Crit Care Resusc
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To describe the six-month functional outcomes of patients who received extracorporeal cardiopulmonary resuscitation (ECPR) following in-hospital cardiac arrest (IHCA) in Australia. ⋯ One in three patients who received ECPR following IHCA were alive at six months and most had a good functional outcome. However, survivors reported higher levels of disability and a worse health status at six months compared with the baseline and ongoing complications were common.
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Extracorporeal membrane oxygenation (ECMO) is a high-risk procedure with significant morbidity and mortality and there is an uncertain volume-outcome relationship, especially regarding long-term functional outcomes. The aim of this study was to examine the association between ECMO centre volume and long-term death and disability outcomes. ⋯ There was no difference in death or disability at six months between high- and low-volume centres in Australia and New Zealand, possibly due to the current model of coordinated care that includes patient transfers and training between high- and low-volume ECMO centres in our region.
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To describe the incidence of bleeding and thrombotic complications in VA-ECMO according to anticoagulation strategy. ⋯ Available literature assessing the association between anticoagulation strategies in VA-ECMO, and bleeding and thrombosis is of limited quality. We identified a substantially higher incidence of major bleeding events than a previous meta-analysis. Limited numbers of patients anticoagulated with alternatives to heparin were reported. Patients with additional mechanical LV unloading represent a cohort at particular risk of bleeding and thrombotic complications.
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To assess current evidence regarding guanfacine use in hospitalized patients with delirium. ⋯ There is limited data on the efficacy of guanfacine for the treatment of delirium. However, given its pharmacologic properties and its available safety data, controlled investigations may be justified.