No abstract

A video depicting cardiopulmonary resuscitation and explaining resuscitation preference options was associated with improved knowledge of in-hospital cardiopulmonary resuscitation options and cardiopulmonary resuscitation terminology among patients and surrogate decision makers in the ICU, compared with receiving a pamphlet on cardiopulmonary resuscitation. Patients and surrogates found the video helpful in decision making and would recommend the video to others.

Objective Acute respiratory distress syndrome (ARDS) is a common complication of critical illness, with high mortality and limited treatment options. Preliminary studies suggest that potentially preventable hospital exposures contribute to ARDS development. We aimed to determine the association between specific hospital exposures and the rate of ARDS development among at-risk patients. Method In a population-based, nested, case-control study, consecutive adult patients who developed ARDS from January 2001 through December 2010 during their hospital stay (cases) were matched to similar-risk patients without ARDS (controls). They were matched for 6 baseline characteristics. Main Outcome Measure(s) Trained investigators blinded to outcome of interest reviewed medical records for evidence of specific exposures, including medical and surgical adverse events, inadequate empirical antimicrobial treatment, hospital-acquired aspiration, injurious mechanical ventilation, transfusion, and fluid and medication administration. Conditional logistic regression was used to calculate the risk associated with individual exposures. Results During the 10-year period, 414 patients with hospital-acquired ARDS were identified and matched to 414 at-risk, ARDS-free controls. Adverse events were highly associated with ARDS development (odds ratio, 6.2; 95% CI, 4.0-9.7), as were inadequate antimicrobial therapy, mechanical ventilation with injurious tidal volumes, hospital-acquired aspiration, and volume of blood products transfused and fluids administered. Exposure to antiplatelet agents during the at-risk period was associated with a decreased risk of ARDS. Rate of adverse hospital exposures and incidence of ARDS decreased during the study period. Conclusions Prevention of certain adverse hospital exposures in at-risk patients may limit the development of ARDS.

Health systems confronting the coronavirus disease 2019 (COVID-19) pandemic must plan for surges in ICU demand and equitably distribute resources to maximize benefit for critically ill patients and the public during periods of resource scarcity. For example, morbidity and mortality could be mitigated by a proactive regional plan for the triage of mechanical ventilators.Extracorporeal membrane oxygenation (ECMO), a resource-intensive and potentially lifesaving modality in severe respiratory failure, has generally not been included in proactive disaster preparedness until recently. This paper explores underlying assumptions and triage principles that could guide the integration of ECMO resources into existing disaster planning.Drawing from a collaborative framework developed by one US metropolitan area with multiple adult and pediatric extracorporeal life support centers, this paper aims to inform decisionmaking around ECMO use during a pandemic such as COVID-19. It also addresses the ethical and practical aspects of not continuing to offer ECMO during a disaster.