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Summary: Extracorporeal cardiopulmonary resuscitation (ECPR) in patients with prolonged or refractory out‐of‐hospital cardiac arrest (OHCA) is likely to be beneficial when used as part of a well developed emergency service system.ECPR is technically challenging to initiate and resource‐intensive, but it has been found to be cost‐effective in hospital‐based ECPR programs.ECPR expansion within Australia has thus far been reactive and does not provide broad coverage or equity of access for patients.Newer delivery strategies that improve access to ECPR for patients with OHCA are being trialled, including networked hospital‐based ECPR and pre‐hospital ECPR programs. The efficacy, scalability, sustainability and cost‐effectiveness of these programs need to be assessed.There is a need for national collaboration to determine the most cost‐effective delivery strategies for ECPR provision along with its place in the OHCA survival chain. [ABSTRACT FROM AUTHOR]

Pancreatitis is a condition that causes inflammation in the pancreas, an organ located behind the stomach. This condition often presents as neuropathic, inflammatory, and/or visceral pain. Acute pancreatitis is typically characterized by sudden and severe abdominal pain, often in the upper right part of the abdomen. The pain from pancreatitis can be caused by different mechanisms, such as abnormal activation of pancreatic zymogens or NF-κB mediated inflammation in the pancreas. The treatment of pancreatitis depends on its type, severity, and underlying cause. Hospitalization and medications are typically necessary, while in others, surgery may be required. Proper management of pancreatitis is essential, as it can help reduce the risk of complications and improve the patient's quality of life. The literature on pancreatitis pain management evaluates systematic approaches and the effectiveness of various treatments, such as lidocaine, opioid agonists, ketamine, magnesium, endoscopic methods, spinal cord stimulation, and other novel treatments present opportunities for exploration in pancreatitis pain management. [ABSTRACT FROM AUTHOR]

Purpose Extracorporeal membrane oxygenation (ECMO) is increasingly being used to support critically ill patients with severe cardiac and/or respiratory failure. It has been claimed that the resulting haemodynamic alterations, particularly in venoarterial ECMO, mean that enteral feeding is unsafe and/or poorly tolerated. This study aims to investigate this question and to identify any barriers to optimal nutrition. Methods Data were retrospectively collected for 86 patients who received ECMO between January 2007 and July 2012 in a tertiary critical care unit/ECMO referral centre. All were fed using existing protocols that emphasise early enteral feeding in preference over parenteral or delayed enteral nutrition. Results Thirty-one patients required ECMO for cardiac failure, and all of these received venoarterial ECMO; the remainder received venovenous ECMO. Enteral feeds started for all patients at average 13.1 h [standard deviation (SD) 16.7 h] after ICU admission, reaching goal rate on day 2.6 (SD 1.4). Thirty-three patients experienced significant feeding intolerance during the first 5 days, but of these 20 were managed effectively with prokinetic medications; 18 required parenteral nutrition to supplement inadequately tolerated tube feeds. Intolerance did not differ between ECMO modes. Overall patients tolerated 79.7 % of goal nutrition each day in the first 2 weeks. Conclusions Enteral feeding can be well tolerated by patients who are receiving ECMO, whether in venovenous or venoarterial mode. ECMO should not exclude patients from receiving the well-documented benefits of early enteral feeding in critical illness., Author(s): Suzie Ferrie [sup.1] [sup.2], Robert Herkes [sup.1] [sup.2], Paul Forrest [sup.2] [sup.3] Author Affiliations: (1) grid.413249.9, 0000000403850051, Intensive Care Service, Critical Care Dietitian, Department of Nutrition and Dietetics, Royal [...]

Objective: To describe on‐scene times for out‐of‐hospital cardiac arrests (OHCA) transferred to hospital, the number of these that were extracorporeal cardiopulmonary resuscitation (ECPR) eligible and potential association between end‐tidal carbon dioxide (ETCO2) and survival so as to inform planned interventional studies. Methods: Prospective cohort study of all OHCA, of suspected medical cause, where resuscitation was commenced and who were transported to participating hospitals from October 2020 to May 2021. Results: One hundred and forty‐nine OHCA were included. Forty‐four (30%) patients survived to hospital discharge. Eighteen (8%) met ECPR inclusion criteria. Median on‐scene time was 33 min (interquartile range [IQR] 24–44). Initial hospital ETCO2 for non‐survivors was 35 mmHg (IQR 19–50), survivors 36 mmHg (IQR 33–45); P = 0.215. No patient with an ETCO2 less than 20 mmHg on hospital arrival to survived to hospital discharge. Conclusions: Average on‐scene time did not differ on survivorship. A small number of transferred patients with OHCA were ECPR eligible. ETCO2 less than 20 mmHg portends adverse prognosis. Our data will be used for future interventional studies. [ABSTRACT FROM AUTHOR]

In recent years, extracorporeal membrane oxygenation has become increasingly common in the treatment of in-hospital cardiac arrest in non-cardiac surgery patients. This includes cardiac arrest secondary to perioperative anaphylactic shock refractory to standard advanced life support protocols, which is a rare but catastrophic event associated with significant mortality. Neuromuscular blocking drugs are most commonly implicated in perioperative anaphylaxis, with rocuronium playing a major role. In this article, we report two cases of young and otherwise fit and well patients who experienced a perioperative arrest secondary to rocuronium anaphylaxis before elective surgery; both patients did not respond to conventional advanced life support, but survived neurologically intact after institution of urgent veno-arterial extracorporeal membrane oxygenation. [ABSTRACT FROM AUTHOR]

The increasing use of antegrade cerebral perfusion (ACP) during aortic arch surgery has corresponded with a trend toward warmer target temperatures for hypothermic circulatory arrest. This meta-analysis examined the clinical outcomes using colder or warmer circulatory arrest targets with ACP. Electronic searches were performed using four databases from their inception to February 2017. Comparative studies of adult patients who underwent aortic arch operations using ACP at different circulatory arrest temperatures were included. Data were extracted by 2 independent researchers and analyzed according to predefined end points using a random-effects model. The literature search identified 18 comparative studies, with 1,215 patients in the "cold" cohort and 1,417 in the "warm" cohort. Mean hypothermic circulatory arrest temperatures were 20.3°C and 26.5°C in the cold and warm groups, respectively. A trend existed for increased permanent neurologic deficit overall when colder targets were used (odds ratio, 1.45; 95% confidence interval, 0.98 to 2.13; p = 0.06); this became significant when adjusted estimates were aggregated (odds ratio, 1.65; 95% confidence interval, 1.06 to 2.55; p = 0.03). No difference in the mortality rate was seen when adjusted effects were aggregated. Temporary neurologic deficit, postoperative dialysis, ventilator time, and intensive care unit stay were significantly reduced in the warm cohort overall. No significant differences in reexploration for bleeding were found. ACP with warmer circulatory arrest temperatures may reduce the incidence of permanent neurologic deficit as well as potentially other clinical outcomes. Further studies are required to determine the safe circulatory arrest durations for visceral organs at warmer temperatures. [ABSTRACT FROM AUTHOR]

Abstract Objective Retrograde cerebral perfusion is becoming less frequently used as a method of neuroprotection during aortic surgery. The present meta-analysis aims to compare outcomes after arch surgery with hypothermic circulatory arrest versus hypothermic circulatory arrest + retrograde cerebral perfusion. Methods Electronic searches were performed using 7 databases from their inception to September 2016. Relevant comparative studies that included patient groups who underwent aortic arch surgery using hypothermic circulatory arrest with continuous retrograde cerebral perfusion or hypothermic circulatory arrest alone were identified, and data were extracted by 2 independent researchers. Data were aggregated using a random-effects model per predefined clinical end points. Results Twenty-eight comparative studies were identified, with 2705 hypothermic circulatory arrest cases and 2817 hypothermic circulatory arrest + retrograde cerebral perfusion cases. No significant differences were seen between both groups in terms of age, gender, proportion of dissections and aneurysms, and hemiarch/total arch repair. The hypothermic circulatory arrest + retrograde cerebral perfusion group had slightly longer cardiopulmonary bypass time and lower body arrest time. Mortality was significantly increased for the hypothermic circulatory arrest cohort compared with the hypothermic circulatory arrest + retrograde cerebral perfusion cohort (odds ratio, 1.75; 95% confidence interval, 1.16-2.63; P =.007; I2 = 54%), but not on pooling of adjusted estimates. Stroke was also increased for the hypothermic circulatory arrest cohort (odds ratio, 1.50; 95% confidence interval, 1.07-2.10; P =.02; I2 = 29%). No difference in temporary neurologic deficit was identified (P =.66). Meta-regression found the treatment effect for mortality and stroke to be less pronounced in more contemporary series. Conclusions These results suggest that the addition of retrograde cerebral perfusion during aortic arch surgery may provide better outcomes than using hypothermic circulatory arrest alone, although significant confounders exist. Further robust studies are required to confirm the utility of retrograde cerebral perfusion in arch surgery. [ABSTRACT FROM AUTHOR]