Rescue Strategy Research Articles

Management of headaches in children and adolescents

Pediatric headache impacts up to 80% of children, many recurrently, by the time they are 15 years old. Preventing the progression of episodic to chronic headache results in less truancy, staying current with schoolwork and improves children's quality of life. Lifestyle choices can play an important role in headache treatment. Early effective treatment of episodic headache can prevent transformation into a chronic form. While details of a child's headache are critical for making a proper diagnosis; patient education is critical and effective rescue and preventive treatment strategies enable patients to focus on enjoying activities of daily living. Recognizing "red flags" that may suggest a serious underlying etiology is critical in the early stages of diagnosing and preparing to treat children with headaches. Finally directing patients to manage their headaches at home and when to proceed to an emergency department, urgent care or infusion unit can lower the economic burden of acute headache management.

An adaptive frequency – Voltage control model for extracorporeal supporting flow regulation in an extracorporeal membrane oxygenation system

Extracorporeal membrane oxygenation (ECMO) is employed to treat critical patients for one to a few days of life support in intensive care units. Venovenous (VV) and venoarterial (VA) ECMO configurations are the most commonly used rescue strategies for temporary cardiac and respiratory function support. However, both ECMO modes sometimes cannot meet a patient’s demands because of (a) less oxygenated blood in either the upper body or lower body, or (b) a deterioration in the patient’s hemodynamic status. Veno-Venoarterial (VVA) ECMO is an upgraded system that provides sufficiently oxygenated blood to the systemic and pulmonary circulation systems. Drainage cannulas and gas flow exchanges are determined to provide the maximum drainage blood flow required by the patient through a servo-regulator that adjusts the motor speed. A generalized regression neural network (GRNN) based estimator is created to automatically estimate the desired pump speed and then provide sufficient drainage flow for temporary life support. To achieve stability flow in an ECMO circuit, a bisection approach algorithm (BAA) is employed to improve the performance of transient responses in step controls and steady state controls. Experimental studies are used to validate the proposed model and it is compared with conventional controllers to indicate good performance in clinical VVA ECMO applications.

Nonsurgical rescue after basket-stone impaction by endoscopic cutting of a metallic lithotripter and laser lithotripsy.

Video 1Endoscopic rescue strategy for basket-stone impaction.

Platelet Aggregation Dysfunction in Sickle Cell Disease

Acute systemic painful vaso-occlusive crisis (VOC) is the predominant clinical event requiring sickle cell disease (SCD) patients to seek emergency medical care. VOC often serves as an antecedent to acute chest syndrome (ACS), which is a type of acute lung injury and the leading cause of mortality in SCD. Current treatments for ACS are primarily supportive, and there is a critical need for rescue strategies to prevent the progression of VOC to ACS. ACS involves thrombosis across pulmonary artery branches, but the pathophysiology of thrombosis in SCD is largely unknown. Adenosine diphosphate (ADP) released from lysed erythrocytes can activate platelets by stimulating the purinergic receptors P2Y1 and P2Y12, suggesting that blocking these receptors may prevent VOC. Surprisingly, P2Y12 receptor blockade was unsuccessful in preventing VOC in a recent DOVE trial, justifying the need for better understanding of purinergic signaling in SCD.We used a novel intravital microscopy enabled experimental model of vaso-occlusive pulmonary thrombosis in transgenic SCD mice triggered by an intravenous (IV) administration of ADP. This method allows real time in vivo visualization of platelet aggregation in the lung of live SCD mice using multi-photon-excitation based quantitative fluorescence intravital lung microscopy (qFILM). We discovered that vaso-occlusive thrombosis involves entrapment of large circulating platelet aggregates in the bottle-necks located between the pulmonary arterioles and capillaries. Surprisingly, the dose of ADP that led to the pulmonary vaso-occlusive thrombosis in control mice, failed to induce vaso-occlusive thrombosis in SCD mice. Remarkably, further in vivo and in vitro platelet aggregation studies confirmed that SCD mouse platelets were indeed refractory to ADP but not collagen.Our preliminary findings suggest that therapeutic inhibition of P2Y1 and P2Y12 platelet receptors will not be a successful therapy in SCD. Our findings also warrant the need for further studies to understand the role of purinergic signaling in SCD DisclosuresNo relevant conflicts of interest to declare.

Equity Crowdfunding sebagai Opsi Penyelamatan UMKM dari Krisis Akibat Pandemi

This study aims to identify the role of equity crowdfunding in saving MSMEs from the crisis due to the pandemic. This study used a qualitative descriptive method using various sources of information from previous research, regulations, and published repot by various agencies such as OJK and Kemenkopukm. The Covid-19 pandemic that entered Indonesia resulted in a drastic decrease in the profits of MSME business players. This makes MSMEs have to carry out various strategies to maintain their business so they are not swept away by a pandemic storm. Reducing workforce, saving sales figures using online platforms, and pivoting are some of the strategies undertaken by MSMEs to maintain their business. This makes MSMEs need to take their business through the addition. Equity crowdfunding is an option for MSMEs to increase capital to carry out various rescue strategies. In addition to providing opportunities for MSMEs to get additional funds, through the equity crowdfunding platform, MSMEs can also support their business to the wider community. This can increase the value of products and brands and increase the popularity of the customer base so as to increase the MSME business value.

Estimating cardiac output based on gas exchange during veno-arterial extracorporeal membrane oxygenation in a simulation study using paediatric oxygenators

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) therapy is a rescue strategy for severe cardiopulmonary failure. The estimation of cardiac output during VA-ECMO is challenging. A lung circuit ({dot{text{Q}}}Lung) and an ECMO circuit ({dot{text{Q}}}ECMO) with oxygenators for CO2 removal (mathop {text{V}}limits^{.}CO2) and O2 uptake (mathop {text{V}}limits^{.}O2) simulated the setting of VA-ECMO with varying ventilation/perfusion (mathop {text{V}}limits^{.}/{dot{text{Q}}}) ratios and shunt. A metabolic chamber with a CO2/N2 blend simulated mathop {text{V}}limits^{.}CO2 and mathop {text{V}}limits^{.}O2. {dot{text{Q}}}Lung was estimated with a modified Fick principle: {dot{text{Q}}}Lung = {dot{text{Q}}}ECMO × (mathop {text{V}}limits^{.} CO2 or mathop {text{V}}limits^{.}O2Lung)/(mathop {text{V}}limits^{.}CO2 or mathop {text{V}}limits^{.}O2ECMO). A normalization procedure corrected mathop {text{V}}limits^{.}CO2 values for a mathop {text{V}}limits^{.}/{dot{text{Q}}} of 1. Method agreement was evaluated by Bland–Altman analysis. Calculated {dot{text{Q}}}Lung using gaseous mathop {text{V}}limits^{.}CO2 and mathop {text{V}}limits^{.}O2 correlated well with measured {dot{text{Q}}}Lung with a bias of 103 ml/min [− 268 to 185] ml/min; Limits of Agreement: − 306 ml/min [− 241 to − 877 ml/min] to 512 ml/min [447 to 610 ml/min], r2 0.85 [0.79–0.88]). Blood measurements of mathop {text{V}}limits^{.}CO2 showed an increased bias (− 260 ml/min [− 1503 to 982] ml/min), clinically not applicable. Shunt and mathop {text{V}}limits^{.}/{dot{text{Q}}} mismatch decreased the agreement of methods significantly. This in-vitro simulation shows that mathop {text{V}}limits^{.}CO2 and mathop {text{V}}limits^{.}O2 in steady-state conditions allow for clinically applicable calculations of {dot{text{Q}}}Lung during VA-ECMO therapy.

Discussion on the Rescue Strategy of Metro Electric Bus

Discussion on the Rescue Strategy of Metro Electric Bus

Public strategies to rescue the hospitality industry following the impact of COVID-19: A case study of the European Union.

The COVID-19 pandemic has caused a “zero tourism” situation throughout the world with unpredictable consequences. Several authors analyzed the economic impacts of the COVID-19 pandemic during the second trimester of 2020, but none of them have specifically examined European Union countries and the joint actions taken to fight the pandemic. Using a case study methodology, this paper presents a literature review of the most up-to-date studies on the impacts of the COVID-19 global pandemic. Secondly, we specify the different public intervention measures implemented by the European Union in accordance with supranational governance theory and stakeholder theory. Finally, we set out the different COVID-19-related public rescue strategies for the tourism and hospitality sector at the individual level (for tourists), at the business level (for touristic companies) and at the destination level (for the European Union countries), from the perspective of stakeholders. The main contribution of our research is therefore to explore the public strategies to rescue the tourism and hospitality sector in the context of the European Union.

Stent-retriever alone vs. aspiration and stent-retriever combination in large vessel occlusion stroke: A matched analysis.

Three randomized clinical trials have reported similar safety and efficacy for contact aspiration and stent-retriever thrombectomy. We aimed to determine whether the combined technique (stent-retriever + contact aspiration) was superior to stent-retriever alone as first-line thrombectomy strategy in a patient cohort where balloon guide catheter was universally used. A prospectively maintained mechanical thrombectomy database from January 2018 to December 2019 was reviewed. Patients were included if they had anterior circulation proximal occlusion ischemic stroke (intracranial ICA or MCA-M1/M2 segments) and underwent stent-retriever alone thrombectomy or stent-retriever + contact aspiration as first-line therapy. The primary outcome was the first-pass effect (mTICI2c-3). Secondary outcomes included modified first-pass effect (mTICI2b-3), successful reperfusion (mTICI2b-3) prior to and after any rescue strategy, and 90-day functional independence (mRS ≤ 2). Safety outcomes included rate of parenchymal hematoma type-2 and 90-day mortality. Sensitivity analyses were performed after dividing the overall cohort according to first-line modality into two matched groups. A total of 420 patients were included in the analysis (mean age 64.4 years; median baseline NIHSS 16 (11-21)). As compared to first-line stent-retriever alone, first-line stent-retriever + contact aspiration resulted in similar rates of first-pass effect (53% vs. 51%, adjusted odds ratio (aOR) 1.122, 95%CI (0.745-1.691), p = 0.58), modified first-pass effect (63% vs. 60.4%, aOR1.250, 95%CI (0.782-2.00), p = 0.35), final successful reperfusion (97.6% vs. 98%, p = 0.75), and higher chances of successful reperfusion prior to any rescue strategy (81.8% vs. 72.5%, aOR 2.033, 95%CI (1.209-3.419), p = 0.007). Functional outcome and safety measures were comparable between both groups. Likewise, the matched analysis (148 patient-pairs) demonstrated comparable results for all clinical and angiographic outcomes except for significantly higher rates of successful reperfusion prior to any rescue strategies with the first-line stent-retriever + contact aspiration treatment (81.8% vs. 73.6%, aOR 1.881, 95%CI (1.039-3.405), p = 0.037). Our findings reinforce the findings of ASTER-2 trial in that the first-line thrombectomy with a combined technique did not result in increased rates of first-pass reperfusion or better clinical outcomes. However, the addition of contact aspiration after initial stent-retriever failure might be beneficial in achieving earlier reperfusion.

POS0653 IMPACT OF UPADACITINIB OR ADALIMUMAB AS INITIAL THERAPY ON THE ACHIEVEMENT OF 48-WEEK TREATMENT GOALS IN PATIENTS WITH RHEUMATOID ARTHRITIS AND INADEQUATE RESPONSE TO METHOTREXATE: POST HOC ANALYSIS OF A PHASE 3 STUDY

Background:In the randomized, double-blinded, Phase 3 SELECT-COMPARE study, upadacitinib (UPA) + MTX demonstrated greater clinical and functional responses vs adalimumab (ADA) + MTX in patients (pts) with RA and inadequate response to MTX.1,2 Pts with insufficient response to initial therapy were switched from UPA to ADA (and vice versa) according to treat-to-target (T2T) principles.Objectives:We analyzed 1-year treatment outcomes in SELECT-COMPARE according to initial randomization group, regardless of whether pts subsequently switched therapy.Methods:Pts initially randomized to UPA 15 mg once daily (QD) or ADA 40 mg every other week (EOW; both + MTX) for up to 48 weeks in SELECT-COMPARE were included in the analysis. As per the protocol-directed rescue strategy, pts experiencing <20% improvement in tender or swollen joint counts at Week 14, 18, or 22, or Clinical Disease Activity Index (CDAI) >10 at Week 26, were switched from UPA to ADA or ADA to UPA in a blinded fashion. Efficacy outcomes included CDAI remission (≤2.8) and low disease activity (LDA; ≤10), DAS of 28 joints using CRP (DAS28[CRP]) <2.6 and ≤3.2, and a composite of “deep response” (CDAI remission, HAQ-Disability Index <0.5, and pain score <20). Data are presented and attributed to initial randomized group (UPA or ADA) regardless of any subsequent switch in therapy. Time-averaged response rates were calculated as area under the curve of response rate standardized by 48 weeks. The proportions of pts who maintained Week 26 responses through 6 months of follow-up are also reported.Results:This analysis included 651 pts initially randomized to UPA (of whom 245 switched to ADA) and 327 pts initially randomized to ADA (of whom 157 switched to UPA). Baseline characteristics including age, sex, and BMI were generally well balanced between randomized groups. At Week 48, similar proportions of pts initially randomized to UPA or ADA therapy achieved CDAI remission/LDA (27.6%/61.9% vs 24.8%/59.0%) and DAS28(CRP) <2.6/≤3.2 (45.0%/60.2% vs 43.7%/59.0%) (Figure 1). However, a small but significantly greater proportion of pts achieved a deep response with initial UPA vs initial ADA therapy (17.8% vs 12.8%; p<0.05). In addition, time-averaged response rates over 48 weeks were higher for initial UPA vs initial ADA therapy across efficacy outcomes. Similar trends were observed for other outcomes. Additionally, similar proportions of pts maintained Week 26 responses with initial UPA vs initial ADA therapy based on CDAI remission/LDA and DAS28(CRP) <2.6/≤3.2 during 6-month follow-up (Table 1).Conclusion:Using a stringent T2T approach to RA management, rates of LDA or remission at 1 year were similar, regardless of whether pts were initially randomized to UPA or ADA. However, initial UPA therapy led to more frequent deep responses and higher time-averaged response rates vs initial ADA therapy.

The Mechanism of Operation Effectiveness of Emergency Shelter Rescue Systems

Natural disasters cause serious damage to buildings and infrastructure, and victims lose a comfortable living environment. A large number of people are left homeless. Emergency shelter is an important component that cannot be ignored in the comprehensive disaster prevention and mitigation plan. However, to the best of our knowledge, no study has collectively taken into account the rapid and accurate resettlement of evacuees by taking stratification of demand, distribution of supplies, and diversion evacuation as an organic model. Given the bottleneck of rapid and accurate resettlement in the complex sheltered environment, we combine field research, literature analysis, and previous case study. This paper explains that the three main factors that affect the resettlement of evacuees are the complexity of demand, the shortage of materials, and the blindness of refuge. Additionally, then an effective analysis framework of the hierarchy of demand, distribution rapidity and refuge accuracy are constructed. Finally, this paper puts forward the structural framework of demand for layered, comprehensive distribution and diversion of evacuees and further explains the structure relationship, mode of rescue and operation strategy of effective resettlement of evacuees.

Knockdown of miR-26a in zebrafish leads to impairment of the anti-inflammatory function of TnP in the control of neutrophilia

Our recent data show the valuable potential of TnP for the development of a new and safe anti-inflammatory drug due to its ability to control the traffic and activation of leukocytes in response to inflammation. Although there is considerable knowledge surrounding the cellular mechanisms of TnP, less is known about the mechanistic molecular role of TnP underlying its immunomodulatory functions. Here, we conducted investigations to identify whether miRNAs could be one of the molecular bases of the therapeutic effect of TnP. Using a zebrafish model of neutrophilic inflammation with a combination of genetic gain- and loss-of-function approaches, we showed that TnP treatment was followed by up-regulation of only four known miRNAs, and mature dre-miR-26a-1, herein referred just as miR-26a was the first most highly expressed. The knockdown of miR-26a ubiquitously resulted in a significant reduction of miR-26a in embryos, accompanied by impaired TnP immunomodulatory function observed by the loss of the control of the removal of neutrophils in response to inflammation, while the overexpression increased the inhibition of neutrophilic inflammation promoted by TnP. The striking importance of miR-26a was confirmed when rescue strategies were used (morpholino and mimic combination). Our results identified miR-26a as an essential molecular regulator of the therapeutic action of TnP, and suggest that miR-26a or its targets could be used as promising therapeutic candidates for enhancing the resolution of inflammation.

Vibrotactile biofeedback devices in Parkinson's disease: a narrative review.

Parkinson's disease (PD) is often associated with a vast list of gait-associated disabilities, for which there is still a limited pharmacological/surgical treatment efficacy. Therefore, alternative approaches have emerged as vibrotactile biofeedback systems (VBS). This review aims to focus on the technologies supporting VBS and identify their effects on improving gait-associated disabilities by verifying how VBS were applied and validated with end-users. It is expected to furnish guidance to researchers looking to enhance the effectiveness of future vibrotactile cueing systems. The use of vibrotactile cues has proved to be relevant and attractive, as positive results have been obtained in patients' gait performance, suitability in any environment, and easy adherence. There seems to be a preference in developing VBS to mitigate freezing of gait, to improve balance, to overcome the risk of fall, and a prevalent use to apply miniaturized wearable actuators and sensors. Most studies implemented a biofeedback loop able to provide rescue strategies during or after the detection of a gait-associated disability. However, there is a need of more clinical evidence and inclusion of experimental sessions to evaluate if the biofeedback was effectively integrated into the patients' motor system.

Managerial and Organizational Aspects of Safety Management in the Mountain Environment

Purpose: The primary goal of this article is to present the organizational, legal, and managerial foundations of mountain rescue organizations in Europe, in the world and in Poland. They belong to non-profit organizations whose aim is to safeguard the safety and public health of citizens. The secondary purpose of the article was to present selected scientific and research problems that occur in mountain rescue. Design/Methodology/Approach: Analysis of materials and source data, review of the literature on the subject. Findings: Mountain rescue is an interdisciplinary phenomenon and process that includes knowledge and skills in many fields and scientific disciplines. Among the sciences that significantly affect the practical functioning of mountain rescue, the following can be identified: medical sciences, health sciences, technical and engineering sciences as well as social sciences. Practical implications: The further development of research on the presented aspects of mountain rescue leads to the improvement of rescue strategies and techniques used in them. Knowledge of the presented research areas allows scientists to constantly deepen their research and theory in this field: technology for rescue and transport, life functions of the human body in mountain accident conditions and human behavior during mountain activity. Originality/value: The activities of mountain rescue organizations include various forms of conducting rescue operations, which include the following aspects: medical and therapeutic, logistics and transport, meteorological, technological, psychosocial and, finally, competence and training.

Multi-institutional Analysis of 100 Consecutive Patients with COVID-19 and Severe Pulmonary Compromise Treated with Extracorporeal Membrane Oxygenation: Outcomes and Trends Over Time.

The role of extracorporeal membrane oxygenation (ECMO) in the management of severely ill patients with coronavirus disease 2019 (COVID-19) continues to evolve. The purpose of this study is to review a multi-institutional clinical experience in 100 consecutive patients, at 20 hospitals, with confirmed COVID-19 supported with ECMO. This analysis includes our first 100 patients with complete data who had confirmed COVID-19 and were supported with ECMO. The first patient in the cohort was placed on ECMO on March 17, 2020. Differences by the mortality group were assessed using χ2 tests for categorical variables and Kruskal–Wallis rank-sum tests and Welch’s analysis of variance for continuous variables. The median time on ECMO was 12.0 days (IQR = 8–22 days). All 100 patients have since been separated from ECMO: 50 patients survived and 50 patients died. The rate of survival with veno-venous ECMO was 49 of 96 patients (51%), whereas that with veno-arterial ECMO was 1 of 4 patients (25%). Of 50 survivors, 49 have been discharged from the hospital and 1 remains hospitalized at the ECMO-providing hospital. Survivors were generally younger, with a lower median age (47 versus 56.5 years, p = 0.014). In the 50 surviving patients, adjunctive therapies while on ECMO included intravenous steroids (26), anti-interleukin-6 receptor blockers (26), convalescent plasma (22), remdesivir (21), hydroxychloroquine (20), and prostaglandin (15). Extracorporeal membrane oxygenation may facilitate salvage and survival of selected critically ill patients with COVID-19. Survivors tend to be younger. Substantial variation exists in the drug treatment of COVID-19, but ECMO offers a reasonable rescue strategy.

Pharmacokinetic Disposition of Amiodarone When Given with an Intralipid Rescue Strategy.

While the antiarrhythmic drug amiodarone is commonly used in clinical practice, it has a narrow therapeutic index that can lead to acute overdose. One proposed method to deal with this toxicity is lipid emulsion therapy, which may potentially quench the free amiodarone in blood and prevent its further distribution to target organs and tissues. In this study, we utilize an established swine model to examine the effects of Intralipid™ (IL) administration for acute amiodarone toxicity. A total of 14 pigs received an overdose of intravenous amiodarone. After twenty minutes, half of the pigs (n = 7) received IL while the control group (n = 7) received normal saline. Serum concentrations of amiodarone were then analyzed using a validated high-performance liquid chromatography (HPLC) method. Noncompartmental pharmacokinetic analyses were performed on the observed concentrations. There were no statistical differences in the area under the concentration time curve (6 h) or clearance, but there was a difference in the half-life between the two groups (3.12 vs. 0.85 h, p = 0.01). The administration of IL did not statistically change the overall exposure of amiodarone in the blood in the first 6 h; however, trends toward prolonged blood retention in the IL group were seen.

In vivo genome editing in mouse restores dystrophin expression in Duchenne muscular dystrophy patient muscle fibers

BackgroundMutations in the DMD gene encoding dystrophin—a critical structural element in muscle cells—cause Duchenne muscular dystrophy (DMD), which is the most common fatal genetic disease. Clustered regularly interspaced short palindromic repeat (CRISPR)-mediated gene editing is a promising strategy for permanently curing DMD.MethodsIn this study, we developed a novel strategy for reframing DMD mutations via CRISPR-mediated large-scale excision of exons 46–54. We compared this approach with other DMD rescue strategies by using DMD patient-derived primary muscle-derived stem cells (DMD-MDSCs). Furthermore, a patient-derived xenograft (PDX) DMD mouse model was established by transplanting DMD-MDSCs into immunodeficient mice. CRISPR gene editing components were intramuscularly delivered into the mouse model by adeno-associated virus vectors.ResultsResults demonstrated that the large-scale excision of mutant DMD exons showed high efficiency in restoring dystrophin protein expression. We also confirmed that CRISPR from Prevotella and Francisella 1(Cas12a)-mediated genome editing could correct DMD mutation with the same efficiency as CRISPR-associated protein 9 (Cas9). In addition, more than 10% human DMD muscle fibers expressed dystrophin in the PDX DMD mouse model after treated by the large-scale excision strategies. The restored dystrophin in vivo was functional as demonstrated by the expression of the dystrophin glycoprotein complex member β-dystroglycan.ConclusionsWe demonstrated that the clinically relevant CRISPR/Cas9 could restore dystrophin in human muscle cells in vivo in the PDX DMD mouse model. This study demonstrated an approach for the application of gene therapy to other genetic diseases.

A reliable location design of unmanned vending machines based on customer satisfaction

The location problem of unmanned vending machine is challenging due to the variety of customer preferences and random breakdown in service. In this paper, we present an optimization model for reliable location design of unmanned vending machines, with the goal to minimize total costs and maximize customer satisfaction. We solve the problem through a two-stage approach in order to mine customers preference from their behaviours and improve design reliability. At the first stage, we design a multi-dimensional measurement to mine customers’ preferences and satisfaction based on their behavioural information. At the second stage, we use a clustering method to analyse the set of candidate points from a systematic perspective. Candidate points with similar locations and customer preferences will be clustered into one “demand zone” and the mutual rescue strategy is considered when breakdown occurred. An experimental study is designed based on the proposed approach and solved by combinational genetic algorithm.

Extracorporeal cardiopulmonary resuscitation (ECPR) survival: A quaternary center analysis.

Extracorporeal cardiopulmonary resuscitation (ECPR) has emerged as a rescue strategy for nonresponders to conventional CPR (CCPR) in cardiac arrest. Definitive guidelines for ECPR deployment do not exist. Prior studies suggest that arrest rhythm and cardiac origin of arrest may be variables used to assess candidacy for ECPR. To describe a single-center experience with ECPR and to assess associations between survival and physician-adjudicated origin of arrest and arrest rhythm. A retrospective review of all patients who underwent ECPR at a quaternary care center over a 7-year period was performed. Demographic and clinical characteristics were extracted from the medical record and used to adjudicate the origin of cardiac arrest, etiology, rhythm, survival, and outcomes. Univariate analysis was performed to determine the association of patient and arrest characteristics with survival. Between 2010 and 2017, 47 cardiac arrest patients were initiated on extracorporeal membrane oxygenation (ECMO) at the time of active CPR. ECPR patient survival to hospital discharge was 25.5% (n = 12). Twenty-six patients died on ECMO (55.3%) while nine patients (19.1%) survived decannulation but died before discharge. Neither physician-adjudicated arrest rhythm nor underlying origin were significantly associated with survival to discharge, either alone or in combination. Younger age was significantly associated with survival. Nearly all survivors experienced myocardial recovery and left the hospital with a good neurological status. Arrest rhythm and etiology may be insufficient predictors of survival in ECPR utilization. Further multiinstitutional studies are needed to determine evidenced-based criteria for ECPR deployment.

Treatment of acute cholecystitis in high-risk surgical patients.

Acute cholecystitis (AC) is the most common biliary stone disease complication. While there is consensus regarding cholecystectomy for AC, gallbladder drainage is indicated in elderly or high-risk surgical patients. We systematically reviewed available evidence in the field of EUS-guided gallbladder drainage (EUS-GBD) for AC in high-risk surgical patients. The studies were classified according to their level of evidence (LE) according to the Oxford Centre for Evidence Based Medicine classification. Literature search retrieved 175 manuscripts; most of them were expert opinions (LE V, N.=53) or case-series (LE IV, N.=29). There was no meta-analysis of RCT (LE Ia), while two randomized controlled trials (LE Ib) demonstrated that EUS-GBD was superior to percutaneous transhepatic-GBD (PT-GBD) regarding long-term outcomes (adverse events, recurrent cholecystitis, and reintervention). Several meta-analyses of cohort studies (LE IIa, N.=11) were designed to compare the three available drainage strategies (endoscopic, echoendoscopic and percutaneous) and to assess the pooled risk of adverse events. Comparison between surgery and EUS-GBD was done in a single retrospective study with a propensity score analysis (LE III). The outcomes of conversion from PT-GBD to EUS-GBD were covered by few retrospective studies (LE III). Several manuscripts (N.=69) were published on EUS-GBD as a rescue strategy in case of malignant biliary obstruction. The levels of evidence of EUS-GBD in the literature have evolved from initial descriptive studies to recent randomized controlled trials and meta-analysis of cohort studies. While several articles addressed the comparison among different techniques for GBD, in our opinion some topics and questions have not been adequately investigated. are still debated.