Life Support Research Articles

Correction to: 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces.

Correction to: 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces.

Well-Being Domains in U.S. Military Veterans: Identifying Modifiable Factors to Promote Whole Health.

The U.S. Department of Veterans Affairs is actively transitioning away from a disease-centric model of healthcare to one that prioritizes disease prevention and the promotion of overall health and well-being. Described as Whole Health, this initiative aims to provide personalized, values-centered care that optimizes physical, behavioral, spiritual, and socioeconomic well-being. To inform this initiative, we analyzed cross-sectional data from a nationally representative sample of primarily older U.S. military veterans to estimate levels of well-being across these domains, and identify sociodemographic, military, and potentially modifiable health and psychosocial correlates of them. Results revealed that, overall, veterans reported high domain-specific well-being (average scores ranging from 6.7 to 8.3 out of 10), with the highest levels in the socioeconomic domain and lowest in the physical domain. Several modifiable factors, including purpose in life, resilience, and social support, were strongly associated with the examined well-being domains. Interventions targeting these constructs may help promote well-being among U.S. veterans.

Empirical meropenem versus piperacillin/tazobactam for adult patients with sepsis (EMPRESS) trial: Protocol.

Piperacillin/tazobactam may be associated with less favourable outcomes than carbapenems in patients with severe bacterial infections, but the certainty of evidence is low. The Empirical Meropenem versus Piperacillin/Tazobactam for Adult Patients with Sepsis (EMPRESS) trial is an investigator-initiated, international, parallel-group, randomised, open-label, adaptive clinical trial with an integrated feasibility phase. We will randomise adult, critically ill patients with sepsis to empirical treatment with meropenem or piperacillin/tazobactam for up to 30 days. The primary outcome is 30-day all-cause mortality. The secondary outcomes are serious adverse reactions within 30 days; isolation precautions due to resistant bacteria within 30 days; days alive without life support and days alive and out of hospital within 30 and 90 days; 90- and 180-day all-cause mortality and 180-day health-related quality of life. EMPRESS will use Bayesian statistical models with weak to somewhat sceptical neutral priors. Adaptive analyses will be conducted after follow-up of the primary outcome for the first 400 participants concludes and after every 300 subsequent participants, with adaptive stopping for superiority/inferiority and practical equivalence (absolute risk difference <2.5%-points) and response-adaptive randomisation. The expected sample sizes in scenarios with no, small or large differences are 5189, 5859 and 2570 participants, with maximum 14,000 participants and ≥99% probability of conclusiveness across all scenarios. EMPRESS will compare the effects of empirical meropenem against piperacillin/tazobactam in adult, critically ill patients with sepsis. Due to the pragmatic, adaptive design with high probability of conclusiveness, the trial results are expected to directly inform clinical practice.

Assessment of Impacts of Flood and Coping Strategies among Rural Households in Gicumbi District, Rwanda

Abstract Floods have become recurrent events in Rwanda, causing diverse effects on rural households across the country. However, little is known about the effects of floods encountered by people and their coping strategies, which are crucial for reducing vulnerability. Gicumbi District is among the most exposed to climate hazards and is vulnerable to the impacts of climate change. The effects of floods on rural households in Gicumbi district and their coping strategies were examined. A mixed approach was adopted where quantitative data was collected to inform wider understanding of a population and qualitative ones to acquire deep contextual insights about individual’s lived experiences. A structured questionnaire was used to collect data from 399 heads of households stratified into six district sectors. The study employed descriptive and inferential statistics for data analysis. Common effects of flooding experienced by the respondents included crop destruction, house damage, lack of sufficient food and safe drinking water. The coping strategies adopted by the respondents included saving money and food, support from friends and families, selling assets, borrowing money to restore losses, and migrating to other communities. In addition, flood victims received support from local authorities and Non-Governmental Organizations (NGOs), including financial support, temporary shelters, and life support materials. Adaptation strategies adopted by households included drainage channels, plantation of trees, radical terraces and sandbags. The results showed that lack of flood risk knowledge and access to early warnings, inadequate housing, living in high-risk areas, and dependence on a single source of income were the main factors influencing the severity of flood effects. Early warnings (p&lt;0.001) and flood risk awareness (p=0.009) significantly elicited positive coping mechanisms. Governments and relevant stakeholders should develop effective strategies and establish programs enabling timely access to early warning systems and increasing disaster risk awareness to reduce vulnerability for improved livelihoods and community resilience.

Central Venopulmonary Extracorporeal Membrane Oxygenation: Background and Standardized Nomenclature.

This review highlights advancements in extracorporeal life support (ECLS), emphasizing the critical role of standardized terminology, particularly for extracorporeal membrane oxygenation (ECMO) in treating right ventricular and respiratory failure. Advocating for the adoption of the Extracorporeal Life Support Organization (ELSO) Maastricht Treaty for ECLS Nomenclature guidelines, it aims to resolve communication barriers in the ECMO field. Focusing on venopulmonary (VP) ECMO utilizing central pulmonary artery (PA) access, this review details surgical approaches and introduces a terminology guide to support effective knowledge exchange and advancements in patient care.

Does a participatory live music practice support nurses to deliver compassionate care to hospitalised patients? A qualitative study.

To gain more insight into how nurses experience a participatory live music practice in relation to their ability to deliver compassionate care to medically hospitalised patients. Qualitative interpretive design. Sixteen nurses participating in a live music practice with patients were interviewed using in-depth interviews with open-ended questions. Audio recordings were transcribed verbatim and subsequently coded. Theory-driven inductive and deductive approaches were applied in thematic data analysis. We identified four themes: (1) Nurses' empathy and compassion; (2) The caring nurse-patient relationship; (3) Person-centred approaches to care and (4) Nurses' subjective wellbeing. By observing patients' reactions to the music, nurses described that they obtained a deeper insight and understanding of patients' emotional wellbeing. These observations led to increased feelings of compassion in patient contact and stimulated informal communication between nurses and patients through a sense of shared humanity. According to nurses, these aspects positively affected collaboration with patients in delivering care and stimulated them to pursue person-centred approaches to care. Participating in the live music practice also positively affected nurses' wellbeing, enhanced relaxation and created an ambiance in which compassion could be expressed. A live music practice can positively contribute to the delivery of compassionate care by providing meaningful shared moments that increase feelings of empathy and compassion and strengthen the caring relationship. Offering a live music practice at the ward and bedside offers a unique possibility to enhance engagement in person-centred, compassionate care. While compassion and compassionate care are essential component of nursing, nurses often experience multiple barriers to its provision in daily practice. An innovative way to stimulate compassionate care is through the participation of nurses and patients in a live music practice, providing a meaningful moment shared between them. This stimulates feelings of shared humanity and bonding in the caring relationship. The COnsolidated criteria for REporting Qualitative research (COREQ). No Patient or Public Contribution.

Predictive value of fluid balance before extubation on its outcome in mechanically ventilated adults in the intensive care unit.

Although there are many reasons for extubation failure, maintaining negative or lower positive fluid balances 24 hours before extubation may be a key measure for successful extubation. To assess the predictive value of fluid balance before extubation and its outcome in mechanically ventilated cases in the intensive care unit (ICU). This retrospective cohort study involved collecting clinical data from patients undergoing mechanical ventilation in Lanzhou general adult ICU from January 2022 to December 2022. Based on extubation outcomes, the patients were divided into a successful extubation group and a failed extubation group. Their fluid balance levels 24 h before extubation were compared with analyse the predictive value of fluid balance on extubation outcomes in patients undergoing mechanical ventilation. In this study, clinical data from 545 patients admitted to a general adult ICU were collected. According to the inclusion and exclusion criteria, 265 (48.6%) patients were included, of which 197 (74.3%) were successfully extubated; extubation was unsuccessful in 68 (25.7%) patients. The total intake and fluid balance levels in patients in the failed extubation group 24 h before extubation were significantly higher than those in the successful extubation group, with a median of 2679.00 (2410.44-3193.50) mL versus 2435.40 (1805.04-2957.00) mL, 831.50 (26.25-1407.94) mL versus 346.00 (-163.00-941.50) mL. Receiver operating characteristic (ROC) curve analysis showed that the optimal cut-off value for predicting extubation outcomes was 497.5 mL (sensitivity 64.7%, specificity 59.4%) for fluid balance 24 h before extubation. The area under the ROC curve was 0.627 (95% confidence interval [CI] 0.547-0.707). Based on the logistic regression model, cumulative fluid balance >497.5 mL 24 h before extubation could predict its outcomes in mechanically ventilated patients in the ICU (OR = 5.591, 95% CI [2.402-13.015], p < .05). The fluid balance level 24 h before extubation was correlated with the outcome of extubation in mechanically ventilated patients in the ICU. The risk of extubation failure was higher when the fluid balance level was >497.5 mL. Tracheal intubation is a crucial life support technique for many critically ill patients, and determining the appropriate time for extubation remains a challenge for clinicians. Although there are many reasons for extubation failure, acute pulmonary oedema caused by continuous positive fluid balance and volume overload is one of the main reasons for extubation failure. Therefore, it is very important to study the relationship between fluid balance and extubation outcome to improve the prognosis of patients with invasive mechanical ventilation in ICU.

Extracorporeal Membrane Oxygenation: Rescue Therapy in Pediatric Bupropion Cardiotoxicity

Abstract Objective Our objective was to describe clinical characteristics and course of pediatric bupropion ingestions requiring extracorporeal membrane oxygenation (ECMO) life support. Desgin The study included a retrospective cohort of patients ≤18 years of age reported to a regional poison control (PC) system covering three states in the upper Midwest United States. All bupropion exposures ≤18 years of age, coded as receiving ECMO to treat toxicity, were included. Clinical presentation and management including ECMO are presented as descriptive statistics. Results During the study period, 4,951 bupropion exposures were reported; 1,145 (23.1%) were children. Nine patients were coded as undergoing ECMO; four (44.4%) were ≤18 years of age (median 16, range 14–17). All were treated with venoarterial ECMO. The median time from ingestion to presentation was 2.25 hours (range: 1–3.5). Median first systolic blood pressure and pulse were 100 mm Hg (range: 70–124) and 119.5 (range: 70–175). The median time from ingestion to ECMO was 17.63 hours (range: 7.25–33.75); median number of vasopressors was 2.5 (range: 2–3). All experienced multiple seizures, ventricular dysrhythmias, and hypotension. Three of four sustained cardiac arrest. All but one required transfer to an ECMO-capable facility for definitive care. Three patients survived with full neurologic recovery; one died. Conclusion Pediatric bupropion cases requiring ECMO were rare in this study. Time to initiation and duration of EMCO suggest that the variable onset of hemodynamic instability may delay ECMO initiation. It is incumbent on PCs and medical toxicologists to educate prescribers and pediatricians about bupropion's potential lethality and to consider early transfer to an ECMO center.

Formative research to adapt a cardiac rehabilitation program to breast cancer survivors: the heart health after cancer treatment (HEART-ACT) study.

Breast cancer survivors are disproportionately at risk for cardiovascular disease; exercise-based interventions may improve cardiovascular health. The objective of this formative research is to better understand the needs of patients and barriers to participation in an adapted cardiac rehabilitation program for diverse breast cancer survivors in an urban safety net setting. We recruited 30 participants (10 English-speaking, 10 Spanish-speaking, and 10 Cantonese-speaking) who had received treatment with curative intent for breast cancer from an urban safety net hospital between November 9, 2021, to August 30, 2022. Participants completed surveys and interviews about perspectives on health behaviors and participating in an adapted cardiac rehabilitation program. Interviews were qualitatively analyzed using rapid template analysis with pre-selected constructs from the Theory of Planned Behavior, Unified Theory of Acceptance and Use of Technology, and Consolidated Framework for Implementation Research, as well as emergent codes. We developed a Participant User Journey for a program based on responses and conducted human-centered design sessions with 8 participants to iteratively revise the Participant User Journey. Among 30 participants, mean age was 56.7 years (standard deviation [SD] 10.2) with 100% female sex assigned at birth; 1 participant withdrew before completing study procedures. Most participants had limited health literacy (18/29, 62%). Mean body mass index was 31.4 (SD 8.3), 21/29 (72%) had blood pressure below 140/90 mmHg, and 12/29 (41%) had blood pressure below 130/80. Mean 6-minute walk distance was 384.9 meters (SD 78.3). The desired benefits of a program included healthy living and prevention of cancer recurrence. Barriers to participation included motivation, social support, transportation, and concerns about exercise safety. Participants emphasized the need for practicality, such as fitting physical activity into daily life and nutrition support, including recipes and shopping lists. Trusted experts and cultural and language concordance were viewed as important aspects of the program. Through participant interviews and human-centered design sessions, we developed the HEART-ACT program, a 12-week multi-disciplinary program addressing physical activity, nutrition, emotional well-being, cardiovascular risk, survivorship, and other components if indicated (e.g., tobacco cessation). Future research will test the effects of this program on patient-centered outcomes.

Problems of the transition of the Ukrainian economy to a “green economy” based on sustainable technological change

The article reveals the problems of the transition to a “green” economy based on sustainable technological changes, which are caused by global ecological pollution of the ecosystem, which leads to warming and ecological changes and the insufficiency of the natural resource potential to meet the needs of the population of the planet, which does not contribute to development. The essence of the study is to determine the impact of a green economy on economic growth and development, in which natural assets continue to provide resources and environmental services. It is shown that the green economy provides a practical and flexible approach to achieving concrete, measurable progress in all its economic and environmental principles, while at the same time fully taking into account the social consequences of greening the dynamics of economic growth. Green economy strategies aim to ensure that natural assets can fully realize their economic potential in a sustainable manner. This potential includes the provision of vital life support services—clean air and water, as well as the sustainable biodiversity needed to support food production and human health. Natural assets cannot be replaced indefinitely, so the policy of the green economy should take this into account. It is characterized that the green economy provides a practical and flexible approach to achieving concrete, measurable progress in all its economic and environmental principles, while at the same time fully taking into account the social consequences of greening the dynamics of economic growth. The problems of the post-war revival of Ukraine’s economy are systematized and proposals for their solution are substantiated, which is the scientific contribution of the authors to the coverage of this problem. The global problems of the transition to a green economy, which are closely related to Ukrainian realities, are revealed. The practical content is determined by the fact that the theoretical and methodological provisions, conclusions and scientific and practical recommendations constitute the scientific basis for the development of a new holistic concept of the development of the green economy of Ukraine. The conclusions that it is the “green” economy that is able to most closely link the ecological and economic aspects of the national economy, acting as a key direction for ensuring the sustainable “green” development of the region and the state as a whole, actualize the prospects of creating a green economy in Ukraine and become necessary and quite achievable in the post-war period.

Azithromycin for Pediatric Critical Asthma: A Multicenter Retrospective Cohort Study.

To characterize the prescribing trends and clinical outcomes related to azithromycin (AZI) among children hospitalized for critical asthma (CA). We performed a multicenter, retrospective cohort study using the Pediatric Health Information Systems registry of children 3 to 17 years of age hospitalized in a PICU for CA from January 2011 to December 2022. We excluded for alternative indications for AZI (eg, atypical pneumonia, B. pertussis infection, acute otitis media, acute sinusitis, pharyngitis/tonsillitis, and urethritis). The primary outcome was AZI prescribing rate by hospital and calendar year (trends assessed by Joinpoint regression). Cohorts with and without AZI exposure were further characterized by demographics, CA treatments, and inpatient outcomes using descriptive and comparative (ie, χ2 and Wilcoxon rank tests) statistics. Of the 47 797 children studied, 9901 (20.7%) were prescribed AZI with a downward annual trend noted from 34.7% in 2011% to 12.4% in 2022 (-1.7% per year, R2 = 0.91). Median institutional AZI prescribing rate was 19.2% (interquartile range [IQR] 11.7%-28%; total range 5.6%-60%). Compared with children not prescribed AZI, those prescribed AZI were older (median 8.3 [IQR 5.7-11.6] vs 7.3 [4.9-10.8] years, P < .001) and experienced a more severe clinical trajectory with greater rates of bilevel positive airway pressure ventilation (19.7% vs 12.6%, P < .001), invasive ventilation (22.1% vs 13.5%, P < .001), extracorporeal life support (0.8% vs 0.1%, P < .001), and median length of stay (4 [IQR 3-6] vs 3 [IQR 2-4] days, P < .001). Between 2011 and 2022, 20.7% of children hospitalized for CA were prescribed AZI notwithstanding the absence of trial-derived efficacy or safety data for this indication and population.

Outcome of patients with different stages of acute-on-chronic liver failure treated with artificial liver support system

BackgroundElevated international normalized ratio of prothrombin time (PT-INR) is one of the key characteristics of acute-on-chronic liver failure (ACLF). Whether the staging of PT-INR has the ability to screen out subgroups of ACLF patients who would be more eligible for artificial liver support system (ALSS) treatment has not been studied in detail.MethodsA previous study enrolled patients receiving ALSS treatment with regional citrate anticoagulation from January 2018 to December 2019. Patients with different PT-INR intervals were retrospectively enrolled: 1.3 ≤ PT-INR &amp;lt; 1.5 (Pre-stage), 1.5 ≤ PT-INR &amp;lt; 2.0 (Early-stage), 2.0 ≤ PT-INR &amp;lt; 2.5 (Mid-stage), and PT-INR ≥ 2.5 (End-stage). The Cox proportional hazards models were used to estimate the association between stages of ACLF or sessions of ALSS treatment and 90 day mortality.ResultsA total of 301 ACLF patients were enrolled. The 90 day mortality risk of Early-stage ACLF patients (adjusted hazard ratio (aHR) (95% confidence interval (CI)), 3.20 (1.15–8.89), p = 0.026), Mid-stage ACLF patients (3.68 (1.34–10.12), p = 0.011), and End-stage ACLF patients (12.74 (4.52–35.91), p &amp;lt; 0.001) were higher than that of Pre-stage ACLF patients, respectively. The 90 day mortality risk of Mid-stage ACLF patients was similar to that of Early-stage ACLF patients (1.15 (0.69–1.94), p = 0.591). The sessions of ALSS treatment was an independent protective factor (aHR (95% CI), 0.81 (0.73–0.90), p &amp;lt; 0.001). The 90 day mortality risk in ACLF patients received 3–5 sessions of ALSS treatment was lower than that of patients received 1–2 sessions (aHR (95% CI), 0.34 (0.20–0.60), p &amp;lt; 0.001), whereas the risk in patients received ≥6 sessions of ALSS treatment was similar to that of patients received 3–5 sessions (0.69 (0.43–1.11), p = 0.128).ConclusionACLF patients in Pre-, Early-, and Mid-stages might be more eligible for ALSS treatment. Application of 3–5 sessions of ALSS treatment might be reasonable.

THE HF–ABCDE+FG APPROACH IN HEART FAILURE: A SIMPLIFIED DECISION– MAKING ALGORITHM FOR MANAGEMENT IN EMERGENCY DEPARTMENT

Abstract The–HF– ABCDE+FG protocol is an easy to memorize algorithm for diagnosis and treatment of Heart failure (HF) in the setting of Emergency Department (ED). The acronym “ABCDE” recalls the more famous ABCDE sequence proposed in Advanced Life Support (ALS), the most widely used and standardized approach to critical patients in the ED. Using a similar approach, the algorithm here proposed can help to recall the main elements of the patient’s assessment presenting acute heart failure (AHF) concerning diagnosis and early therapy. It should be interpreted as a continuum since each step is partially overlapped and mnemonically linked to the previous and to the next one. As Acute heart failure can present with a variable pattern of signs and symptoms, diagnosis in the Emergency Department can be supported by a rapid and easy to memorize pathway made up of 5 steps: A (history assessment), B (blood exams/ blood gas analysis), C (Chest X–Ray), D (Dysfunction– lung anch heart ultrasound), E (Electricity– verify ICD or PM when implanted). On the other hand, with reference to the therapeutic algorithm, we suggest an extended protocol ABCDE+FG: each word of the acronym stands for a Class I recommendation coming from 2021 ESC Guidelines: A (ACE–i/ ARBs/ARNI), B (standing for Beta–Blockers), C (anti–choagulation) and D (Diuretics) which represent the standard desease–controlling therapy. In addiction, attention must be paid to associated conditions, like underlying electrical instability requiring PM or ICD (E standing for Electrical Therapy), iron deficiency (F standing for Ferric Carboxymaltose) and poor glycemic control (G standing for Glyfozines). In fact, it has been demonstrated that an optimyzed therapy from a very early stage can deeply impact on the evolution of desease and remarkably reduce further accesses for AHF. Thus, once the patient has been stabilyzed in the ED, we suggest to initiate the most appropriate therapy as soon as possible and eventually send the patient to the best setting of care (discharge, short observation, non intensive/intensive care).

PROSTHETIC GRAFT INFECTION: WHEN ECHOCARDIOGRAPHY IS NOT ENOUGH!

Abstract A 68–year–old Caucasian male, post–Bentall procedure with a bioprosthetic valve following extensive aortic dissection involving the ascending aorta and aortic arch, presented to the Emergency Department with persistent fever for over a month. During his hospitalization, he experienced ventricular fibrillation in the setting of hypokalemia, successfully managed with Advanced Cardiovascular Life Support (ACLS) and DC shock, leading to the restoration of sinus rhythm. Subsequently, he was admitted to the Cardiovascular Intensive Care Unite. Blood tests revealed neutrophilic leukocytosis with elevated inflammatory markers, anemia, and a troponin curve consistent with myocardial injury in the context of sepsis and anemia. Echocardiography demonstrated a left ventricle of normal dimensions with globally depressed function (EF 45%), attributed to apical akinesia. The prosthetic valve was functioning normally, and there were no signs of endocarditic vegetations or pericardial involvement. A transesophageal echocardiogram confirmed the absence of vegetations. Given echocardiographic signs of myocardial ischemia, coronary angiography was performed, revealing a coronary circulation free from significant stenosis. Cultural exams showed positivity for Enterococcus faecalis. A PET–CT revealed the presence of radioisotope uptake around the vascular prosthesis situated in the aortic arch. An Infectious Disease specialist recommended antibiotic therapy with Piperacillin/Tazobactam and Teicoplanin. At the one–month follow–up, the patient remained asymptomatic, free from new febrile episodes. The follow–up echocardiogram indicated improved global systolic function, and inflammatory markers remained consistently negative. Repeat blood cultures were negative. This case illustrates a suspected endocarditis on a prosthetic valve where both transthoraci and transesophageal echocardiography yielded negative results. The use of PET–CT, on the other hand, revealed the presence of vascular graft infection, proving to be a valuable method in this clinical setting.

Increasing Eligibility to Transplant Through the Selective Cytopheretic Device: A Review of Case Reports Across Multiple Clinical Conditions.

A stable, minimum physiological health status is required for patients to qualify for transplant or artificial organ support eligibility to ensure the recipient has enough reserve to survive the perioperative transplant period. Herein, we present a novel strategy to stabilize and improve patient clinical status through extracorporeal immunomodulation of systemic hyperinflammation with impact on multiple organ systems to increase eligibility and feasibility for transplant/device implantation. This involves treatment with the selective cytopheretic device (SCD), a cell-directed extracorporeal therapy shown to adhere and immunomodulate activated neutrophils and monocytes toward resolution of systemic inflammation. In this overview, we describe a case series of successful transition of pediatric and adult patients with multiorgan failure to successful transplant/device implantation procedures by treatment with the SCD in the following clinical situations: pediatric hemophagocytic lymphohistiocytosis, and adult hepatorenal and cardiorenal syndromes. Application of the SCD in these cases may represent a novel paradigm in increasing clinical eligibility of patients to successful transplant outcomes.

Social support in maintaining mental health and quality of life among community-dwelling older people with functional limitations in Malaysia: a population-based cross-sectional study

ObjectiveThis study aimed to examine the mediation role of perceived social support in the relationship between functional limitations, depressive symptoms and quality of life among older people in Malaysia.SettingThe Malaysian...

Flipped classroom approach for trauma education: Attitudes of participants towards pre-course assignments before the advanced trauma life supports (ATLS) instructor course

A flipped classroom approach in principle, denotes pre-course engagement for an upcoming educational course. Although never used in trauma education, other educational literature is resplendent with the beneficial effects of pre-course engagement on the learning outcomes of the course itself. In this article we share the attitudes and perspectives of prospective Advanced Trauma Life Supports Instructors towards pre-course assignments to see whether this works in the field of trauma education.After an online pre-course session, we administered a validated questionnaire to 100 participants. The questionnaire had 4 categories - the first dealing with participants’ characteristics and the rest with their attitude and perspectives towards the pre-course sessions. The last category included three open ended questions for qualitative analysis to explain the attitudes of the participants.The participants showed a significantly positive attitude (p&amp;#60;0.029) towards this flipped classroom approach. The reasons cited were “effective sensitization”, “adequate feedback”, “peer learning” “user friendly platform” “enjoyable” and “relevance”. A significantly higher level of agreement with the questionnaire statements was seen amongst the private sector doctors as compared to those working in public sector medical colleges (p = 0.004). Same was observed amongst clinical specialists as compared to pre or para clinical specialists (p = 0.001). The Questionnaire had a Cronbach’s alpha of 0.86.The study concludes that a flipped classroom approach can work well in trauma education. A tailored approach, depending upon participant characteristics, may be needed to enhance the relevance of a flipped classroom approach.

Frailty, Outcomes, Recovery and Care Steps of Critically Ill Patients (FORECAST): a prospective, multi-centre, cohort study.

Frailty is common in critically ill patients but the timing and optimal method of frailty ascertainment, trajectory and relationship with care processes remain uncertain. We sought to elucidate the trajectory and care processes of frailty in critically ill patients as measured by the Clinical Frailty Scale (CFS) and Frailty Index (FI). This is a multi-centre prospective cohort study enrolling patients ≥ 50years old receiving life support > 24h. Frailty severity was assessed with a CFS, and a FI based on the elements of a comprehensive geriatric assessment (CGA) at intensive care unit (ICU) admission, hospital discharge and 6months. For the primary outcome of frailty prevalence, it was a priori dichotomously defined as a CFS ≥ 5 or FI ≥ 0.2. Processes of care, adverse events were collected during ICU and ward stays while outcomes were determined for ICU, hospital, and 6months. In 687 patients, whose age (mean ± standard deviation) was 68.8 ± 9.2years, frailty prevalence was higher when measured with the FI (CFS, FI %): ICU admission (29.8, 44.8), hospital discharge (54.6, 67.9), 6months (34.1, 42.6). Compared to ICU admission, aggregate frailty severity increased to hospital discharge but improved by 6months; individually, CFS and FI were higher in 45.3% and 50.6% patients, respectively at 6months. Compared to hospital discharge, 18.7% (CFS) and 20% (FI) were higher at 6months. Mortality was higher in frail patients. Processes of care and adverse events were similar except for worse ICU/ward mobility and more frequent delirium in frail patients. Frailty severity was dynamic, can be measured during recovery from critical illness using the CFS and FI which were both associated with worse outcomes. Although the CFS is a global measure, a CGA FI based may have advantages of being able to measure frailty levels, identify deficits, and potential targets for intervention.

Anesthetic Considerations and Outcomes in Amniotic Fluid Embolism: A Retrospective Study over a 15-Year Period

(1) Background: A rare and unexpected consequence of childbirth, labor, or the immediate postpartum period is amniotic fluid embolism (AFE). This study aims to identify AFE cases during or immediately after birth from anesthetic management perspectives. Secondary goals include assessing patient clinical features, obstetric care techniques, birth outcomes, and case survival. (2) Methods: A retrospective observational study assessed AFE patients hospitalized in three Romanian clinical institutions from October 2007 to April 2023. Based on the Society of Maternal-Fetal Medicine (SMFM) criteria, we diagnosed 11 AFE patients. (3) Results: AFE occurred in eight cases (73%) during peripartum, two (18%) within 30 min after placental delivery, and 1 (9%) during a scheduled cesarean surgery. Only one of six cardiorespiratory arrest patients responded to external cardiac massage, while the other five (83%) needed defibrillation. The patients received, on average, five units of red blood cells, six of fresh frozen plasma, and two of activated platelets. Six patients (55%) received factor VIIa infusions. Maternal mortality was 36.3%. Six neonates (75%) needed neonatal resuscitation, and two (25%) died on the second and third days. (4) Conclusions: AFE management necessitates a multidisciplinary approach and the incorporation of advanced life support techniques to optimize outcomes for both the mother and newborn.

The effect of spaced E-Learning on knowledge of basic life support and satisfaction of nursing students: a quasi-experimental study

AimCardiopulmonary resuscitation (CPR) training is essential for all students, especially nursing students. One of the educational approaches to creating long-term learning in inclusive is spaced learning. Spaced learning consists of three or more training sessions in which information is presented over time and at intervals. The present study was conducted to investigate the effect of basic life support (BLS) training through spaced E-learning on the knowledge and satisfaction of nursing students.MethodsIn this quasi-experimental study with two groups, 106 undergraduate nursing students of Alborz University of Medical Sciences in Iran participated. The control group (n = 47) received BLS training with massed E-learning in one three-hour session, and the intervention group (n = 59) received spaced E-learning in three one-hour sessions. An electronic questionnaire including demographic information and a pre-test of BLS knowledge were sent to both groups. Also, immediately after receiving the training, two weeks later and one month later, they completed a post-test of BLS knowledge. Students were asked to indicate their level of satisfaction with the provided education by completing the SLS-OLE.ResultsThe post-test scores immediately after, two weeks later, and one month later of the intervention group were higher than the control group. The results of repeated measurement ANOVA showed that the score changes of knowledge are significant over time (p < 0.001), the number of sessions (p < 0.001), and the interactive effect of them (p < 0.001). There was no statistically significant difference in the level of satisfaction with education in both groups.ConclusionBased on the results, BLS training in both groups increased the knowledge of BLS. however, the increase in knowledge and its retention was higher in the intervention group that received the training in spaced learning.