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Sun Y, Wang H, Wu Y, Luo L, Shi C. Parents' knowledge and attitudes towards extracorporeal membrane oxygenation and their post-traumatic stress symptoms. Sci Rep 2024; 14:10700. [PMID: 38730232 PMCID: PMC11087580 DOI: 10.1038/s41598-024-60880-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/29/2024] [Indexed: 05/12/2024] Open
Abstract
This cross-sectional study, conducted between January 2020 and July 2023, aimed to assess the knowledge, attitude, and post-traumatic stress symptoms (PTSS) among parents with children undergoing extracorporeal membrane oxygenation (ECMO) treatment. Out of 201 valid questionnaires collected, the median knowledge score was 3.00, the mean attitude score was 27.00 ± 3.20, and the mean PTSS score was 3.50 ± 1.54. Logistic regression identified associations between PTSS and parents with lower education levels, particularly junior high school and high school/technical secondary school education, as well as those occupied as housewives. Structural equation modeling highlighted direct effects, such as the impact of residence on education, education on employment status, and associations between knowledge, attitude, PTSS, employment status, monthly income, and parental demographics. The findings indicated inadequate knowledge and suboptimal attitudes among parents, especially those with lower education levels, emphasizing the need for educational resources. Furthermore, addressing parental PTSS through psychosocial support and screening was deemed essential, providing valuable insights for tailored interventions in this context.
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Affiliation(s)
- Yuyan Sun
- Surgical Intensive Care Unit, Henan Children's Hospital Zhengzhou Children's Hospital, Henan, 450018, China
| | - Huanhuan Wang
- Surgical Intensive Care Unit, Henan Children's Hospital Zhengzhou Children's Hospital, Henan, 450018, China
| | - Yingying Wu
- Rehabilitation Department, Henan Children's Hospital Zhengzhou Children's Hospital, Henan, 450053, China
| | - Leng Luo
- Surgical Intensive Care Unit, Henan Children's Hospital Zhengzhou Children's Hospital, Henan, 450018, China
| | - Caixiao Shi
- Nursing Department, Henan Children's Hospital Zhengzhou Children's Hospital, Henan, 450018, China.
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Rizvi SSA, Nagle M, Roberts B, McDermott L, Miller K, Pasquarello C, Braddock A, Choi C, Yang Q, Hirose H. Cardiac Extracorporeal Membrane Oxygenation in Community Cardiac Surgery Program: Are the Results Comparable? Cureus 2024; 16:e58947. [PMID: 38800214 PMCID: PMC11126332 DOI: 10.7759/cureus.58947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) outcomes in small centers are commonly considered less favorable than in large-volume centers. New ECMO protocols and procedures were established in our regional community hospital system as part of a cardiogenic shock initiative. This retrospective study aims to evaluate the outcomes of veno-arterial extracorporeal membrane oxygenation (VA ECMO) and extracorporeal cardiopulmonary resuscitation (ECPR) in a community hospital system with cardiac surgery capability and assess whether protocol optimization and cannulation standards result in comparable outcomes to larger centers whether the outcomes of this new ECMO program at the community hospital setting were comparable to the United States averages. METHODS Our regional system comprises five hospitals with 1500 beds covering southwestern New Jersey, with only one of these hospitals having cardiac surgery and ECMO capability. In May 2021, the new ECMO program was initiated. Patients were screened by a multidisciplinary call, cannulated by our ECMO team, and subsequently treated by the designated team. We reviewed our cardiac ECMO outcomes over two years, from May 2021 to April 2023, in patients who required ECMO due to cardiogenic shock or as a part of extracorporeal cardiopulmonary resuscitation (ECPR). RESULTS A total of 60 patients underwent cardiac ECMO, and all were VA ECMO, including 18 (30%) patients who required ECPR for cardiac arrest. The overall survival rate for our cardiac ECMO program turned out to be 48% (29/60), with 50% (22/42) in VA ECMO excluding ECPR and 39% (7/18) in the ECPR group. The hospital survival rate for the VA ECMO and ECPR groups was 36% (15/42) and 28% (5/18), respectively. The ELSO-reported national average for hospital survival is 48% for VA ECMO and 30% for ECPR. Considering these benchmarks, the hospital survival rate of our program did not significantly lag behind the national average. CONCLUSIONS With protocol, cannulation standards, and ECMO management optimized, the VA ECMO results of a community hospital system with cardiac surgery capability were not inferior to those of larger centers.
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Affiliation(s)
| | - Matthew Nagle
- Surgery, Virtua Our Lady of Lourdes Hospital, Camden, USA
| | - Brian Roberts
- Surgery, Virtua Our Lady of Lourdes Hospital, Camden, USA
| | | | | | | | | | - Chun Choi
- Surgery, Virtua Our Lady of Lourdes Hospital, Camden, USA
| | - Qiong Yang
- Surgery, Virtua Our Lady of Lourdes Hospital, Camden, USA
- Cardiovascular and Thoracic Surgery, Cleveland Clinic, Cleveland, USA
| | - Hitoshi Hirose
- Surgery, Virtua Our Lady of Lourdes Hospital, Camden, USA
- Cardiovascular and Thoracic Surgery, Cleveland Clinic, Cleveland, USA
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Stevens K, Anandan SR, Rahman H, Parikh S, Leung AG, Benintendi A, Van Ogtrop KM, Stancavage A, Magalee CJ, Manetta F, Saikus C, Lopez S. Caring for Patients Requiring Venous Arterial Extracorporeal Membrane Oxygenation: Can Upstream Palliative Care Make a Difference? Am J Hosp Palliat Care 2024:10499091241226606. [PMID: 38195411 DOI: 10.1177/10499091241226606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
OBJECTIVE Palliative care consultation is relevant for patients requiring Venous-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO); however, evidence is limited to support its value. For this population, we compared length of stay (LOS) (primary outcome), operational metrics and goals of care (GOC) frequency before and after a collaboration between cardiothoracic (CT) surgery and Geriatrics and Palliative Medicine (GaP). METHODS Retrospective chart review of patients (18+) admitted to a quaternary center that required VA-ECMO between 2019-2021 and received GaP consultation. Demographics, LOS, times to consult, illness severity, GOC, and outcomes were analyzed. RESULTS 120 patients met inclusion criteria and 64 (53.3%) had GaP consultation. No differences were observed regarding demographics and insertion status (emergent vs elective). Median (IQR) days to GaP consult for 2019, 2020 and 2021 were 6.5 (4.0-14.5), 5.0 (2.0-11.0) and 3.0 (2.0-5.0), respectively (P = .006). Median days from insertion to consult for 2019, 2020 and 2021 were 6.0 (4.0-20.0), 3.0 (1.0-6.0) and 2.0 (1.0-4.0) (P = .003). Among survivors, over the 3-year course, median LOS was not statistically different. Between expired patients, median (IQR) LOS for 2019, 2020, and 2021 was 28.5 (23.0-40.0), 12.0 (8.0-14.0), 11.0 (5.0-17.0) days (P = .013). For patients not seen by GaP, 8 (14.3%) GOC notes were documented, compared with 42 (65.6%) for patients seen. Mortality was similar (53.6% vs 53.1% [GaP]). CONCLUSION For patient on VA-ECMO, early GaP consultation may improve hospital LOS and GOC rates. We suggest organizations consider early palliative integration when instituting mechanical circulatory support.
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Affiliation(s)
- Katie Stevens
- Department of Cardiothoracic Surgery, Zucker School of Medicine at Hofstra Northwell, Manhasset, NY, USA
| | - Samuel R Anandan
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Zucker School of Medicine at Hofstra Northwell, Manhasset, NY, USA
| | - Husneara Rahman
- Biostatistics Unit, Feinstein Institutes for Medical Research, Northwell Health, Great Neck, NY, USA
| | - Sima Parikh
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Zucker School of Medicine at Hofstra Northwell, Manhasset, NY, USA
| | - An Gao Leung
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Zucker School of Medicine at Hofstra Northwell, Manhasset, NY, USA
| | - Andrea Benintendi
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Zucker School of Medicine at Hofstra Northwell, Manhasset, NY, USA
| | - Katlynn M Van Ogtrop
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Zucker School of Medicine at Hofstra Northwell, Manhasset, NY, USA
| | - Alyssa Stancavage
- Department of Cardiothoracic Surgery, Zucker School of Medicine at Hofstra Northwell, Manhasset, NY, USA
| | - Christopher J Magalee
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Zucker School of Medicine at Hofstra Northwell, Manhasset, NY, USA
| | - Frank Manetta
- Department of Cardiothoracic Surgery, Zucker School of Medicine at Hofstra Northwell, Manhasset, NY, USA
| | - Christina Saikus
- Department of Cardiothoracic Surgery, Zucker School of Medicine at Hofstra Northwell, Manhasset, NY, USA
| | - Santiago Lopez
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Zucker School of Medicine at Hofstra Northwell, Manhasset, NY, USA
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Massoth C, Küllmar M, Pajares Moncho A, Susana GS, Grigoryev E, Ivkin A, von Dossow V, Ott S, Rau N, Meersch M, Zarbock A. Implementation of the Kidney Disease Improving Global Outcomes guidelines for the prevention of acute kidney injury after cardiac surgery: An international cohort survey. Eur J Anaesthesiol 2023; 40:418-424. [PMID: 37052046 DOI: 10.1097/eja.0000000000001837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
BACKGROUND Increasing evidence from randomised controlled trials supports the implementation of a six-measure care bundle proposed by the Kidney Disease Improving Global Outcomes (KDIGO) guidelines in patients at high risk for acute kidney injury (AKI) to reduce its incidence after cardiac surgery. OBJECTIVE To assess compliance with the KDIGO bundle in clinical practice. DESIGN Prospective observational multinational study. SETTING Six international tertiary care centres, from February 2021 to November 2021. PATIENTS Five hundred and thirty-seven consecutive patients undergoing cardiac surgery during a 1-month observational period. INTERVENTIONS All patients were assessed for the postoperative implementation of the following measures: avoidance of nephrotoxic medication and radiocontrast agents whenever possible, strict glycaemic control, close monitoring of renal function, optimisation of haemodynamic and volume status and functional monitoring of haemodynamic status. MAIN OUTCOME MEASURES The primary endpoint was the proportion of patients receiving fully compliant care. Secondary outcomes were occurrence of AKI and major adverse kidney event rate at day 30. RESULTS The full care bundle was applied to 0.4% of patients. There was avoidance of nephrotoxic drugs in 15.6%, radiocontrast agents in 95.3% and hyperglycaemia in 39.6%. Close monitoring of urine output and serum creatinine was achieved in 6.3%, 57.4% underwent optimisation of volume and haemodynamic status, and 43.9% received functional haemodynamic monitoring. 27.2% developed AKI within 72 h after surgery. The average number of implemented measures was 2.6 ± 1.0 and did not differ between AKI or non-AKI patients ( P = 0.854). CONCLUSION Adherence with the KDIGO bundle was very low in cardiac surgery patients. Initiatives to improve guideline compliance might provide a strategy to mitigate the burden of AKI. TRIAL REGISTRATION www.drks.de DRKS00024204.
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Affiliation(s)
- Christina Massoth
- From the Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Germany (CM, MK, MM, AZ), Department of Anaesthesiology, La Fe University and Polytechnic Hospital Valencia (APM), Department of Anaesthesiology, University Hospital Vall d ́Hebron Barcelona, Spain (SGS), Scientific Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia (EG, AI), Institute of Anaesthesiology and Pain Therapy, Heart and Diabetes Center Bad Oeynhausen, Ruhr- University (VvD), Department of Cardiac Anaesthesiology and Intensive Care Medicine, German Heart Center Berlin (SO, NR), Department of Cardiac Anaesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Germany (SO) and Department of Intensive Care Medicine, University Hospital Vall d'Hebron Barcelona, Spain
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