Extracorporeal life support in patients with severe trauma: An advanced treatment strategy for refractory clinical settings

ObjectivesMajor trauma is a leading cause of death, particularly among young patients. New strategies in management are needed to improve poor outcomes in cases of severe trauma. Extracorporeal life support (ECLS) has proven to be effective in acute cardiopulmonary failure of different causes, even when conventional therapies fail. We report our initial experience with ECLS as a rescue therapy in severely polytraumatized patients in a refractory clinical setting. This study identifies the pre-ECLS characteristics of patients to predict the appropriateness of ECLS treatment.MethodsFrom December 2008 to May 2012, 375 patients with polytrauma were treated in the Careggi Teaching Hospital, a tertiary-level referral trauma center. Our ECLS team was alerted on 30 patients and applied ECLS in 18 adult patients with trauma. We adopted venoarterial ECLS in 14 patients with cardiopulmonary failure with refractory shock and venovenous ECLS in 4 patients with isolated refractory acute respiratory failure.ResultsECLS was initiated at a mean of 359.176 ± 216.606 (145-950) minutes from trauma. In 4 patients, the ECLS treatment failed because of an incapability to maintain adequate ECLS flow and perfusion. In 14 patients, efficiently supported by ECLS, the cardiac index, mean arterial pressure, blood lactate concentration, arterial oxygen tension, arterial carbon dioxide tension, and pH showed significant improvement, with normal values reached at 3.5 ± 1.5 hours.ConclusionsFrom our data, ECLS seems to be a valuable option to resuscitate patients with severe trauma when conventional therapies are insufficient. ECLS is safe, feasible, and effective in providing hemodynamic support and blood gas exchange

Analysis of problem-based learning impact on academic performance according to the forgotten(fuzzy) effects theory

In a globalized, demanding, and virtualized environment, uncertainty is part of the academic performance. This condition affects all schools irrespective the education level, size, or location, and therefore the tendency to suffer the consequences of the volatility of phenomena, including the change rate in methodological strategies. In the present work, the factors that motivate the exposure of higher education centres are identified, using a model based on the principles of fuzzy or diffuse subsets, called the Forgotten (fuzzy) Effects. This methodology has allowed the gathering of qualitative information, derived from the appreciation of a group of experts, whose knowledge comes from daily experience. This characteristic gives it the empiricism necessary for a scientific contextualization. It has been found that factors such as a) lack of information, b) poor curricular planning, c) teacher's attitude, though other factors such as the hourly load, the lack of research culture, motivation and the constant changes of public policies, influence the exposure of schools to unforeseen variations of the methodological type. After determining the factors intervening in academic performance, the Problem-Based-Learning model was applied in the Engineering field; the average of the graduation subjects' examination (taken from 2017 to 2020), and the integration projects, showed 15% improvement in academic performance. This evidences that cause-effect factors such as the very theoretic management, or its contents, do not contribute to the enhancement of the students' graduation profile; neither they offer real solutions to the society

Association of comorbid burden with clinical outcomes after transcatheter aortic valve implantation

Objectives To investigate the association of the CharlsonComorbidity Index (CCI) with clinical outcomes after transcatheter aortic valve implantation (TA VI).Background Patients undergoing TAVI have high comorbid burden; however, there is limited evidence of its impact on clinical outcomes.Methods Data from 1887 patients from the UK, Canada, Spain, Switzerland and Italy were collected between 2007 and 2016. The association of CCI with 30-day mortality, Valve Academic Research Consortium-2 (VARC-2) composite early safety, long-term survival and length of stay (LoS) was calculated using logistic regression and Cox proportional hazard models, as a whole cohort and at a country level, through a two-stage individual participant data (IPD) random effect meta-analysis.Results Most (60%) of patients had a CCI >= 3. A weak correlation was found between the total CCI and four different preoperative risks scores (rho=0.16 to 0.29), and approximately 50% of patients classed as low risk from four risk prediction models still presented with a CCI >= 3. Per-unit increases in total CCI were not associated with increased odds of 30-day mortality (OR 1.09, 95% CI 0.96 to 1.24) or VARC-2 early safety (OR 1.04, 95% CI 0.96 to 1.14) but were associated with increased hazard of long-term mortality (HR 1.10, 95% CI 1.05 to 1.16). The two-stage IPD meta-analysis indicated that CCI was not associated with LoS (HR 0.97, 95% CI 0.93 to 1.02).Conclusion In this multicentre international study, patients undergoing TA VI had significant comorbid burden. We found a weak correlation between the CCI and well-established preoperative risks scores. The CCI had a moderate association with long-term mortality up to 5 years post-TAVI