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Three-dimensional (3D) right ventricular (RV) strain analysis is not routinely performed perioperatively. Although 3D RV strain adds incrementally to outcome prediction in various cardiac diseases, its role in the perioperative setting is not sufficiently understood. The aim of this study was to investigate the association between 3D RV strain measured on RV meshes created from 3D transesophageal echocardiographic data and short-term outcomes among patients undergoing cardiac surgery.A total of 496 patients undergoing cardiac surgery who underwent intraoperative 3D transesophageal echocardiography (under general anesthesia, before sternotomy) were retrospectively selected, and RV meshes were generated using commercially available speckle-tracking software. Custom-made software automatically quantified longitudinal and circumferential RV strains on the mesh surfaces. Echocardiographic and clinical parameters were entered into logistic regression models to determine their associations with the primary (in-hospital death or need for extracorporeal life support) and secondary (postoperative ventilation48 hours) end points.Mesh-derived RV strain analysis was feasible in 94% of patients and revealed distinct regional patterns with basal-apical gradients for both longitudinal and circumferential strain. Thirty-seven patients (7.6%) reached the primary end point, and 118 patients (23.8%) reached the secondary end point. In a multivariable logistic regression model, serum lactate (P .01), an emergency indication for surgery (P .01), tricuspid regurgitation (P .001), and mesh-derived RV global longitudinal strain (RV-GLS; P .01) were independently associated with the primary end point, while established measures of RV function (3D RV ejection fraction, fractional area change, tricuspid annular plane systolic excursion) and left ventricular (LV) function (3D-derived LV ejection fraction and LV-GLS) were not independently associated. Hematocrit (P .01), serum lactate (P .001), pulmonary hypertension (P = .04), tricuspid regurgitation (P .01), emergency procedures (P = .02), LV-GLS (P = .02), and RV-GLS (P .001) were associated with the secondary end point.RV-GLS measured on RV meshes derived from 3D transesophageal echocardiography was independently associated with short-term outcomes in patients undergoing cardiac surgery and might be helpful for identifying patients at risk for adverse postoperative events.

Background: The ideal timing of a durable assist device implantation in patients with end-stage heart failure presenting with INTERMACS profile I is still controversial. The data on extracorporeal life support (ECLS) bridge to durable left ventricular assist device (LVAD) in these patients is limited. Materials and methods: We retrospectively analyzed the outcomes of 35 patients in acute cardiogenic shock (CS) who, between December 2013 and September 2020, were bridged with ECLS to durable LVAD. The mean age was 52.3 ± 12.0 years. The primary endpoints of this study were in-hospital, 30-day, 6-month, and 1-year mortality. The secondary endpoint was the development of any postoperative adverse events and other characteristics during the follow-up period. We also assessed the impact of the rescue ECLS on the recovery of the end-organ function. Results: In-hospital, 30-day, 6-month, and 1-year survival was 65.6%, 75.9%, 69.2%, and 62.7% respectively. The median time on ECLS was 7 days (IQR 5.0–13.0). We observed a high incidence of a severe right heart failure (22.9%), acute kidney injury on dialysis (68.6%), and respiratory failure (77.1%). Bridge with ECLS provided a significant recovery of liver and kidney function prior to durable LVAD implantation. Conclusion: The concept of bridging patients presenting in end-stage heart failure and cardiogenic shock with ECLS prior to durable LVAD implantation is a feasible method to ensure acceptable survival rates and significant recovery of the end-organ function.

The role of palliative care in lung transplantation has grown exponentially in the past two decades. From assisting with evaluating and optimizing candidates for transplant, to playing a crucial role in patients requiring extracorporeal cardiopulmonary life support (ECLS) as a bridge to lung transplant, perioperatively, or even during their first year post-transplant, palliative care has been shown to be an effective if underutilized tool in the armamentarium used to care for lung transplant patients. For patients being considered for primary transplantation and for lung transplant recipients, palliative care can decrease symptom burden and help to lessen the psychological distress experienced by patients and family members. For older patients listed for transplant, palliative care can help address cognitive impairment, depression, and frailty. Patients listed for lung re-transplant also benefit from palliative care involvement to address frequent symptom exacerbations, hospitalizations, and higher morbidity and mortality. Even for organ donors and their families, palliative care can facilitate communication and provide support to the family. While palliative care use in lung transplantation may be gradually increasing, further work is necessary to optimally integrate palliative care into lung transplantation. Barriers to lung transplant patients receiving palliative care are multifactorial and include physician, patient, and institutional factors. The potential role of palliative care in every aspect of lung transplantation has made a knowledge of palliative care principles crucial for the lung transplant practitioner. In this review, we will clearly delineate the potential benefit of palliative care for the perioperative lung transplant patient and make an argument for its increased use in this patient population.

Point of view on the necessity and appropriateness of the standards in medicine is given in the article. Authors highlight the positive effects of the application of standards in case when we have limits of the time and the data. On the other hand, the authors warn that the mechanical adherence to the standards makes impossible to take the right decision in unusual and rare cases. ATLS (Advance trauma life support) system is given as a successful example of the standard use. ATLS is also a training program developed by the American College of Surgeons. The main principles of the ATLS standard are: to treat the greatest threat to life first, the lack of a definitive diagnosis and a detailed history should not slow the application of indicated treatment for life-threatening injury, with the most time-critical interventions performed early. The first and key part of the assessment of patients presenting with trauma is called the primary survey. During this time, life-threatening injuries are identified, and simultaneously resuscitation is begun. A simple mnemonic, ABCDE, is used as a memory aid for the order, in which problems should be addressed.

У статті наведені нормативно-правові засади надання медичної допомоги хворим і постраждалим дітям в умовах відділення екстреної (невідкладної) медичної допомоги. Підкреслено значення симуляційного навчання лікарів медицини невідкладних станів за програмою Advanced Paediatric Life Support (APLS) при клінічних станах, що є загрозливими для життя хворих або постраждалих дітей. Наведено доцільність використання стрічки Брозлоу у дітей в умовах відділення екстреної (невідкладної) медичної допомоги.

Rates of survival with functional recovery for both in-hospital and out-of-hospital cardiac arrest are notably low. Extracorporeal cardiopulmonary resuscitation (ECPR) is emerging as a modality to improve prognosis by augmenting perfusion to vital end-organs by utilizing extracorporeal membrane oxygenation (ECMO) during conventional CPR and stabilizing the patient for interventions aimed at reversing the aetiology of the arrest. Implementing this emergent procedure requires a substantial investment in resources, and even the most successful ECPR programs may nonetheless burden healthcare systems, clinicians, patients, and their families with unsalvageable patients supported by extracorporeal devices. Non-randomized and observational studies have repeatedly shown an association between ECPR and improved survival, versus conventional CPR, for in-hospital cardiac arrest in select patient populations. Recently, randomized controlled trials suggest benefit for ECPR over standard resuscitation, as well as the feasibility of performing such trials, in out-of-hospital cardiac arrest within highly coordinated healthcare delivery systems. Application of these data to clinical practice should be done cautiously, with outcomes likely to vary by the setting and system within which ECPR is initiated. ECPR introduces important ethical challenges, including whether it should be considered an extension of CPR, at what point it becomes sustained organ replacement therapy, and how to approach patients unable to recover or be bridged to heart replacement therapy. The economic impact of ECPR varies by health system, and has the potential to outstrip resources if used indiscriminately. Ideally, studies should include economic evaluations to inform health care systems about the cost-benefits of this therapy.

Background: Prehospital emergency care providers are frequently called to assist with the management of mental healthcare users (MHCUs). The Mental Health Care Act no. 17 of 2002 regulates mental healthcare in South Africa, but the act fails to consider the responsibilities of prehospital emergency care providers in the provision of mental healthcare. Rather South African Police Services were given authority over the well-being of a MHCU in the prehospital setting. Aim: To investigate prehospital emergency care providers’ understanding of their responsibilities towards MHCUs and the community during the management of behavioural emergencies. Setting: The research was carried out at prehospital emergency care providers from the three main levels of care, currently operational within the boundaries of Pretoria, South Africa. Methods: A grounded theory qualitative study design was chosen using semi-structured focus groups for each level of prehospital emergency care – basic life support (BLS), intermediate life support (ILS) and advanced life support (ALS). Data from each focus group were collected through audio recordings and transcribed and analysed using a framework approach. Results: A total of 19 prehospital emergency care providers participated; two focus group interviews were performed for each level of care. The BLS focus groups each consisted of two participants. The ILS focus groups consisted of three participants each, and the ALS focus groups consisted of six and three participants. Four key themes were identified: perceptions of behavioural emergencies, responsibilities, understanding of legislation and barriers experienced. Conclusion: Participants placed high value on their moral and medical responsibilities towards MHCUs, which they described as ensuring the safety of themselves, MHCUs and the community; preventing further harm; and transporting MHCUs to an appropriate healthcare facility. There was a desire for revision of legislation, better education, skill development and awareness of mental healthcare in the prehospital emergency care setting.&nbsp

Accidental hypothermia (core temperature

BACKGROUND Major airway surgery can pose a complex problem to perioperative central airway management. Adjuncts to advanced ventilation strategies have included cardiopulmonary bypass, veno-arterial, or veno-venous extracorporeal life support. We performed a systematic review to assess the existing evidence utilizing these strategies. METHODS An electronic search was conducted to identify studies written in English reporting the use of extracorporeal life support (ECLS) during central airway surgery. Thirty-six articles consisting of 78 patients were selected and patient-level data were analyzed. RESULTS Median patient age was 47 [IQR: 34-53] and 59.0% (46/78) were male. Indications for surgery included central airway or mediastinal cancer in 57.7% (45/78), lesion or injury in 15.4% (12/78), and stenosis in 12.8% (10/78). Support was initiated pre-operatively in 9.9% (7/71) and at the time of induction in 55.3% (42/76). It was most commonly used at the time of tracheal resection/repair [93.2% (68/73)], intubation of the tracheal stump [94.4% (68/72)], and re-anastomosis [94.2% (65/69)]; 13.7% (10/73) patients were supported post-operatively. The most commonly performed surgery was tracheal repair or resection in 70.3% (52/74). Median hospital stay was 12 [8, 25] days and in-hospital mortality was 7.9% (6/76). There was no significant difference in survival between the three groups (p = .54). CONCLUSIONS Extracorporeal membrane oxygenation offers versatility in timing, surgical approach, and ECLS runtime that makes it a viable addition to the surgical armamentarium for treating complex central airway pathologies.

Introduction Although the technology used for extracorporeal life support (ECLS) has improved greatly in recent years, the application of these devices to the patient is quite complex and requires extensive training of team members both individually and together. Human factors is an area that addresses the activities, contexts, environments, and tools which interact with human behavior in determining overall system performance. Hypothesis Analyses of the cognitive behavior of ECLS teams and individual members of these teams with respect to the occurrence of human errors may identify additional opportunities to enhance safety in delivery of ECLS. Results The aim of this article is to support health-care practitioners who perform ECLS, or who are starting an ECLS program, by establishing standards for the safe and efficient use of ECLS with a focus on human factor issues. Other key concepts include the importance of ECLS team leadership and management, as well as controlling the environment and the system to optimize patient care. Conclusion Expertise from other industries is extrapolated to improve patient safety through the application of simulation training to reduce error propagation and improve outcomes.

Accidental hypothermia (AH) in Mediterranean countries often is underestimated. AH should be suspected in patients also in moderate climates throughout all seasons. Compared with other countries, the mortality rate due to AH in Spain is low, and hypothermia rarely is recognized and treated. The case of a patient who experienced cardiac arrest due to severe AH and was resuscitated for more than six hours using extracorporeal life support recently was published. Herein that case is reviewed, with the anesthetic management during cannulation detailed. In addition, the authors highlight how the application of extracorporeal cardiopulmonary resuscitation guidelines is different in AH patients, how in-hospital (HOPE score) triage criteria should be applied, and how the establishment of clear standard operating procedures and education strategies should be promoted.

Background and ObjectivesMultidisciplinary acute stroke teams improve acute ischemic stroke management but may hinder trainees' education, which in turn may contribute to poorer outcomes in community hospitals on graduation. Our goal was to assess graduate neurology trainee performance independently of a multidisciplinary stroke team in the management of acute ischemic stroke, tissue plasminogen activator (tPA)–related hemorrhage, and cerebral herniation syndrome.MethodsIn this prospective, observational, single-center simulation-based study, participants (subinterns to attending physicians) managed a patient with acute ischemic stroke followed by tPA-related hemorrhagic conversion leading to cerebral herniation. Critical actions were developed by a modified Delphi approach based on relevant American Heart Association guidelines and the Neurocritical Care Society's Emergency Neurologic Life Support protocols. The primary outcome measure was graduate neurology trainees' critical action item sum score. We sought validity evidence to support our findings by comparing performance across 4 levels of training.ResultsFifty-three trainees (including 31 graduate neurology trainees) and 5 attending physicians completed the simulation. The mean sum of critical actions completed by graduate neurology trainees was 15 of 22 (68%). Ninety percent of graduate neurology trainees properly administered tPA; 84% immediately stopped tPA infusion after patient deterioration; but only 55% reversed tPA according to guidelines. There was a moderately strong effect of level of training on critical action sum score (level 1 mean [SD] score 7.2 [2.8] vs level 2 mean [SD] score 12.3 [2.6] vs level 3 mean [SD] score 13.3 [2.2] vs level 4 mean [SD] score 16.3 [2.4], p < 0.001, R2 = 0.54).DiscussionGraduate neurology trainees reassuringly perform well in initial management of acute ischemic stroke but frequently make errors in the treatment of hemorrhagic transformation after thrombolysis, suggesting the need for more education surrounding this low-frequency, high-acuity event. High-fidelity simulation holds promise as an assessment tool for acute stroke management performance.

Supercritical fluid is a state of matter when its temperature and pressure are above the critical point. Supercritical situation is a state of the economy in its cumulative manifestations and mutual influence, whereby the state of key life-support profiles is below the critical point of controllability. Various forecasts are increasingly actualizing the probability of a natural (and man-made) macro-catastrophe (a large meteorite fall, an earthquake of 10–12 points and others, as well as a pandemic similar to COVID–19, but with more severe consequences). As the coronavirus pandemic has shown, modern civilization is becoming ever more vulnerable to such disasters. To overcome the destabilizing trends of a natural (and man-made) macro-catastrophe, it is necessary to adopt proactively a set of measures in Russia that will drastically increase the efficiency of public administration in relation to the list of regulated resource, economic, technical, social and other parameters incorporating mechanisms and procedures of public administration into market mechanisms and the budgeting structure with regard to external and internal factors of the supersystem's vital activities.

Background and ObjectivesTo determine thresholds of serum neuron-specific enolase (NSE) for prediction of poor outcome after cardiac arrest with >95% specificity using a unique method of multiple thresholds meta-analysis.MethodsData from a systematic review by the European Resuscitation Council (ERC 2014) were updated with literature searches from PubMed, Cochrane, and Scopus until August 2020. Search terms included the MeSH terms “heart arrest” and “biomarkers” and the text words “cardiac arrest,” “neuron specific enolase,” “coma” and “prognosis.” Cohort studies with comatose cardiac arrest survivors aged >16 years undergoing targeted temperature management (TTM) and NSE levels within 96 hours of resuscitation were included. Poor outcome was defined as cerebral performance category 3–5 at hospital discharge or later. Studies without extractable contingency tables were excluded. A multiple thresholds meta-analysis model was used to generate summary receiver operating characteristic curves for various time points. NSE thresholds (and 95% prediction intervals) for >95% specificity were calculated. Evidence appraisal was performed using a method adapted from the American Academy of Neurology grading criteria.ResultsData from 11 studies (n = 1,982) at 0–24 hours, 21 studies (n = 2,815) at 24–48 hours, and 13 studies (n = 2,557) at 48–72 hours was analyzed. Areas under the curve for prediction of poor outcomes were significantly larger at 24–48 hours and 48–72 hours compared to 0–24 hours (0.82 and 0.83 vs 0.64). Quality of evidence was very low for most studies because of the risk of incorporation bias—knowledge of NSE levels potentially influenced life support withdrawal decisions. To minimize falsely pessimistic predictions, NSE thresholds at the upper 95% limit of prediction intervals are reported. For prediction of poor outcome with specificity >95%, upper limits of the prediction interval for NSE were 70.4 ng/mL at 24–48 hours and 58.6 ng/mL at 48–72 hours. Sensitivity analyses excluding studies with inconsistent TTM use or different outcome criteria did not substantially alter the results.ConclusionsNSE thresholds for highly specific prediction of poor outcome are much higher than generally used. Future studies must minimize bias by masking treatment teams to the results of potential predictors and by prespecifying criteria for withdrawal of life support.

The WHO has declared severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) as a pandemic; it affected approximately 44.5million people since its first breakout in December 2019. COVID-19 can present with wide spectrum of clinical manifestations which range from mild illness with myalgia only to acute respiratory distress syndrome with or without multi-organ dysfunction syndrome necessitating the advance critical care and life support. Pregnant women presenting to emergency department needs to be triaged based on imminent risk factors for maternal and fetal compromise, present haemodynamic status of mother with consideration of gestational age. Pregnant women with comorbid conditions require multidisciplinary team approach for better pregnancy outcomes, resource management and minimizing the risk infection to health care providers. This review emphasizes on management of labour, pregnancy outcomes, co-morbidities and complex critical situations associated with COVID-19 infected pregnant women. Development of safe medical practices and infection prevention protocols with involvement of multidisciplinary team including anaesthesiologist, obstetrician, neonatologist, critical care specialist, infectious disease experts and nursing staff for the perioperative management; is required to optimize the patient outcome and mitigate the infection risk to health personnel and their families. Keywords: COVID­ 19, Obstetrics anaesthesia, Critical care, Comorbidities.

Aim To evaluate missed nursing care (MNC) phenomenon on Neonatal Intensive Care Units (NICUs) infants. Design A cross-sectional study. Methods A sample of 113 eligible Registered Nurses (RNs) and Registered Midwives (RMs) were prospectively recruited at the Neonatal Intensive Care Units (NICUs). The study uses a self -designed authors questionnaire (ADQ) and the Neonatal Extent of Work Rationing Instrument (NEWRI). Results MNC evidence was the most significant in the parental support and teaching subscales (M = 2.21, SD = 0.87) and the least in life support and discharge planning (M = 1.19, SD = 0.9). MNC in the care coordination and discharge planning subscales significantly (p

Objective: Children requiring multiple consecutive extracorporeal membrane oxygenation (ECMO) runs likely have ongoing cardiac pathology (eg, residual lesions, myocardial dysfunction) and are exposed to increased complications and end-organ failure. Often, repeat back-to-back ECMO is suggested to be futile due to poor reported survival. Methods: Using Extracorporeal Life Support Organization (ELSO) data (2011-2019), we evaluated children (n = 669) who received multiple cardiac ECMO runs (≥2) within 30 days interval. Factors associated with hospital mortality were evaluated using multivariable regression analysis. Results: Median ECMO runs was 2 (range: 2-5) including 294 (44%) patients who received extracorporeal cardiopulmonary resuscitation (ECPR). There were 250 (37%) hospital survivors. Survivors were more likely older, Caucasian, and less likely to have hypoplastic left heart syndrome, require >2 runs, receive longer support duration, require inotropes or have acidosis while on ECMO, or develop renal and neurological complications. On multivariable analysis, factors associated with death included neonates (odds ratio [OR] = 3.6, 95% CI = 1.8-7.5, P = .0002), African Americans (OR = 2.7, 95% CI = 1.4-4.9, P = .0307), longer ECMO duration (OR = 1.1, 95% CI = 1.05-1.11, P < .0001, per 10 hours), central cannulation at initial run (OR = 1.7, 95% CI = 1.1-2.8, P = .0285), renal failure (OR = 3.0, 95% CI = 1.9-4.6, P < .0001), and neurological complications (OR = 3.8, 95% CI = 2.2-6.8, P < .0001). Conclusions: In selected children with cardiac pathology, multiple back-to-back ECMO and/or ECPR runs are associated with 37% hospital survival. Although registry data limit the ability to clearly determine selection criteria for repeat ECMO, our findings suggest that in properly selected patients, repeat ECMO support is not futile. Ongoing assessment of support adequacy, end-organ function, and cardiopulmonary recovery is necessary as longer support and emerging complications are associated with poor survival.

The article deals with the life path and research activities of the founder of resuscitation science (intensive care) Vladimir A. Negovsky. He was born in 1909 in the city of Kozelets, Ukraine. After graduating from university in 1933, Negovsky worked as a researcher in the pathophysiological laboratory of the Central Institute of Hematology and Blood Transfusion in Moscow, where he worked for about a year with Professor S.S. Bryuchonenko, the creator of one of the world’s first heart-lung apparatus and where, apparently, his scientific interests were finally formed. In 1936, Negovsky wrote a letter to the Prime Minister of the USSR V.M. Molotov, in which he substantiated the prospects and importance of research in the field of cardiopulmonary resuscitation and asked for help in creating a research laboratory on this problem. Surprisingly, his request was granted — in the same year an order was issued on the organization of a special-purpose laboratory on the problem: ‘Restoration of life processes in phenomena similar to death”. Such a scientific research laboratory was created for the first time in the world. V.A. Negovsky and his collaborators modified the resuscitation method proposed by F.A. Andreev (1879–1952) and included the injection of Ringer-Locke’s solution with adrenaline into the carotid artery towards the heart (centripetally, i.e. against the blood flow). This method was improved by Negovsky and the Laboratory staff by using the radial and brachial arteries as an access for centripetal blood injection, which made it possible to simplify the technique for use in clinical practice and was supplemented by artificial lung ventilation by forced air injection into the lungs with bellows, as they have shown that intra-arterial pumping alone without mechanical ventilation is often ineffective. In the years before the attack of Nazi Germany on the USSR (1938–1941), V.A. Negovsky and his colleagues carried out a series of experimental studies devoted to the resuscitation of animals with lethal blood loss, as well as to the problem of extinction and restoration of brain functions, the results of which were published in several articles. In 1942, V.A. Negovsky defended his PhD on the topic “The relationship of respiration and blood circulation in the process of dying of animals from blood loss and in the subsequent period of restoration of vital functions”. During World War II, Negovsky organized a front-line medical teams, with which he went to the front line and where, in 1943, the developed complex of resuscitation measures was first used for wounded soldiers. In his dissertation on medicine “Restoration of vital functions of an organism in a state of agony or a period of clinical death” defended in 1943, he outlined the main provisions of the pathophysiology of terminal states and the principles of a complex method of resuscitation; the dissertation was published in a book in the same year. In 1945–1946, V.A. Negovsky publishes reports in the journals “JAMA” and “Nature” about the clinical experience of using the developed method of cardiopulmonary resuscitation and the importance of developing this problem of medicine, thus providing a priority in creating a new scientific direction. In 1946, using the experience gained in the war, the Laboratory staff continued their clinical work, starting to provide medical care to dying patients at the Institute of Thoracic Surgery of the USSR of the Academy of Medical Sciences, thus creating their own clinical resuscitation unit. In 1947, V.A. Negovsky was awarded the title of professor. Despite the successes achieved, Negovsky and his colleagues had to overcome stubborn misunderstanding and expressed resistance from many representatives of the medical community. An interesting fact in the biography of V.A. Negovsky was his participation in 1953 in the CPR (chest compression and administration of pharmacological drugs) of Joseph Stalin. In 1952, the Laboratory team created the first instruction, which was published by the USSR Ministry of Health for use in clinical practice “On the introduction into medical practice of methods for restoring the vital functions of an organism in a state of agony or clinical death”, which was republished in 1955, 1959 and 1963 with the introduction of changes to the CPR algorithm. In 1959, on the initiative of V. \A. Negovsky, the first prototype of the intensive care unit in the USSR was organized, which was named “Center for the Treatment of Shock and Terminal States”. In 1961, he reported about creating a new medical science — resuscitation science, the subject of which is nonspecific general pathological reactions of the body, pathogenesis, therapy, and prevention of terminal states, life support in critical states. In 1972, in the first issue of the newly created journal “Resuscitation”, V.A. Negovsky published an article “The second step in resuscitation — the treatment of the ‘post-resuscitation’ disease”, in which he outlines the pathophysiological mechanisms of the development of post-resuscitation changes in the body. A special topic is overcoming the “iron curtain” and acquaintance of V.A. Negovsky with the American founder of the first Intensive Care Units (ICU) P. Safar, who laid the foundation for many years of scientific interaction and personal friendship. In 1985, on the basis of the Laboratory, Negovsky organized the Research Institute of General Reanimatology of the USSR of the Academy of Medical Sciences, which now bears his name. Vladimir Negovsky loved classical music, especially I.S. Bach, painting — Sandro Botticelli, Francisco Goya, always found time and energy for skiing. He died on August 2, 2003, and is buried in Moscow.

Objective Few studies have focused on factors associated with the incremental cost of video‐assisted thoracoscopic surgery (VATS) in China. We aim to systematically classify the complications after VATS major lung resection and explore their correlation with hospital costs. Methods Patients with pathologically stage I–III lung cancer who underwent VATS major lung resections from January 2007 to December 2018 were included. The Thoracic Mortality and Morbidity (TM&M) Classification system was used to evaluate postoperative complications. Grade I and II complications, defined as minor complications, require no therapy or pharmacologic intervention only. Grade III and IV complications, defined as major complications, require surgical intervention or life support. Grade V results in death. A generalized linear model was used to explore the correlation of incremental hospital costs and complications, as well as other clinicopathologic parameters between 2013 and 2016. Results A total of 2881 patients were enrolled in the first part, and the minor and major complications rates were 24.3% (703 patients) and 8.3% (228 patients), respectively. Six hundred and eighty‐two patients were enrolled in the second part. The complications grade II (odds ratio [OR] 1.12, 95% confidence interval [CI] 1.05–1.2, p = 0.0005), grade III (OR 1.55, 95% CI 1.26–1.9, p, The severity of complications graded by the Thoracic Mortality and Morbidity Classification system was associated with increased in‐hospital costs. This research has the potential in costs reduction under the current medical insurance system reform in China.

The Toxicology Investigators Consortium (ToxIC) Registry was established by the American College of Medical Toxicology in 2010. The registry collects data from participating sites with the agreement that all bedside and telehealth medical toxicology consultation will be entered. This eleventh annual report summarizes the Registry’s 2020 data and activity with its additional 6668 cases. Cases were identified for inclusion in this report by a query of the ToxIC database for any case entered from January 1 to December 31, 2020. Detailed data was collected from these cases and aggregated to provide information which included demographics, reason for medical toxicology evaluation, agent and agent class, clinical signs and symptoms, treatments and antidotes administered, mortality, and whether life support was withdrawn. Gender distribution included 50.6% cases in females, 48.4% in males, and 1.0% identifying as transgender. Non-opioid analgesics were the most commonly reported agent class, followed by opioid and antidepressant classes. Acetaminophen was once again the most common agent reported. There were 80 fatalities, comprising 1.2% of all registry cases. Major trends in demographics and exposure characteristics remained similar to past years’ reports. Sub-analyses were conducted to describe race and ethnicity demographics and exposures in the registry, telemedicine encounters, and cases related to the COVID-19 pandemic. Supplementary Information The online version contains supplementary material available at 10.1007/s13181-021-00854-3.

Introduction. In megacities, the use of organs obtained from those who died as a result of sudden out-of-hospital cardiac arrest (OHCA) for transplantation is one of the promising ways of addressing the problem of organ donor shortage. In St. Petersburg, the model of transition from life support via extracorporeal membrane oxygenation (ECMO) of patients after OHCA to ECMO life support for organs of potential donors was tested for the first time.Materials and methods. In order to implement the program, round-the-clock ECMO and transplantation teams were organized at the inpatient emergency ward of Pavlov First St. Petersburg State Medical University. Interaction with the St. Petersburg City Emergency Station, St. Petersburg was established. The protocol of work with potential donors brought to the hospital after a sudden circulatory arrest was developed, approved by the ethics committee, and implemented in clinical practice. This was the first in Russia and in international practice. Between 2017 and 2020, 67 patients with sudden OHCA were brought to the inpatient emergency ward. In 4 (5.97%) cases, advanced cardiovascular life support was successful, and 11 (16.42%) patients became effective donors. Mortality among this group of patients without subsequent postmortem donation was 77.61% (52 patients).Results. Liver transplantation from non-heart-beating donors (NHBDs) whose blood circulation was restored by ECMO (ECMO NHBD) was performed in 5 recipients who were in severe condition against the background of liver failure. In 1 (20%) case, there was severe liver allograft dysfunction for 33 days with subsequent complete restoration of function. Kidney transplantation was performed in 22 patients. Immediate graft function occurred in 10 (45.45%), while delayed function occurred in 12 (54.55%) patients. Kidney graft survival was 86.4%, kidney graft recipient survival was 95.5%, liver graft recipient survival was 80%, and the follow-up period was 24.1 ± 7.15 months.Conclusion. The use of ECMO to save the lives of patients with sudden OHCA can be implemented in conditions of a high degree of organization and synchronization of the work of the city emergency medical station and the emergency department of a multidisciplinary hospital. If cardiopulmonary resuscitation with ECMO (ECMO CPR) fails, it is possible to launch the ECMO NHBD donor program. Long-term outcomes of liver and kidney transplantation from ECMO NHBD are consistent with those using organs from brain-dead donors. Widespread implementation of the new organ donation model will increase the availability of transplant care.

Critical infrastructure services determine where people can survive and what they can do with their survival. This fact conditions political possibilities at a fundamental level but remains underexplored in the literature. Those who wish to extend the boundaries of political action, or to win protections and the possibility of a new political community for themselves and others, should focus a substantial part of their energies and attention on developing alternative infrastructure systems for supporting human life. Without such systems, political action – no matter how revolutionary or ingenious – will ultimately find itself constrained by its position within the zones of survivability established by existing forms of infrastructure and by the hierarchies and configurations of power linked with those forms of infrastructure. As a result, those who wish to change current political and economic conditions should think of the capacity to take care of everyone as a condition for such change rather than its result.

The survival of completely buried victims in an avalanche mainly depends on burial duration. Knowledge is limited about survival probability after 60 min of complete burial. We aimed to study the survival probability and prehospital characteristics of avalanche victims with long burial durations. We retrospectively included all completely buried avalanche victims with a burial duration of ≥60 min between 1997 and 2018 in Switzerland. Data were extracted from the registry of the Swiss Institute for Snow and Avalanche Research and the prehospital medical records of the physician-staffed helicopter emergency medical services. Avalanche victims buried for ≥24 h or with an unknown survival status were excluded. Survival probability was estimated by using the non-parametric Ayer-Turnbull method and logistic regression. The primary outcome was survival probability. We identified 140 avalanche victims with a burial duration of ≥60 min, of whom 27 (19%) survived. Survival probability shows a slight decrease with increasing burial duration (23% after 60 min, to

The purpose of the study is a comparative analysis of the implemented projects of closed ecological systems and the creation on their basis of own scheme of autonomous life-support complex for the conditions of the Arctic and the Far North. Materials and methods of research. The object of the study is implemented projects of closed ecological systems. The subject of the study is the principles of configuration of such projects, their main components and the relationship between them. Research results and their analysis. The support systems created at different times, with the purpose to be used in long-duration space flights or to carry out fundamental ecological research, were analyzed. Such projects were based on the use of biological systems, which opens the possibility of their use to ensure the autonomy of infrastructure in the Arctic and Far North. The scheme of the complex planned for development is proposed. This complex allows to recycle waste products, meets human nutritional needs and produces biofuel of the third generation.

International audience; Background: Immunocompromised children are likely to develop a refractory acute respiratory distress syndrome (ARDS). The usefulness of providing extracorporeal life support (ECLS) to these patients is a subject of debate. The aim of our study was to report the outcomes and to compare factors associated with mortality between immunocompromised and non-immunocompromised children supported with veno-venous ECMO. Methods: We performed a retrospective monocentric study in the French pediatric ECMO center of Armand Trousseau Hospital, including all pediatric patients aged from 1 month to 18 years requiring ECLS for ARDS. Results: Between 2007 and 2018, one hundred and eleven (111) patients underwent ECMO for respiratory failure; among them twenty-five (25) were immunocompromised. Survival rate at 6 months after intensive care discharge was significantly lower for immunocompromised patients compared to non-immunocompromised ones (41.7% vs. 62.8%; p = 0.04). ARDS severity was similar between the 2 groups. Fungal pneumonias were reported only in immunocompromised patients (12.5% versus 0% in the control group; p = 0.001). Bleeding complications were significantly more frequent in the immunocompromised group and blood product transfusions were also more frequently required in this group. Conclusion: Six months after intensive care discharge, survival rate of immunocompromised children supported with ECMO for pediatric ARDS is lower than for nonimmunocompromised patients. But, the expectation for a favorable outcome is real and it is worth it if their condition is likely to be compatible with a good long-term quality of life.