29 results on '"Tonna J"'
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2. Infection Prevention and Control Practices, and Barriers to Compliance among Medical Doctors and Clinical Medical Students, in a State University Teaching Hospital, Southeast Nigeria
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Tonna J. Aneke, Chinonyelum J. Orji, Onyinye H. Chime, and Edmund O. Ndibuagu
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General Medicine - Abstract
Aim: Objective of study was to assess infection prevention and control practices, and barriers to compliance among doctors, and students in a state university teaching hospital. Study Design: The study was of descriptive, cross sectional design. Place and Duration of Study: Conducted in the departments of Medicine, and Surgery, Enugu state University Teaching hospital, Southeast Nigeria. Four weeks in August 2019 was used in collecting data from 61 doctors, and 100 students. Methodology: Self-administered questionnaire was used in collecting information from respondents, selected through Convenience sampling method. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 22. Results were expressed in frequencies and percentages of responses. Results: More than 50.0% doctors reported compliance with hand hygiene, face mask use, eye goggle use, protective gown use, head cover use, hand gloves use, and disposal of sharps in Safety boxes. However, 95.1% of doctors recap used needles. Also, more than 50.0% of medical students reported good compliance with the above-stated items except for the use of eye goggles and use of hand gloves when attending to fever patients. Up to 76.0% of students recap used needles. Respectively, 70.5% of doctors and 67.0% of students identified inadequate supply of personal protective equipment as a barrier to compliance with infection prevention and control practices. Also, 67.2% of doctors and 65.0% of students forget to wash their hands as prescribed. 19.7% of doctors and 37.0% of students didn’t know that needles/sharps should be disposed of in safety boxes. Conclusions: Infection Prevention and Control (IPC) practices are relevant components of the healthcare system, and involve different methods designed to mitigate the risk of spreading infectious diseases in healthcare facilities. Most of the respondents in this study, had good hand hygiene, and personal protective equipment uses and practices, but the embarrassing level of recapping used needle practice.
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- 2022
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3. Blood Flow Rate and Drainage Cannula Size Impact the Outcome of Patients Receiving VV-ECMO for ARDS
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Mauri, T., primary, Spinelli, E., additional, Ibrahim, Q., additional, Rochwerg, B., additional, Lorusso, R., additional, Tonna, J., additional, Price, S., additional, MacLaren, G., additional, Pesenti, A., additional, Slutsky, A., additional, and Brodie, D., additional
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- 2023
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4. Prognostic factors associated with favourable functional outcome among adult patients requiring extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest: A systematic review and meta-analysis
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Tran, A., Rochwerg, B., Fan, E., Belohlavek, J., Suverein, M. M., van de Poll, M. C. G., Lorusso, R., Price, S., Yannopoulos, D., Maclaren, G., Ramanathan, K., Ling, R. R., Thiara, S., Tonna, J. E., Shekar, K., Hodgson, C. L., Scales, D. C., Sandroni, Claudio, Nolan, J. P., Slutsky, A. S., Combes, A., Brodie, D., Fernando, S. M., Sandroni C. (ORCID:0000-0002-8878-2611), Tran, A., Rochwerg, B., Fan, E., Belohlavek, J., Suverein, M. M., van de Poll, M. C. G., Lorusso, R., Price, S., Yannopoulos, D., Maclaren, G., Ramanathan, K., Ling, R. R., Thiara, S., Tonna, J. E., Shekar, K., Hodgson, C. L., Scales, D. C., Sandroni, Claudio, Nolan, J. P., Slutsky, A. S., Combes, A., Brodie, D., Fernando, S. M., and Sandroni C. (ORCID:0000-0002-8878-2611)
- Abstract
Background: Extracorporeal cardiopulmonary resuscitation (ECPR), has demonstrated promise in the management of refractory out-of-hospital cardiac arrest (OHCA). However, evidence from observational studies and clinical trials are conflicting and the factors influencing outcome have not been well established. Methods: We conducted a systematic review and meta-analysis summarizing the association between pre-ECPR prognostic factors and likelihood of good functional outcome among adult patients requiring ECPR for OHCA. We searched Medline and Embase databases from inception to February 28, 2023 and screened studies with two independent reviewers. We performed meta-analyses of unadjusted and adjusted odds ratios, adjusted hazard ratios and mean differences separately. We assessed risk of bias using the QUIPS tool and certainty of evidence using the GRADE approach. Findings: We included 29 observational and randomized studies involving 7,397 patients. Factors with moderate or high certainty of association with increased survival with favourable functional outcome include pre-arrest patient factors, such as younger age (odds ratio (OR) 2.13, 95% CI 1.52 to 2.99) and female sex (OR 1.37, 95% CI 1.11 to 1.70), as well as intra-arrest factors, such as shockable rhythm (OR 2.79, 95% CI 2.04 to 3.80), witnessed arrest (OR 1.68 (95% CI 1.16 to 2.42), bystander CPR (OR 1.55, 95% CI 1.19 to 2.01), return of spontaneous circulation (OR 2.81, 95% CI 2.19 to 3.61) and shorter time to cannulation (OR 1.14, 95% CI 1.17 to 1.69 per 10 minutes). Interpretation: The findings of this review confirm several clinical concepts wellestablished in the cardiac arrest literature and their applicability to the patient for whom ECPR is considered – that is, the impact of pre-existing patient factors, the benefit of timely and effective CPR, as well as the prognostic importance of minimizing low-flow time. We advocate for the thoughtful consideration of these prognostic factors as part of a risk st
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- 2023
5. Infection Prevention and Control Practices, and Barriers to Compliance among Medical Doctors and Clinical Medical Students, in a State University Teaching Hospital, Southeast Nigeria
- Author
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Ndibuagu, Edmund O., primary, Chime, Onyinye H., primary, Orji, Chinonyelum J., primary, and Aneke, Tonna J., primary
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- 2022
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6. Extracorporeal membrane oxygenation support in COVID-19: an international cohort study of the Extracorporeal Life Support Organization registry
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Barbaro, R, Maclaren, G, Boonstra, P, Iwashyna, T, Slutsky, A, Fan, E, Bartlett, R, Tonna, J, Hyslop, R, Fanning, J, Rycus, P, Hyer, S, Anders, M, Agerstrand, C, Hryniewicz, K, Diaz, R, Lorusso, R, Combes, A, Brodie, D, Alexander, P, Barrett, N, Belohlavek, J, Fisher, D, Fraser, J, Hssain, A, Jung, J, Mcmullan, M, Mehta, Y, Ogino, M, Paden, M, Shekar, K, Stead, C, Abu-Omar, Y, Agnoletti, V, Akbar, A, Alfoudri, H, Alviar, C, Aronsky, V, August, E, Auzinger, G, Aveja, H, Bakken, R, Balcells, J, Bangalore, S, Barnes, B, Bautista, A, Bellows, L, Beltran, F, Benharash, P, Benni, M, Berg, J, Bertini, P, Blanco-Schweizer, P, Brunsvold, M, Budd, J, Camp, D, Caridi-Scheible, M, Carton, E, Casanova-Ghosh, E, Castleberry, A, Chipongian, C, Choi, C, Circelli, A, Cohen, E, Collins, M, Copus, S, Coy, J, Crist, B, Cruz, L, Czuczwar, M, Daneshmand, M, Davis II, D, De la Cruz, K, Devers, C, Duculan, T, Durham, L, Elapavaluru, S, Elzo Kraemer, C, Filho, E, Fitzgerald, J, Foti, G, Fox, M, Fritschen, D, Fullerton, D, Gelandt, E, Gerle, S, Giani, M, Goh, S, Govener, S, Grone, J, Guber, M, Gudzenko, V, Gutteridge, D, Guy, J, Haft, J, Hall, C, Hassan, I, Herran, R, Hirose, H, Ibrahim, A, Igielski, D, Ivascu, F, Izquierdo Blasco, J, Jackson, J, Jain, H, Jaiswal, B, Johnson, A, Jurynec, J, Kellter, N, Kohl, A, Kon, Z, Kredel, M, Kriska, K, Kunavarapu, C, Lansink-Hartgring, O, Larocque, J, Larson, S, Layne, T, Ledot, S, Lena, N, Lillie, J, Lotz, G, Lucas, M, Ludwigson, L, Maas, J, Maertens, J, Mast, D, Mccardle, S, Mcdonald, B, Mclarty, A, Mcmahon, C, Meybohm, P, Meyns, B, Miller, C, Moraes Neto, F, Morris, K, Muellenbach, R, Nicholson, M, O'Brien, S, O'Keefe, K, Ogston, T, Oldenburg, G, Oliveira, F, Oppel, E, Pardo, D, Parker, S, Pedersen, F, Pellecchia, C, Pelligrini, J, Pham, T, Phillips, A, Pirani, T, Piwowarczyk, P, Plambeck, R, Pruett, W, Quandt, B, Ramanathan, K, Rey, A, Reyher, C, Riera del Brio, J, Roberts, R, Roe, D, Roeleveld, P, Rudy, J, Rueda, L, Russo, E, Sanchez Ballesteros, J, Satou, N, Saueressig, M, Saunders, P, Schlotterbeck, M, Schwarz, P, Scriven, N, Serra, A, Shamsah, M, Sim, L, Smart, A, Smith, A, Smith, D, Smith, M, Sodha, N, Sonntagbauer, M, Sorenson, M, Stallkamp, E, Stewart, A, Swartz, K, Takeda, K, Thompson, S, Toy, B, Tuazon, D, Uchiyama, M, Udeozo, O, van Poppel, S, Ventetuolo, C, Vercaemst, L, Vinh Chau, N, Wang, I, Williamson, C, Wilson, B, Winkels, H, Barbaro R. P., MacLaren G., Boonstra P. S., Iwashyna T. J., Slutsky A. S., Fan E., Bartlett R. H., Tonna J. E., Hyslop R., Fanning J. J., Rycus P. T., Hyer S. J., Anders M. M., Agerstrand C. L., Hryniewicz K., Diaz R., Lorusso R., Combes A., Brodie D., Alexander P., Barrett N., Belohlavek J., Fisher D., Fraser J., Hssain A. A., Jung J. S., McMullan M., Mehta Y., Ogino M. T., Paden M. L., Shekar K., Stead C., Abu-Omar Y., Agnoletti V., Akbar A., Alfoudri H., Alviar C., Aronsky V., August E., Auzinger G., Aveja H., Bakken R., Balcells J., Bangalore S., Barnes B. W., Bautista A., Bellows L. L., Beltran F., Benharash P., Benni M., Berg J., Bertini P., Blanco-Schweizer P., Brunsvold M., Budd J., Camp D., Caridi-Scheible M., Carton E., Casanova-Ghosh E., Castleberry A., Chipongian C. T., Choi C. W., Circelli A., Cohen E., Collins M., Copus S., Coy J., Crist B., Cruz L., Czuczwar M., Daneshmand M., Davis II D., De la Cruz K., Devers C., Duculan T., Durham L., Elapavaluru S., Elzo Kraemer C. V., Filho E. C., Fitzgerald J., Foti G., Fox M., Fritschen D., Fullerton D., Gelandt E., Gerle S., Giani M., Goh S. G., Govener S., Grone J., Guber M., Gudzenko V., Gutteridge D., Guy J., Haft J., Hall C., Hassan I. F., Herran R., Hirose H., Ibrahim A. S., Igielski D., Ivascu F. A., Izquierdo Blasco J., Jackson J., Jain H., Jaiswal B., Johnson A. C., Jurynec J. A., Kellter N. M., Kohl A., Kon Z., Kredel M., Kriska K., Kunavarapu C., Lansink-Hartgring O., LaRocque J., Larson S. B., Layne T., Ledot S., Lena N., Lillie J., Lotz G., Lucas M., Ludwigson L., Maas J. J., Maertens J., Mast D., McCardle S., McDonald B., McLarty A., McMahon C., Meybohm P., Meyns B., Miller C., Moraes Neto F., Morris K., Muellenbach R., Nicholson M., O'Brien S., O'Keefe K., Ogston T., Oldenburg G., Oliveira F. M., Oppel E., Pardo D., Parker S. J., Pedersen F. M., Pellecchia C., Pelligrini J. A. S., Pham T. T. N., Phillips A. R., Pirani T., Piwowarczyk P., Plambeck R., Pruett W., Quandt B., Ramanathan K., Rey A., Reyher C., Riera del Brio J., Roberts R., Roe D., Roeleveld P. P., Rudy J., Rueda L. F., Russo E., Sanchez Ballesteros J., Satou N., Saueressig M. G., Saunders P. C., Schlotterbeck M., Schwarz P., Scriven N., Serra A., Shamsah M., Sim L., Smart A., Smith A., Smith D., Smith M., Sodha N., Sonntagbauer M., Sorenson M., Stallkamp E. B., Stewart A., Swartz K., Takeda K., Thompson S., Toy B., Tuazon D., Uchiyama M., Udeozo O. I., van Poppel S., Ventetuolo C., Vercaemst L., Vinh Chau N. V., Wang I. -W., Williamson C., Wilson B., Winkels H., Barbaro, R, Maclaren, G, Boonstra, P, Iwashyna, T, Slutsky, A, Fan, E, Bartlett, R, Tonna, J, Hyslop, R, Fanning, J, Rycus, P, Hyer, S, Anders, M, Agerstrand, C, Hryniewicz, K, Diaz, R, Lorusso, R, Combes, A, Brodie, D, Alexander, P, Barrett, N, Belohlavek, J, Fisher, D, Fraser, J, Hssain, A, Jung, J, Mcmullan, M, Mehta, Y, Ogino, M, Paden, M, Shekar, K, Stead, C, Abu-Omar, Y, Agnoletti, V, Akbar, A, Alfoudri, H, Alviar, C, Aronsky, V, August, E, Auzinger, G, Aveja, H, Bakken, R, Balcells, J, Bangalore, S, Barnes, B, Bautista, A, Bellows, L, Beltran, F, Benharash, P, Benni, M, Berg, J, Bertini, P, Blanco-Schweizer, P, Brunsvold, M, Budd, J, Camp, D, Caridi-Scheible, M, Carton, E, Casanova-Ghosh, E, Castleberry, A, Chipongian, C, Choi, C, Circelli, A, Cohen, E, Collins, M, Copus, S, Coy, J, Crist, B, Cruz, L, Czuczwar, M, Daneshmand, M, Davis II, D, De la Cruz, K, Devers, C, Duculan, T, Durham, L, Elapavaluru, S, Elzo Kraemer, C, Filho, E, Fitzgerald, J, Foti, G, Fox, M, Fritschen, D, Fullerton, D, Gelandt, E, Gerle, S, Giani, M, Goh, S, Govener, S, Grone, J, Guber, M, Gudzenko, V, Gutteridge, D, Guy, J, Haft, J, Hall, C, Hassan, I, Herran, R, Hirose, H, Ibrahim, A, Igielski, D, Ivascu, F, Izquierdo Blasco, J, Jackson, J, Jain, H, Jaiswal, B, Johnson, A, Jurynec, J, Kellter, N, Kohl, A, Kon, Z, Kredel, M, Kriska, K, Kunavarapu, C, Lansink-Hartgring, O, Larocque, J, Larson, S, Layne, T, Ledot, S, Lena, N, Lillie, J, Lotz, G, Lucas, M, Ludwigson, L, Maas, J, Maertens, J, Mast, D, Mccardle, S, Mcdonald, B, Mclarty, A, Mcmahon, C, Meybohm, P, Meyns, B, Miller, C, Moraes Neto, F, Morris, K, Muellenbach, R, Nicholson, M, O'Brien, S, O'Keefe, K, Ogston, T, Oldenburg, G, Oliveira, F, Oppel, E, Pardo, D, Parker, S, Pedersen, F, Pellecchia, C, Pelligrini, J, Pham, T, Phillips, A, Pirani, T, Piwowarczyk, P, Plambeck, R, Pruett, W, Quandt, B, Ramanathan, K, Rey, A, Reyher, C, Riera del Brio, J, Roberts, R, Roe, D, Roeleveld, P, Rudy, J, Rueda, L, Russo, E, Sanchez Ballesteros, J, Satou, N, Saueressig, M, Saunders, P, Schlotterbeck, M, Schwarz, P, Scriven, N, Serra, A, Shamsah, M, Sim, L, Smart, A, Smith, A, Smith, D, Smith, M, Sodha, N, Sonntagbauer, M, Sorenson, M, Stallkamp, E, Stewart, A, Swartz, K, Takeda, K, Thompson, S, Toy, B, Tuazon, D, Uchiyama, M, Udeozo, O, van Poppel, S, Ventetuolo, C, Vercaemst, L, Vinh Chau, N, Wang, I, Williamson, C, Wilson, B, Winkels, H, Barbaro R. P., MacLaren G., Boonstra P. S., Iwashyna T. J., Slutsky A. S., Fan E., Bartlett R. H., Tonna J. E., Hyslop R., Fanning J. J., Rycus P. T., Hyer S. J., Anders M. M., Agerstrand C. L., Hryniewicz K., Diaz R., Lorusso R., Combes A., Brodie D., Alexander P., Barrett N., Belohlavek J., Fisher D., Fraser J., Hssain A. A., Jung J. S., McMullan M., Mehta Y., Ogino M. T., Paden M. L., Shekar K., Stead C., Abu-Omar Y., Agnoletti V., Akbar A., Alfoudri H., Alviar C., Aronsky V., August E., Auzinger G., Aveja H., Bakken R., Balcells J., Bangalore S., Barnes B. W., Bautista A., Bellows L. L., Beltran F., Benharash P., Benni M., Berg J., Bertini P., Blanco-Schweizer P., Brunsvold M., Budd J., Camp D., Caridi-Scheible M., Carton E., Casanova-Ghosh E., Castleberry A., Chipongian C. T., Choi C. W., Circelli A., Cohen E., Collins M., Copus S., Coy J., Crist B., Cruz L., Czuczwar M., Daneshmand M., Davis II D., De la Cruz K., Devers C., Duculan T., Durham L., Elapavaluru S., Elzo Kraemer C. V., Filho E. C., Fitzgerald J., Foti G., Fox M., Fritschen D., Fullerton D., Gelandt E., Gerle S., Giani M., Goh S. G., Govener S., Grone J., Guber M., Gudzenko V., Gutteridge D., Guy J., Haft J., Hall C., Hassan I. F., Herran R., Hirose H., Ibrahim A. S., Igielski D., Ivascu F. A., Izquierdo Blasco J., Jackson J., Jain H., Jaiswal B., Johnson A. C., Jurynec J. A., Kellter N. M., Kohl A., Kon Z., Kredel M., Kriska K., Kunavarapu C., Lansink-Hartgring O., LaRocque J., Larson S. B., Layne T., Ledot S., Lena N., Lillie J., Lotz G., Lucas M., Ludwigson L., Maas J. J., Maertens J., Mast D., McCardle S., McDonald B., McLarty A., McMahon C., Meybohm P., Meyns B., Miller C., Moraes Neto F., Morris K., Muellenbach R., Nicholson M., O'Brien S., O'Keefe K., Ogston T., Oldenburg G., Oliveira F. M., Oppel E., Pardo D., Parker S. J., Pedersen F. M., Pellecchia C., Pelligrini J. A. S., Pham T. T. N., Phillips A. R., Pirani T., Piwowarczyk P., Plambeck R., Pruett W., Quandt B., Ramanathan K., Rey A., Reyher C., Riera del Brio J., Roberts R., Roe D., Roeleveld P. P., Rudy J., Rueda L. F., Russo E., Sanchez Ballesteros J., Satou N., Saueressig M. G., Saunders P. C., Schlotterbeck M., Schwarz P., Scriven N., Serra A., Shamsah M., Sim L., Smart A., Smith A., Smith D., Smith M., Sodha N., Sonntagbauer M., Sorenson M., Stallkamp E. B., Stewart A., Swartz K., Takeda K., Thompson S., Toy B., Tuazon D., Uchiyama M., Udeozo O. I., van Poppel S., Ventetuolo C., Vercaemst L., Vinh Chau N. V., Wang I. -W., Williamson C., Wilson B., and Winkels H.
- Abstract
Background: Multiple major health organisations recommend the use of extracorporeal membrane oxygenation (ECMO) support for COVID-19-related acute hypoxaemic respiratory failure. However, initial reports of ECMO use in patients with COVID-19 described very high mortality and there have been no large, international cohort studies of ECMO for COVID-19 reported to date. Methods: We used data from the Extracorporeal Life Support Organization (ELSO) Registry to characterise the epidemiology, hospital course, and outcomes of patients aged 16 years or older with confirmed COVID-19 who had ECMO support initiated between Jan 16 and May 1, 2020, at 213 hospitals in 36 countries. The primary outcome was in-hospital death in a time-to-event analysis assessed at 90 days after ECMO initiation. We applied a multivariable Cox model to examine whether patient and hospital factors were associated with in-hospital mortality. Findings: Data for 1035 patients with COVID-19 who received ECMO support were included in this study. Of these, 67 (6%) remained hospitalised, 311 (30%) were discharged home or to an acute rehabilitation centre, 101 (10%) were discharged to a long-term acute care centre or unspecified location, 176 (17%) were discharged to another hospital, and 380 (37%) died. The estimated cumulative incidence of in-hospital mortality 90 days after the initiation of ECMO was 37·4% (95% CI 34·4–40·4). Mortality was 39% (380 of 968) in patients with a final disposition of death or hospital discharge. The use of ECMO for circulatory support was independently associated with higher in-hospital mortality (hazard ratio 1·89, 95% CI 1·20–2·97). In the subset of patients with COVID-19 receiving respiratory (venovenous) ECMO and characterised as having acute respiratory distress syndrome, the estimated cumulative incidence of in-hospital mortality 90 days after the initiation of ECMO was 38·0% (95% CI 34·6–41·5). Interpretation: In patients with COVID-19 who received ECMO, both estimated
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- 2020
7. (738) - Temporary Mechanical Circulatory Support as Bridge-to-Transplant and its Implications for Allosensitization Risk
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Lázár-Molnár, E., Kyriakopoulos, C., Taleb, I., Hurst, D., Ugolini, S., Selzman, C., Brinker, L., Drakos, S., Tonna, J., Geer, L., Goodwin, M., Wever-Pinzon, O., Hanff, T., Carter, S., and Stehlik, J.
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- 2024
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8. Elso registry analysis-longitudinal trends in bleeding complications on extracorporeal life support (ECLS) over the past twenty years.
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Willers A., Swol J., Buscher H., McQuilten Z., Kuijk S., Ten Cate H., McKellar S., Lorusso R., Tonna J., Willers A., Swol J., Buscher H., McQuilten Z., Kuijk S., Ten Cate H., McKellar S., Lorusso R., and Tonna J.
- Abstract
Background: Extracorporeal life support (ECLS) is increasingly used worldwide over the past two decades and new indications are emerging, including extracorporeal cardiopulmonary resuscitation, trauma and COVID-19 cases. A frequent and remained feared complication is bleeding, and it is associated with high morbidity and mortality. However, trends of bleeding complications and outcomes have been poorly investigated. Method(s): Veno-venous (V-V) and veno-arterial (V-A) ECLS patients from the Extracorporeal Life Support Organization (ELSO) Registry database between 2000 and 2020 were included. Bleeding complication and mortality trends were analyzed. Bleeding complications included surgical site, cannulation site, gastrointestinal, pulmonary central nervous system and tamponade bleeding. Risk factors for bleeding complications were identified with multivariable analysis. Result(s): The analysis included 50.444 patients with single ECLS runs, 30.696 patients with V-A ECLS and 19.748 with V-V ECLS. Bleeding complications were reported in 13.534 patients (26.8%) and occurred more often in V-A ECLS compared to V-V ECLS patients (30.0% versus 21.9%). Bleeding patients showed lower hospital survival rates in both groups. Over the past twenty years bleeding complications showed a decreasing trend with a coefficient of -1.124 and -1.661 for V-V and V-A ECLS respectively. Surgical and cannulation site bleeding showed highest negative trend in both ECLS groups. Conclusion(s): The decrease in bleeding complications, especially cannulation and surgical site related bleeding, over the past two decades suggest improvement in anticoagulation management and possible equipment development. However, the persistent high rates of bleeding complications and association with mortality reinforces the need to understand bleeding complications more thoroughly during ECLS.
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- 2021
9. Heroes v-a: Hemorrhagic complications in veno-arterial extracorporeal life support-development and internal validation of multivariable prediction model in adult patients.
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Willers A., Swol J., Van Kuijk S., Buscher H., McQuilten Z., Ten Cate H., Rycus P., McKellar S., Lorusso R., Tonna J., Willers A., Swol J., Van Kuijk S., Buscher H., McQuilten Z., Ten Cate H., Rycus P., McKellar S., Lorusso R., and Tonna J.
- Abstract
Introduction: There is an increase in use of extracorporeal life support (ECLS) for cardiac support, with new indications emerging. Bleeding complications are the most frequent complications, associated with high morbidity and mortality. Despite the high frequency, the risk factors for bleeding complications remain poorly investigated. Method(s): To develop a prediction model for bleeding complications, adult patients included in the Extracorporeal Life Support Organization (ELSO) registry undergoing V-A ECLS between 2000 and 2020 were analyzed. The primary outcome was bleeding complications during V-A ECLS. Backward stepwise elimination in multivariable logistic regression analysis was used to develop the prediction model. The performance of the model was tested by ROC curves with AUC for discriminative ability and calibration plots. To detect overfitting of the model, internal validation was performed. Result(s): Single V-A ECLS runs were recorded in 28.767 adult patients, of which 29,0% developed bleeding complications. Sex, BMI, surgical cannulation, respiratory and hemodynamic variables prior to ECLS, the use of additional support devices, pre-ECLS interventions and different type of diagnosis were included in the prediction model. The model showed a fair predictive capability with an AUC of 0.66. Internal validation showed almost no overfitting of the model. An online calculator may simplify the use of the model. Conclusion(s): A multivariable model was developed and internally validated to calculate the risk for bleeding complications for adult patients receiving V-A ECLS. This model showed a favorabel predictive capability compared to the current literature. External validation is needed to confirm clinical use of this model.
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- 2021
10. Esophageal verrucous carcinoma arising from hyperkeratotic plaques associated with human papilloma virus type 51
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Tonna, J., Palefsky, J. M., Rabban, J., Campos, G. M., Theodore, P., and Ladabaum, U.
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- 2010
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11. Feasibility and Effectiveness of a Shock Team Approach in Refractory Cardiogenic Shock: Preliminary Results
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Taleb, I., primary, Koliopoulou, A., additional, Tandar, A., additional, McKellar, S., additional, Nativi-Nicolau, J., additional, Wever-Pinzon, O., additional, Gilbert, E., additional, Fang, J., additional, Stehlik, J., additional, Tonna, J., additional, Morshedzadeh, J., additional, ko, B., additional, Owan, T., additional, Ibrahim, H., additional, Selzman, C., additional, Welt, F., additional, and Drakos, S., additional
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- 2018
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12. (803) - Feasibility and Effectiveness of a Shock Team Approach in Refractory Cardiogenic Shock: Preliminary Results
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Taleb, I., Koliopoulou, A., Tandar, A., McKellar, S., Nativi-Nicolau, J., Wever-Pinzon, O., Gilbert, E., Fang, J., Stehlik, J., Tonna, J., Morshedzadeh, J., ko, B., Owan, T., Ibrahim, H., Selzman, C., Welt, F., and Drakos, S.
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- 2018
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13. (738) - Temporary Mechanical Circulatory Support as Bridge-to-Transplant and its Implications for Allosensitization Risk.
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Sideris, K., Lázár-Molnár, E., Kyriakopoulos, C., Taleb, I., Hurst, D., Ugolini, S., Selzman, C., Brinker, L., Drakos, S., Tonna, J., Geer, L., Goodwin, M., Wever-Pinzon, O., Hanff, T., Carter, S., and Stehlik, J.
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ARTIFICIAL blood circulation - Published
- 2024
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14. Successful Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) deployment by emergency medicine physicians for refractory non-traumatic cardiac arrest.
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Brant-Zawadzki G, Hoareau GL, Stoecklein HH, Levin N, Selzman CH, Ciullo A, Tonna J, Kelly C, Jones J, Youngquist ST, and Johnson MA
- Abstract
Aim: Cardiac arrest afflicts over 600,000 people annually in the United States. Rates of survival from cardiac arrest have remained stagnant for decades. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is most commonly used in the management of severe hemorrhagic shock, primarily for non-compressible thoracoabdominal trauma. A growing body of evidence suggests it may serve a role in augmenting cardiac and cerebral perfusion in non-traumatic, refractory cardiac arrest. Typically, REBOA is deployed by interventional radiologists under real-time fluoroscopy. Limited data exist to demonstrate the feasibility or logistics of successful REBOA deployment in emergency departments by emergency medicine physicians., Methods: We describe an emergency medicine-driven training program and treatment protocol developed to deploy REBOA in the emergency department for patients experiencing refractory out-of-hospital cardiac arrest and deemed ineligible for ECPR. We detail the training, certification processes, and clinical outcomes from our first eight cases., Results: Five emergency medicine physicians underwent training for REBOA placement through a didactic curriculum and hands-on training with mannequin and live tissue porcine models. Since protocol implementation, eight patients have undergone REBOA catheterization by emergency medicine physicians: 5 males and 3 females, age range 25-79. The first pass success was 8/8 (100 %), and all 3 commercially available catheters in the United States were successfully used. ROSC was achieved in 3/8 (37.5 %) patients, although no patients survived to hospital discharge. No REBOA catheter-associated complications were identified., Conclusions: This series demonstrates feasibility of emergency physician placed REBOA for non-traumatic, refractory cardiac arrest a novel resuscitative technique. Through a combination of focused education, innovative technology use, robust large animal model-based training, and strategic procedural integration, we showcase the potential for emergency departments to spearhead the adoption of this potentially life-saving intervention., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Austin Johnson is a co-founder, board member, consultant, and stockholder in Certus Critical Care. Dr. Austin Johnson is a board member of TitinKM Biomedical.
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- 2024
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15. Influence of Cooling duration on Efficacy in Cardiac Arrest Patients (ICECAP): study protocol for a multicenter, randomized, adaptive allocation clinical trial to identify the optimal duration of induced hypothermia for neuroprotection in comatose, adult survivors of after out-of-hospital cardiac arrest.
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Meurer WJ, Schmitzberger FF, Yeatts S, Ramakrishnan V, Abella B, Aufderheide T, Barsan W, Benoit J, Berry S, Black J, Bozeman N, Broglio K, Brown J, Brown K, Carlozzi N, Caveney A, Cho SM, Chung-Esaki H, Clevenger R, Conwit R, Cooper R, Crudo V, Daya M, Harney D, Hsu C, Johnson NJ, Khan I, Khosla S, Kline P, Kratz A, Kudenchuk P, Lewis RJ, Madiyal C, Meyer S, Mosier J, Mouammar M, Neth M, O'Neil B, Paxton J, Perez S, Perman S, Sozener C, Speers M, Spiteri A, Stevenson V, Sunthankar K, Tonna J, Youngquist S, Geocadin R, and Silbergleit R
- Subjects
- Humans, Time Factors, Treatment Outcome, Recovery of Function, Neuroprotection, United States, Comparative Effectiveness Research, Hypothermia, Induced methods, Hypothermia, Induced adverse effects, Out-of-Hospital Cardiac Arrest therapy, Out-of-Hospital Cardiac Arrest physiopathology, Coma therapy, Coma etiology, Coma physiopathology, Multicenter Studies as Topic, Randomized Controlled Trials as Topic
- Abstract
Background: Cardiac arrest is a common and devastating emergency of both the heart and brain. More than 380,000 patients suffer out-of-hospital cardiac arrest annually in the USA. Induced cooling of comatose patients markedly improved neurological and functional outcomes in pivotal randomized clinical trials, but the optimal duration of therapeutic hypothermia has not yet been established., Methods: This study is a multi-center randomized, response-adaptive, duration (dose) finding, comparative effectiveness clinical trial with blinded outcome assessment. We investigate two populations of adult comatose survivors of cardiac arrest to ascertain the shortest duration of cooling that provides the maximum treatment effect. The design is based on a statistical model of response as defined by the primary endpoint, a weighted 90-day mRS (modified Rankin Scale, a measure of neurologic disability), across the treatment arms. Subjects will initially be equally randomized between 12, 24, and 48 h of therapeutic cooling. After the first 200 subjects have been randomized, additional treatment arms between 12 and 48 h will be opened and patients will be allocated, within each initial cardiac rhythm type (shockable or non-shockable), by response adaptive randomization. As the trial continues, shorter and longer duration arms may be opened. A maximum sample size of 1800 subjects is proposed. Secondary objectives are to characterize: the overall safety and adverse events associated with duration of cooling, the effect on neuropsychological outcomes, and the effect on patient-reported quality of life measures., Discussion: In vitro and in vivo studies have shown the neuroprotective effects of therapeutic hypothermia for cardiac arrest. We hypothesize that longer durations of cooling may improve either the proportion of patients that attain a good neurological recovery or may result in better recovery among the proportion already categorized as having a good outcome. If the treatment effect of cooling is increasing across duration, for at least some set of durations, then this provides evidence of the efficacy of cooling itself versus normothermia, even in the absence of a normothermia control arm, confirming previous RCTs for OHCA survivors of shockable rhythms and provides the first prospective controlled evidence of efficacy in those without initial shockable rhythms., Trial Registration: ClinicalTrials.gov NCT04217551. Registered on 30 December 2019., (© 2024. The Author(s).)
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- 2024
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16. Venoarterial Extracorporeal Life Support Use in Acute Pulmonary Embolism Shows Favorable Outcomes.
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Scott EJ, Young S, Ratcliffe SJ, Wang XQ, Mehaffey JH, Sharma A, Rycus P, Tonna J, Yarboro L, Bryner B, Collins M, and Teman NR
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- Humans, Female, Male, Middle Aged, Acute Disease, Retrospective Studies, Treatment Outcome, Registries, Aged, Survival Rate trends, Adult, Pulmonary Embolism mortality, Pulmonary Embolism therapy, Extracorporeal Membrane Oxygenation methods
- Abstract
Background: Differences in outcomes by indication for venoarterial extracorporeal life support (VA-ECLS) are poorly described. We hypothesized that patients on VA-ECLS for acute pulmonary embolism (PE) have fewer complications and better survival than patients on VA-ECLS for other indications., Methods: All patients ≥18 years on VA-ECLS from the Extracorporeal Life Support Organization global registry (2010-2019) were evaluated (n = 29,842). After excluding patients aged >79 years (n = 729) and those with incomplete indication data (n = 2530), patients were stratified by VA-ECLS indication for PE vs all other indications. The association between being discharged alive and each type of complication with VA-ECLS indication was assessed., Results: Of 26,583 patients included in the analysis, 978 (3.7%) were on VA-ECLS for a primary diagnosis of acute PE. Acute PE patients were younger (53.1 vs 56.7 years, P < .001) and were more likely to be women (52.1% vs 32.3%, P < .001). Patients who underwent VA-ECLS for acute PE were 78% more likely to be discharged alive vs patients supported with VA-ECLS for other reasons (52.8% vs 40.4%; P < .001). Acute PE patients had fewer cardiovascular and renal complications (26.6% vs 38.0% and 31.1% vs 39.4%, respectively; adjusted P < .001). Acute PE patients had higher odds of having clots and mechanical complications (8.7% vs 7.9% and 16.7% vs 14.6%, respectively; adjusted P < .001)., Conclusions: Patients undergoing VA-ECLS for acute PE have higher odds of survival to hospital discharge compared with those supported for other indications. Additionally, VA-ECLS in this population is associated with fewer cardiovascular and renal complications but higher mechanical complications., (Copyright © 2024 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
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- 2024
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17. Influence of Cooling duration on Efficacy in Cardiac Arrest Patients (ICECAP): study protocol for a multicenter, randomized, adaptive allocation clinical trial to identify the optimal duration of induced hypothermia for neuroprotection in comatose, adult survivors of after out-of-hospital cardiac arrest.
- Author
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Meurer W, Schmitzberger F, Yeatts S, Ramakrishnan V, Abella B, Aufderheide T, Barsan W, Benoit J, Berry S, Black J, Bozeman N, Broglio K, Brown J, Brown K, Carlozzi N, Caveney A, Cho SM, Chung-Esaki H, Clevenger R, Conwit R, Cooper R, Crudo V, Daya M, Harney D, Hsu C, Johnson NJ, Khan I, Khosla S, Kline P, Kratz A, Kudenchuk P, Lewis RJ, Madiyal C, Meyer S, Mosier J, Mouammar M, Neth M, O'Neil B, Paxton J, Perez S, Perman S, Sozener C, Speers M, Spiteri A, Stevenson V, Sunthankar K, Tonna J, Youngquist S, Geocadin R, and Silbergleit R
- Abstract
Background: Cardiac arrest is a common and devastating emergency of both the heart and brain. More than 380,000 patients suffer out-of-hospital cardiac arrest annually in the United States. Induced cooling of comatose patients markedly improved neurological and functional outcomes in pivotal randomized clinical trials, but the optimal duration of therapeutic hypothermia has not yet been established., Methods: This study is a multi-center randomized, response-adaptive, duration (dose) finding, comparative effectiveness clinical trial with blinded outcome assessment. We investigate two populations of adult comatose survivors of cardiac arrest to ascertain the shortest duration of cooling that provides the maximum treatment effect. The design is based on a statistical model of response as defined by the primary endpoint, a weighted 90-day mRS (modified Rankin Scale, a measure of neurologic disability), across the treatment arms. Subjects will initially be equally randomized between 12, 24, and 48 hours of therapeutic cooling. After the first 200 subjects have been randomized, additional treatment arms between 12 and 48 hours will be opened and patients will be allocated, within each initial cardiac rhythm type (shockable or non-shockable), by response adaptive randomization. As the trial continues, shorter and longer duration arms may be opened. A maximum sample size of 1800 subjects is proposed. Secondary objectives are to characterize: the overall safety and adverse events associated with duration of cooling, the effect on neuropsychological outcomes, and the effect on patient reported quality of life measures., Discussion: In-vitro and in-vivo studies have shown the neuroprotective effects of therapeutic hypothermia for cardiac arrest. We hypothesize that longer durations of cooling may improve either the proportion of patients that attain a good neurological recovery or may result in better recovery among the proportion already categorized as having a good outcome. If the treatment effect of cooling is increasing across duration, for at least some set of durations, then this provides evidence of the efficacy of cooling itself versus normothermia, even in the absence of a normothermia control arm, confirming previous RCTs for OHCA survivors of shockable rhythms and provides the first prospective controlled evidence of efficacy in those without initial shockable rhythms., Trial Registration: ClinicalTrials.gov (NCT04217551, 2019-12-30)., Competing Interests: Competing interests {28} B Abella: Funding: NIH, DOD, Neuroptics, Becton Dickinson; equity: VOC Health, Neuroptics, MDAlly, volunteer: AHA T Aufderheide: Unrestricted research grant from ZOLL Medical, Inc. S Berry: Part owner of Berry Consultants K Broglio: Owns stock in AstraZeneca NIH (K23HL157610) and Hyper ne (SAFE MRI study) S Cho: NIH (K23HL157610) and Hyper ne (SAFE MRI study) R Lewis: I am the Senior Medical Scientist at Berry Consultants, LLC, a statistical consulting firm that specializes in the design, conduct, and analysis of Bayesian adaptive clinical trials. Berry Consultants contributed to the statistical design of the trial reported here. All other authors declare that they have no competing interests.
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- 2024
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18. Extracorporeal membrane oxygenation as a bridge to advanced heart failure therapies.
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Acharya D, Manandhar-Shrestha N, Leacche M, Rajapreyar I, William P, Kazui T, Hooker R, Tonna J, Jovinge S, and Loyaga-Rendon R
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- Adult, Humans, Shock, Cardiogenic therapy, Retrospective Studies, Extracorporeal Membrane Oxygenation, Heart Failure therapy, Heart Transplantation, Heart-Assist Devices
- Abstract
Background: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a key support modality for cardiogenic shock. The 2018 United Network for Organ Sharing (UNOS) heart transplant allocation algorithm prioritizes VA-ECMO patients., Objective: To evaluate the role of VA-ECMO in bridging to advanced heart failure therapies., Methods: We analyzed adult patients from the multicenter Extracorporeal Life Support Organization registry receiving VA-ECMO for cardiac support or resuscitation between 2016 and 2021 in the United States, comparing bridge-to-transplant (BTT) and non-BTT intent patients, as well as pre- vs post-2018 patients, on a wide range of demographic and clinical outcome predictors., Results: Of 17,087 patients, 797 received left ventricular assist device (LVAD)/heart transplant, 7,931 died or had poor prognosis, and 8,359 had expected recovery at ECMO discontinuation. Patients supported with BTT intent had lower clinical acuity than non-BTT candidates and were more likely to receive LVAD/transplant. The proportion of patients who received VA-ECMO as BTT and received LVAD/transplant increased after 2018. Post-2018 BTT patients had significantly lower clinical acuity and higher likelihood of transplant than both post-2018 non-BTT patients and pre-2018 BTT patients. ECMO complications were associated with lower likelihood of transplant but were significantly less common post-2018 than pre-2018., Conclusions: After implementation of the 2018 UNOS allocation system, ECMO utilization as BTT or LVAD has increased, and the acuity of BTT intent patients cannulated for ECMO has decreased. There has not yet been an increase in more acute ECMO patients getting transplanted. This may partially explain the post-transplant outcomes of ECMO patients in the current era reported in UNOS., (Copyright © 2023 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)
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- 2023
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19. Reply: Left Ventricular Mechanical Unloading During VA-ECMO: Not If, But Who and When?
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Grandin EW, Nunez JI, Kapur NK, Tonna J, and Garan AR
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- Humans, Shock, Cardiogenic, Heart Ventricles diagnostic imaging, Extracorporeal Membrane Oxygenation, Heart-Assist Devices
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- 2022
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20. The Multicenter Collaborative to Enhance Biologic Understanding, Quality, and Outcomes in Cardiogenic Shock (VANQUISH Shock): Rationale and Design.
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Tehrani BN, Drakos SG, Billia F, Batchelor WB, Luk A, Stelling K, Tonna J, Rosner C, Hanff T, Rao V, Brozzi NA, and Baran DA
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- Hospital Mortality, Humans, Multicenter Studies as Topic, Observational Studies as Topic, Quality of Life, Registries, Shock, Cardiogenic etiology, Treatment Outcome, Biological Products, Myocardial Infarction diagnosis, Myocardial Infarction epidemiology, Myocardial Infarction therapy
- Abstract
Background: Despite efforts to advance therapies in cardiogenic shock (CS), outcomes remain poor. This is likely due to several factors, including major gaps in our understanding of the pathophysiology, phenotyping of patients, and challenges with conducting adequately powered clinical studies. An unmet need exists for a comprehensive multicentre "all-comers" prospective registry to facilitate characterising contemporary presentation, treatment (in a device-agnostic fashion), and short- and intermediate-term outcomes and quality of life (QOL) of CS patients., Methods: The Multicenter Collaborative to Enhance Biological Understanding, Quality and Outcomes in Cardiogenic Shock (VANQUISH Shock) registry is a prospective observational registry that will study unrestricted adult patients with a primary diagnosis of CS at 4 North American centres with multidisciplinary shock programs. Both acute myocardial infarction (AMI-CS) and acute heart failure (HF-CS) etiologies will be included, and the registry will be device agnostic and widely inclusive. The primary end point will be survival at 30 days after hospital discharge. Secondary outcomes will include in-hospital adverse events and survival to 6 and 12 months. Patients will also undergo neurologic and health-related QOL assessments with the Cerebral Performance Category (CPC) and Short-Form 36 (SF-36) health survey tools before discharge and during follow-up. Serial biospecimens will facilitate biomarker studies., Conclusions: The VANQUISH Shock registry provides a unique opportunity to study the pathophysiology, contemporary management, clinical course, and outcomes of CS. By capturing detailed and high-quality longitudinal data, the registry will address existing knowledge gaps and serve as a springboard for future mechanistic clinical studies to advance the field., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)
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- 2022
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21. Neurological Outcome According to the Site of Cannulation in Septic Children Supported by Venoarterial Extracorporeal Membrane Oxygenation.
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Chenouard A, Liet JM, Maminirina P, Denis M, Tonna J, Rycus P, Joram N, and Bourgoin P
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- Catheterization adverse effects, Child, Humans, Retrospective Studies, Extracorporeal Membrane Oxygenation adverse effects, Sepsis epidemiology, Sepsis etiology, Shock, Septic
- Abstract
The impact of cervical cannulation on neurologic outcome has not been yet studied among children receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) in the context of severe sepsis or septic shock. A retrospective cohort study was performed using the extracorporeal life support organization (ELSO) registry. A total of 559 children weighing less than 20 kg with a primary or secondary diagnosis of severe sepsis, septic shock or toxic shock syndrome were included between January 1, 2010, and December 31, 2019. Cervical cannulation was performed in 485 children (87%) and central cannulation in 74 children (13%). The prevalence of acute neurologic event (ANE) was 32%, including clinical and/or electroencephalographic seizures, cerebral infarction, cerebral hemorrhage, and/or brain death. In multivariable analysis, we did not find an association between cervical cannulation and greater/lesser odds of ANE during ECMO (adjusted odds ratio [aOR] = 1.39, 95% confidence interval [CI] 0.72-2.65; P = 0.326). Only pre-ECMO acidosis was independently associated with the development of ANE (pH < 6.99; aOR = 2.71, 95% CI 1.34-5.49; P = 0.006; pH 6.99 to <7.12; aOR = 2.57, 95% CI 1.37-4.82; P = 0.003). Thus, the site of cannulation appears not as a modifiable neurologic risk factor in this young septic population., Competing Interests: Disclosure: P.R. is a member of the ELSO Executive Committee and J.T. is a member of the ELSO Registry committee. The other authors have no conflicts of interest to report., (Copyright © ASAIO 2021.)
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- 2021
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22. Intramuscular adrenaline for out-of-hospital cardiac arrest is associated with faster drug delivery: A feasibility study.
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Pugh AE, Stoecklein HH, Tonna JE, Hoareau GL, Johnson MA, and Youngquist ST
- Abstract
Background: Early adrenaline administration is associated with return of spontaneous circulation (ROSC) and survival in out-of-hospital cardiac arrest (OHCA). Animal data demonstrate a similar rate of ROSC when early intramuscular (IM) adrenaline is given compared to early intravenous (IV) adrenaline., Aim: To evaluate the feasibility of protocolized first-dose IM adrenaline in OHCA and it's effect on time from Public Safety Access Point (PSAP) call receipt to adrenaline administration when compared to IO and IV administration., Methods: This is a before-and-after feasibility study of adult OHCAs in a single EMS service following adoption of a protocol for first-dose IM adrenaline. Time from PSAP call to administration and outcomes were compared to 674 historical controls (from January 1, 2013-February 8, 2021) who received at least one dose of adrenaline by IV or IO routes., Results: During the study period, first-dose IM adrenaline was administered to 99 patients (December 1, 2019-February 8, 2021). IM adrenaline was given a median of 12.2 min (95% CI 11.4-13.1 min) after the PSAP call receipt compared to 15.3 min for the IV route (95% CI 14.6-16.0 min) and 15.3 min for the IO route (95% CI 14.9-15.7 min) with a time savings of 3 min (95% CI 2-4 min). Rates of survival to hospital discharge appeared similar between groups: 10% for IM, 8% for IV and 7% for IO. However, results related to survival were underpowered for statistical comparison., Conclusions: Within the limitations of a small sample size and before-and-after design, first-dose IM adrenaline was feasible and reduced the time to adrenaline administration., (© 2021 The Author(s).)
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- 2021
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23. Analyzing clinical and system drivers of satisfaction in the intensive care unit as a component of high quality care.
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Hummel K, Ou Z, Latchireddi A, Presson AP, and Tonna J
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- Communication, Family, Humans, Quality of Health Care, Intensive Care Units, Personal Satisfaction
- Abstract
Background: Quality improvement in the intensive care unit has transitioned from focusing on mortality to improving care and reducing morbidity., Objective: This study prospectively investigated clinical and system drivers of family satisfaction in a large quaternary hospital ICU., Methods: A validated tool was distributed to family members and a registry chart analysis was conducted. The aims were to assess associations with high or low family satisfaction to evaluate unit-level satisfaction. Candidate predictors were selected from univariate logistic regressions and finalized in a multivariate model by a stepwise selection approach., Results: Overall, 75% (n = 188) of respondents (n = 250) indicated high satisfaction. Respondents with higher satisfaction had a Plan of the Day posted (OR = 3.3, 95% CI: 1.63, 6.89, p = 0.001), and did not live with the patient (OR =0.5, 95% CI: 0.25, 0.96, p = 0.044)., Conclusion: This study indicates that communication and transparency of plans contributes to family satisfaction with ICU care., Competing Interests: Declaration of Competing Interest No authors have any conflict of interest or financial or other relationship that may inappropriately influence the work to report., (Copyright © 2020 Elsevier Inc. All rights reserved.)
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- 2021
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24. Modifiable Risk Factors and Mortality From Ischemic and Hemorrhagic Strokes in Patients Receiving Venoarterial Extracorporeal Membrane Oxygenation: Results From the Extracorporeal Life Support Organization Registry.
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Cho SM, Canner J, Chiarini G, Calligy K, Caturegli G, Rycus P, Barbaro RP, Tonna J, Lorusso R, Kilic A, Choi CW, Ziai W, Geocadin R, and Whitman G
- Subjects
- Adult, Age Factors, Aged, Comorbidity, Female, Hemorrhagic Stroke mortality, Hospital Mortality trends, Humans, Hydrogen-Ion Concentration, Ischemic Stroke mortality, Male, Middle Aged, Oxygen blood, Registries, Retrospective Studies, Risk Factors, Sex Factors, Socioeconomic Factors, Extracorporeal Membrane Oxygenation adverse effects, Hemorrhagic Stroke epidemiology, Ischemic Stroke epidemiology
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Objectives: Although acute brain injury is common in patients receiving extracorporeal membrane oxygenation, little is known regarding the mechanism and predictors of ischemic and hemorrhagic stroke. We aimed to determine the risk factors and outcomes of each ischemic and hemorrhagic stroke in patients with venoarterial extracorporeal membrane oxygenation support., Design: Retrospective analysis., Setting: Data reported to the Extracorporeal Life Support Organization by 310 extracorporeal membrane oxygenation centers from 2013 to 2017., Patients: Patients more than 18 years old supported with a single run of venoarterial extracorporeal membrane oxygenation., Interventions: None., Measurements and Main Results: Of 10,342 venoarterial extracorporeal membrane oxygenation patients, 401 (3.9%) experienced ischemic stroke and 229 (2.2%) experienced hemorrhagic stroke. Reported acute brain injury during venoarterial extracorporeal membrane oxygenation decreased from 10% to 6% in 5 years. Overall in-hospital mortality was 56%, but rates were higher when ischemic stroke and hemorrhagic stroke were present (76% and 86%, respectively). In multivariable analysis, lower pre-extracorporeal membrane oxygenation pH (adjusted odds ratio, 0.21; 95% CI, 0.09-0.49; p < 0.001), higher PO2 on first day of extracorporeal membrane oxygenation (adjusted odds ratio, 1.01; 95% CI, 1.00-1.02; p = 0.009), higher rates of extracorporeal membrane oxygenation circuit mechanical failure (adjusted odds ratio, 1.33; 95% CI, 1.02-1.74; p = 0.03), and renal replacement therapy (adjusted odds ratio, 1.49; 95% CI, 1.14-1.94; p = 0.004) were independently associated with ischemic stroke. Female sex (adjusted odds ratio, 1.61; 95% CI, 1.16-2.22; p = 0.004), extracorporeal membrane oxygenation duration (adjusted odds ratio, 1.01; 95% CI, 1.00-1.03; p = 0.02), renal replacement therapy (adjusted odds ratio, 1.81; 95% CI, 1.30-2.52; p < 0.001), and hemolysis (adjusted odds ratio, 1.87; 95% CI, 1.11-3.16; p = 0.02) were independently associated with hemorrhagic stroke., Conclusions: Despite a decrease in the prevalence of acute brain injury in recent years, mortality rates remain high when ischemic and hemorrhagic strokes are present. Future research is necessary on understanding the timing of associated risk factors to promote prevention and management strategy.
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- 2020
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25. Evaluation of Vasopressor Exposure and Mortality in Patients With Septic Shock.
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Roberts RJ, Miano TA, Hammond DA, Patel GP, Chen JT, Phillips KM, Lopez N, Kashani K, Qadir N, Cairns CB, Mathews K, Park P, Khan A, Gilmore JF, Brown ART, Tsuei B, Handzel M, Chang AL, Duggal A, Lanspa M, Herbert JT, Martinez A, Tonna J, Ammar MA, Nazer LH, Heavner M, Pender E, Chambers L, Kenes MT, Kaufman D, Downey A, Brown B, Chaykosky D, Wolff A, Smith M, Nault K, Gong MN, Sevransky JE, and Lat I
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- APACHE, Adult, Aged, Aged, 80 and over, Dose-Response Relationship, Drug, Female, Fluid Therapy methods, Humans, Intensive Care Units statistics & numerical data, Male, Middle Aged, Organ Dysfunction Scores, Prospective Studies, Shock, Septic drug therapy, Vasoconstrictor Agents administration & dosage, Fluid Therapy statistics & numerical data, Hospital Mortality trends, Shock, Septic mortality, Shock, Septic therapy, Vasoconstrictor Agents therapeutic use
- Abstract
Objectives: The objectives of this study were to: 1) determine the association between vasopressor dosing intensity during the first 6 hours and first 24 hours after the onset of septic shock and 30-day in-hospital mortality; 2) determine whether the effect of vasopressor dosing intensity varies by fluid resuscitation volume; and 3) determine whether the effect of vasopressor dosing intensity varies by dosing titration pattern., Design: Multicenter prospective cohort study between September 2017 and February 2018. Vasopressor dosing intensity was defined as the total vasopressor dose infused across all vasopressors in norepinephrine equivalents., Setting: Thirty-three hospital sites in the United States (n = 32) and Jordan (n = 1)., Patients: Consecutive adults requiring admission to the ICU with septic shock treated with greater than or equal to 1 vasopressor within 24 hours of shock onset., Interventions: None., Measurements and Main Results: Out of 1,639 patients screened, 616 were included. Norepinephrine (93%) was the most common vasopressor. Patients received a median of 3,400 mL (interquartile range, 1,851-5,338 mL) during the 24 hours after shock diagnosis. The median vasopressor dosing intensity during the first 24 hours of shock onset was 8.5 μg/min norepinephrine equivalents (3.4-18.1 μg/min norepinephrine equivalents). In the first 6 hours, increasing vasopressor dosing intensity was associated with increased odds ratio of 30-day in-hospital mortality, with the strength of association dependent on concomitant fluid administration. Over the entire 24 hour period, every 10 μg/min increase in vasopressor dosing intensity was associated with an increased risk of 30-day mortality (adjusted odds ratio, 1.33; 95% CI, 1.16-1.53), and this association did not vary with the amount of fluid administration. Compared to an early high/late low vasopressor dosing strategy, an early low/late high or sustained high vasopressor dosing strategy was associated with higher mortality., Conclusions: Increasing vasopressor dosing intensity during the first 24 hours after septic shock was associated with increased mortality. This association varied with the amount of early fluid administration and the timing of vasopressor titration.
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- 2020
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26. Variation in Fluid and Vasopressor Use in Shock With and Without Physiologic Assessment: A Multicenter Observational Study.
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Chen JT, Roberts R, Fazzari MJ, Kashani K, Qadir N, Cairns CB, Mathews K, Park P, Khan A, Gilmore JF, Brown ART, Tsuei B, Handzel M, Lee Chang A, Duggal A, Lanspa M, Herbert JT, Martinez A, Tonna J, Ammar MA, Hammond D, Nazer LH, Heavner M, Pender E, Chambers L, Kenes MT, Kaufman D, Downey A, Brown B, Chaykosky D, Wolff A, Smith M, Nault K, Sevransky J, and Gong MN
- Subjects
- APACHE, Adult, Aged, Aged, 80 and over, Blood Pressure, Central Venous Pressure, Dose-Response Relationship, Drug, Female, Fluid Therapy methods, Humans, Intensive Care Units statistics & numerical data, Male, Middle Aged, Organ Dysfunction Scores, Prospective Studies, Shock diagnosis, Shock drug therapy, Vasoconstrictor Agents administration & dosage, Fluid Therapy statistics & numerical data, Hospital Mortality trends, Shock mortality, Shock therapy, Vasoconstrictor Agents therapeutic use
- Abstract
Objectives: To characterize the association between the use of physiologic assessment (central venous pressure, pulmonary artery occlusion pressure, stroke volume variation, pulse pressure variation, passive leg raise test, and critical care ultrasound) with fluid and vasopressor administration 24 hours after shock onset and with in-hospital mortality., Design: Multicenter prospective cohort study between September 2017 and February 2018., Settings: Thirty-four hospitals in the United States and Jordan., Patients: Consecutive adult patients requiring admission to the ICU with systolic blood pressure less than or equal to 90 mm Hg, mean arterial blood pressure less than or equal to 65 mm Hg, or need for vasopressor., Interventions: None., Measurement and Main Results: Of 1,639 patients enrolled, 39% had physiologic assessments. Use of physiologic assessment was not associated with cumulative fluid administered within 24 hours of shock onset, after accounting for baseline characteristics, etiology and location of shock, ICU types, Acute Physiology and Chronic Health Evaluation III, and hospital (beta coefficient, 0.04; 95% CI, -0.07 to 0.15). In multivariate analysis, the use of physiologic assessment was associated with a higher likelihood of vasopressor use (adjusted odds ratio, 1.98; 95% CI, 1.45-2.71) and higher 24-hour cumulative vasopressor dosing as norepinephrine equivalent (beta coefficient, 0.37; 95% CI, 0.19-0.55). The use of vasopressor was associated with increased odds of in-hospital mortality (adjusted odds ratio, 1.88; 95% CI, 1.27-2.78). In-hospital mortality was not associated with the use of physiologic assessment (adjusted odds ratio, 0.86; 95% CI, 0.63-1.18)., Conclusions: The use of physiologic assessment in the 24 hours after shock onset is associated with increased use of vasopressor but not with fluid administration.
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- 2020
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27. Highlights from the Extracorporeal Life Support Organization Registry: 2006-2017.
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Nasr VG, Raman L, Barbaro RP, Guner Y, Tonna J, Ramanathan K, Pappalardo F, Thiagarajan RR, and Alexander PMA
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- Adult, Child, Humans, Infant, Newborn, Respiratory Insufficiency therapy, Extracorporeal Membrane Oxygenation statistics & numerical data, Registries
- Abstract
Extracorporeal membrane oxygenation (ECMO) is a supportive therapy for patients with severe cardiovascular or respiratory failure refractory to conventional medical therapy. Improvements in ECMO technology, easy access to ECMO devices, and a greater understanding of care of ECMO patients have led to increased utilization of ECMO. The Extracorporeal Life Support Organization (ELSO) registry was established in 1984, to collect data on patients receiving ECMO support to help improve outcomes of these patients. The registry has grown to include over 400 contributing centers from 60 countries with data for more than 90,000 patients. Many investigators have used the ELSO registry to answer clinical questions on outcomes and care of this vulnerable patient population. This report provides a brief summary of 16 peer-reviewed articles that have advanced the knowledge and treatment of neonates, children, and adults supported with ECMO using data from the ELSO registry.
- Published
- 2019
- Full Text
- View/download PDF
28. Transesophageal Echocardiography During Cardiopulmonary Resuscitation Is Associated With Shorter Compression Pauses Compared With Transthoracic Echocardiography.
- Author
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Fair J 3rd, Mallin MP, Adler A, Ockerse P, Steenblik J, Tonna J, and Youngquist ST
- Subjects
- Adult, Female, Humans, Male, Retrospective Studies, Time Factors, Video Recording, Cardiopulmonary Resuscitation methods, Echocardiography, Transesophageal, Heart Massage methods, Point-of-Care Systems
- Abstract
Study Objective: Point-of-care ultrasonography provides diagnostic information in addition to visual pulse checks during cardiopulmonary resuscitation (CPR). The most commonly used modality, transthoracic echocardiography, has unfortunately been repeatedly associated with prolonged pauses in chest compressions, which correlate with worsened neurologic outcomes. Unlike transthoracic echocardiography, transesophageal echocardiography does not require cessation of compressions for adequate imaging and provides the diagnostic benefit of point-of-care ultrasonography. To assess a benefit of transesophageal echocardiography, we compare the duration of chest compression pauses between transesophageal echocardiography, transthoracic echocardiography, and manual pulse checks on video recordings of cardiac arrest resuscitations., Methods: We analyzed 139 pulse check CPR pauses among 25 patients during cardiac arrest., Results: Transesophageal echocardiography provided the shortest mean pulse check duration (9 seconds [95% confidence interval {CI} 5 to 12 seconds]). Mean pulse check duration with transthoracic echocardiography was 19 seconds (95% CI 16 to 22 seconds), and it was 11 seconds (95% CI 8 to 14 seconds) with manual checks. Intraclass correlation coefficient between abstractors for a portion of individual and average times was 0.99 and 0.99, respectively (P<.001 for both)., Conclusion: Our study suggests that pulse check times with transesophageal echocardiography are shorter versus with transthoracic echocardiography for ED point-of-care ultrasonography during cardiac arrest resuscitations, and further emphasizes the need for careful attention to compression pause duration when using transthoracic echocardiography for point-of-care ultrasonography during ED cardiac arrest resuscitations., (Copyright © 2019 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.)
- Published
- 2019
- Full Text
- View/download PDF
29. Emergency physician-performed transesophageal echocardiography for extracorporeal life support vascular cannula placement.
- Author
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Fair J, Tonna J, Ockerse P, Galovic B, Youngquist S, McKellar SH, and Mallin M
- Subjects
- Humans, Out-of-Hospital Cardiac Arrest diagnosis, Catheterization methods, Echocardiography, Transesophageal methods, Education, Medical, Graduate methods, Extracorporeal Membrane Oxygenation education, Extracorporeal Membrane Oxygenation methods, Out-of-Hospital Cardiac Arrest therapy, Physicians
- Abstract
Introduction: There is growing interest and application of extracorporeal membrane oxygenation (ECMO) as a life-saving procedure for out-of-hospital cardiac arrest (OHCA), also called extracorporeal life support (ECLS). Extracorporeal membrane oxygenation cannulation with ongoing chest compressions is challenging, and transesophageal echocardiography (TEE) is an invaluable tool with which to guide ECMO wire guidance and cannula positioning., Methods: We describe our protocol for TEE guidance by emergency physicians in our hospital., Results: Of our first 12 cases of ECLS, 10 have had TEE guidance by an emergency physician with successful placement and without complication or need for repositioning. Emergency physician-performed TEE for ECLS vascular cannula placement has been both feasible and useful in our experience and warrants further study., (Copyright © 2016 Elsevier Inc. All rights reserved.)
- Published
- 2016
- Full Text
- View/download PDF
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