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Introduction: Prone position ventilation (PPV) of patients with adult respiratory distress syndrome (ARDS) supported with veno-venous extracorporeal membrane oxygenation (V-V ECMO) may improve oxygenation and alveolar recruitment and is recommended when extensive dorsal consolidations are present, but only few data regarding adverse events (AE) related to PPV in this group of patients have been published. Methods: Nationwide retrospective analysis of 68 COVID-19 patients admitted from March 2020 – December 2021 with severe ARDS and need of V-V ECMO support. The number of patients treated with PPV, number of PPV-events, timing, the time spent in prone position, number and causes of AE are reported. Causes to stop the PPV regimen and risk factors for AE were explored. Results: 44 out of 68 patients were treated with PPV, and 220 PPV events are evaluated. AE were identified in 99 out of 220 (45%) PPV events and occurred among 31 patients (71%). 1 fatal PPV related AE was registered. Acute supination occurred in 19 events (9%). Causes to stop the PPV regimen were almost equally distributed between effect (weaned from ECMO), no effect, death (of other reasons) and AE. Frequent causes of AE were pressures sores and ulcers, hypoxia, airway related and ECMO circuit related. Most AE occurred during patients first or second PPV event. Conclusions: PPV treatment was found to carry a high incidence of PPV related AE in these patients. Causes and preventive measures to reduce occurrence of PPV related AE during V-V ECMO support need further exploration. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Severe acute respiratory syndrome (ARDS) may require veno‐venous extracorporeal membrane oxygenation (V‐V ECMO). The aim of this study was to provide data on patient selection and outcome in a nationwide cohort study of patients with COVID‐19 associated ARDS supported with V‐V ECMO.We identified all patients with COVID‐19, who were supported with V‐V ECMO in Denmark from March 10, 2020, to December 31, 2021, and retrieved data on patients who were referred to‐ and accepted for ECMO, demographics, outcome data, and complications. Risk factors for mortality were analysed using multivariate Cox regression analysis.During the study period, 1836 patients were admitted to Danish intensive care units (ICUs). In the same period, there were 197 enquiries for ECMO of whom 118 patients were considered eligible. Overall, 71 patients were cannulated for ECMO; three patients were cannulated for veno‐arterial extracorporeal membrane oxygenation (V‐A ECMO) due to right sided heart failure and 68 patients were cannulated for V‐V ECMO. Two patients accepted for V‐V ECMO died during cannulation. The median age was 55 years (IQR 45–60) and 66% were males. The median duration of ECMO support was 13 days (IQR 7–21), mechanical ventilation median 26 days (IQR 14–42), ICU stay median 34 days (IQR 17–46), and length of hospital stay median 41 days (IQR 25–56). Ninety‐day mortality was 43%. Age of 60 years or more was associated with an increased risk of mortality. Pre‐existing hypertension was associated with a decreased risk of mortality.A nationwide, Danish cohort study of 68 COVID‐19 patients supported with V‐V ECMO, showed a 90‐day survival of 43%, which is in accordance with reports from comparable cohorts. Age of 60 years or more was associated with an increased risk of mortality. Pre‐existing hypertension was associated with a decreased risk of mortality. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Prone position ventilation (PPV) is recommended for patients with COVID‐19 induced severe Adult Respiratory Distress Syndrome (ARDS) and is used for patients supported with V‐V ECMO as well. The purpose of this study was to describe the use of PPV in these patients focusing on physiological effects with the hypothesis that PPV could reduce oxygen need and improve dynamic compliance.This study was a nationwide retrospective analysis of all COVID‐19 patients in Denmark from March 2020 – December 2021 with severe ARDS and need of V‐V ECMO support. Data on the number of patients treated with PPV, number of PPV sessions, timing, the time spent in prone position, pulmonary physiological response types with analysis of variables affecting the response are reported.Out of 68 patients 44 were treated with 220 PPV sessions and a positive clinical response was observed in 80% of patients but only in 45% of sessions. On a single session level, increased compliance was observed in 38% and increased oxygenation in only 15% of 220 sessions, with within‐patient heterogeneity. Higher dynamic compliance at the beginning of a PPV session was associated with a lower delta change in dynamic compliance during PPV. The response to a PPV session could not be predicted by the response in the prior session. Dynamic compliance did not change during the ECMO course.Eighty percent of patients responded positively during a PPV session, but this was not associated with overall pulmonary improvement. On a single patient level, responses were heterogenous and only 45% of sessions resulted in clinical improvement. Response in dynamic compliance was associated with starting values of compliance. [ABSTRACT FROM AUTHOR]

Formalised educational programmes for consultants are uncommon in Denmark. Our objective was to introduce a checklist for training and formative evaluation for consultants to see if this was a feasible method. Sixteen anaesthesiologists participated. A checklist for the use of a difficult airway device was developed. The consultants observed an experienced colleague use the device and then did the procedure themselves supervised in the clinical setting, and finally taught a fellow consultant how to do the procedure. Afterwards they were interviewed about the training method. Checklists seem a promising method for consultants and may be applied in the future.

Anaemia in surgical patients has been proven to increase morbidity and mortality. Due to the risk of adverse effects and the cost of blood transfusions it is important to reduce the need for transfusions by pre- and intra-operative interventions. Tranexamic acid has long been used in orthopaedic surgery as an antifibrinolytic agent. Several studies within the orthopaedic fields have underlined the effect of the drug in reducing blood loss and need for transfusions. However, more studies are needed to examine the optimal dosage and administration along with the risks associated with the drug.