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Background: The high-quality evidence on managing COVID-19 patients requiring extracorporeal membrane oxygenation (ECMO) support is insufficient. Furthermore, there is little consensus on allocating ECMO resources when scarce. The paucity of evidence and the need for guidance on controversial topics required an international expert consensus statement to understand the role of ECMO in COVID-19 better. Twenty-two international ECMO experts worldwide work together to interpret the most recent findings of the evolving published research, statement formulation, and voting to achieve consensus. Objectives: To guide the next generation of ECMO practitioners during future pandemics on tackling controversial topics pertaining to using ECMO for patients with COVID-19-related severe ARDS. Methods: The scientific committee was assembled of five chairpersons with more than 5 years of ECMO experience and a critical care background. Their roles were modifying and restructuring the panel's questions and, assisting with statement formulation in addition to expert composition and literature review. Experts are identified based on their clinical experience with ECMO (minimum of 5 years) and previous academic activity on a global scale, with a focus on diversity in gender, geography, area of expertise, and level of seniority. We used the modified Delphi technique rounds and the nominal group technique (NGT) through three face-to-face meetings and the voting on the statement was conducted anonymously. The entire process was planned to be carried out in five phases: identifying the gap of knowledge, validation, statement formulation, voting, and drafting, respectively. Results: In phase I, the scientific committee obtained 52 questions on controversial topics in ECMO for COVID-19, further reviewed for duplication and redundancy in phase II, resulting in nine domains with 32 questions with a validation rate exceeding 75% (Fig. 1). In phase III, 25 questions were used to formulate 14 statements, and six questions achieved no consensus on the statements. In phase IV, two voting rounds resulted in 14 statements that reached a consensus are included in four domains which are: patient selection, ECMO clinical management, operational and logistics management, and ethics. Conclusion: Three years after the onset of COVID-19, our understanding of the role of ECMO has evolved. However, it is incomplete. Tota14 statements achieved consensus; included in four domains discussing patient selection, clinical ECMO management, operational and logistic ECMO management and ethics to guide next-generation ECMO providers during future pandemic situations. [ABSTRACT FROM AUTHOR]

Purpose: To review the relevant literature of acute kidney injury (AKI) and continuous renal replacement therapy (CRRT) as it relates to pediatric extracorporeal membrane oxygenation (ECMO). Methods: Available online relevant literature. Results: ECMO is a therapeutic modality utilized to support patients with refractory respiratory and/or cardiac failure. AKI and fluid overload (FO) are frequently observed in this patient population. There are multiple modalities that can be utilized for AKI and FO which include the following: diuretics, in-line hemofiltration, and CRRT. There are multiple considerations when using CRRT with ECMO including access, CRRT flows, hemolysis, anticoagulation, and CRRT termination. Conclusion: While each ECMO center has its own set of equipment, experiences, and practices, it is imperative that the international ECMO community continues to work together to provide an evidence-based approach to address the morbidity and mortality associated with AKI and FO. [ABSTRACT FROM AUTHOR]

Objectives: The following three studies examined if 4–5 year olds, 7–8 year olds and adults recognized the impact of physical and sedentary activities on weight. Methods: Study 1 examined if 4–5 year olds and adults recognized the impact of physical activities on weight. Study 2 investigated if all three age groups of participants recognized the difference that physical activities and sedentary activities would have on weight. Study 3 examined if participants recognized the short-term and long-term impact of active and sedentary activities on weight. Results: The results demonstrated that compared to 7 and 8 year olds, 4 and 5 year olds had a difficult time in making a clear distinction between the impact of physical and sedentary activities on weight. Conclusions: Preschoolers have an impoverished recognition of the impact of activities on weight compared to children in middle childhood. This suggests the need for parents and educators to further emphasize the importance of physical activities in maintaining a healthy lifestyle in early childhood. [ABSTRACT FROM AUTHOR]

The following three studies examined young children’s and adults’ recognition of the impact of healthy and unhealthy foods on height and weight. Study 1 examined the impact of foods on height and weight. Study 2 examined the role of foods on characters of different ethnicities. Study 3 controlled for participants’ prior knowledge about the impact of food by presenting fictitious alien characters. The results indicated that preschoolers recognized that healthy foods promoted an increase in height but only for African-American images. Adults recognized the impact of nutrition on both height and weight with a greater emphasis of nutrition for weight than height. These results demonstrate that preschoolers’ biological model is more sophisticated and differentiated than previously reported. [ABSTRACT FROM AUTHOR]