligations, organizational problems, inadequate teamwork and equipment and inadequacies in person-centred care. Intensive care nurses frequently experience moral distress due to the nature of intensive care. However, information on the moral stress they experience during one of the most critical moments, the Advanced Cardiopulmonary Life Support (ACLS), is limited. In order to decrease the moral distress of nurses, regular training should be planned in which case studies are discussed and supported by ACLS simulations. Furthermore, a healthy working environment where intensive care nurses can comfortably share and resolve the moral distress that they experience during ACLS.

POCUS in pediatric arrest (Res-US pulse check): development and evaluation of a simulation-based curriculum.

Collocated mixed reality for basic life support training in medical students: a randomised pilot feasibility trial.

Advanced life support (ALS) competence may deteriorate within months after certification, but what supports ongoing competence in critical care remains unclear. To map factors influencing maintenance of ALS competence among critical care professionals working in critical care settings. Scoping review conducted in accordance with Joanna Briggs Institute guidance and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. MEDLINE, CINAHL and the Cochrane Library were searched (from February to March 2025). We included peer-reviewed and grey sources from hospital-based critical care settings that assessed ALS competencies over time. Data were synthesised using inductive thematic analysis. Twenty-five sources were included (19 peer-reviewed, 6 grey). Factors were mapped to three domains. Educational factors were most frequently reported and centred on simulation-based rehearsal, structured feedback and debriefing and spaced refreshers delivered in brief, frequent sessions. Institutional determinants related to protected training time, access to resources, standardised roles and content and monitoring through audit and feedback. Individual determinants included clinical exposure and experience, perceived preparedness and self-confidence, stress and cognitive load, engagement in ongoing learning and non-technical behaviours. Outcomes were largely simulation-based or self-reported, and longer-term durability was inconsistently assessed. Maintenance of ALS competence appears to require coordinated educational and organisational supports; longitudinal evaluations with explicit definitions and validated outcomes are needed. Critical care services may strengthen ALS competence maintenance by embedding recurrent, context-aligned rehearsal with feedback, supported by protected training time, accessible training infrastructure and ongoing performance monitoring. The review protocol was prospectively registered on the Open Science Framework https://doi.org/10.17605/OSF.IO/PEQJH.

Extracorporeal Membrane Oxygenation (ECMO) serves as a temporary life support for critically ill patients, and with its advancing clinical application, survival rates have significantly improved. However, research focus is shifting from saving lives to improving survivors' quality of life. Currently, most studies concentrate on short-term outcomes such as in-hospital mortality, while long-term psychosocial adaptation after discharge remains understudied. Extracorporeal Membrane Oxygenation patients often face psychological distress during Intensive Care Unit stays and multiple challenges after discharge, which can profoundly affect their long-term quality of life and social reintegration. Therefore, it is necessary to conduct an in-depth study on the psychosocial adaptation of ECMO survivors and its influencing factors. To assess the long-term psychosocial adaptation status of survivors after Extracorporeal Membrane Oxygenation (ECMO) and to identify its key influencing factors. A multicentre cross-sectional study. This study utilized a convenience sampling method to recruit 205 patients discharged after Extracorporeal Membrane Oxygenation treatment from three tertiary hospitals, China. Data were collected using the Self-Report Psychosocial Adjustment to Illness Scale, general information questionnaire, the Connor-Davidson Resilience Scale and the Social Support Rating Scale. A total of 205 ECMO patients were included in this multicentre study. The psychosocial adaptation score of Extracorporeal Membrane Oxygenation patients was 48.40 ± 22.43. Multiple linear regression analysis revealed that age, income, residence, education level and time since discharge were significant influencing factors for psychosocial adaptation in these patients. The psychosocial adaptation of Extracorporeal Membrane Oxygenation patients was found to be at a moderate level, indicating a need for further improvement. Healthcare professionals should implement targeted interventions to enhance their psychosocial adaptation and promote better disease outcomes. For clinical nurses, these findings highlight the need to systematically assess not only patients' physical function but also their psychological resilience and ability to utilise social support during follow-up. Targeted interventions focusing on resilience-building and actively coaching patients on how to effectively seek and accept support should be integrated into post-ECMO care plans to improve long-term psychosocial adaptation. For patients and families, this underscores the importance of developing skills to actively engage with support networks and resources throughout the recovery journey.

Basic life support (BLS) refers to the immediate care provided to individuals experiencing respiratory arrest, cardiac arrest, or airway obstruction. This study aimed to assess the knowledge and attitudes regarding BLS among postgraduate trainee doctors. A descriptive cross-sectional study was conducted among 105 postgraduate trainees from various disciplines at Mymensingh Medical College Hospital, Bangladesh over a six-month period from January to June 2018. Of the respondents, 55.2% were male and 44.8% were female, with a mean age of 30.7±2.5 years. Participants represented Medicine (48.6%), Surgery (23.8%) and Obstetrics and Gynaecology (27.6%) faculties. Most respondents had three years of clinical training (31.3%), followed by two years (21.0%), four years (21.0%), more than one year (18.1%) and more than six months (8.6%). Only 24.8% of the trainees had received prior BLS training and their knowledge scores (8.61±2.55) were significantly higher than those without training (p<0.05). However, overall knowledge gaps were evident, with the majority uncertain about the initial response for an unresponsive patient (70.5%), correct chest compression location in adults (71.4%) and infants (68.6%), compression depth, compression rate, rescue-breath frequency and management of foreign body aspiration in both adults and children. Many were also unsure of the meanings of key abbreviations such as AED (Automated external defibrillator) and EMS (Emergency Medical Services). Regarding attitudes, most participants agreed that all doctors should receive BLS training (49.5%) and that BLS should be included in the undergraduate curriculum (63.8%). Half (50.5%) emphasized the need for supervised hands-on training. Common reasons for hesitation to perform BLS included fear of harming patients (36.2%), lack of practice (28.6%), risk of contamination during mouth-to-mouth ventilation (21.0%) and fear of mishap in public settings (19.0%); 12.4% reported no hesitation. The study concludes that standardized and reinforced practical BLS training is essential for postgraduate medical trainees and practicing physicians to ensure preparedness and competence.

Serious Arrhythmia Increased 30-Day Mortality in Patients with Fulminant Myocarditis on Veno-Arterial Extracorporeal Life Support