Critical Care Topics
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Does Surviving an ECMO Stay Put Patients at Greater Risk for Mental Health Problems?
Survivors of extracorporeal membrane oxygenation (ECMO) demonstrated a modest increase in risk of new mental health diagnoses after discharge vs. ICU survivors who do not undergo ECMO.
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ECMO-Supported CPR Disappoints for Treating Out-of-Hospital Cardiac Arrest
For patients with out-of-hospital cardiac arrest that was refractory to initial resuscitation efforts, adding extracorporeal membrane oxygenation to standard CPR did not result in a significant improvement in survival with favorable neurologic outcome.
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Clarity and Consistency Help Families Facing Serious Medical Decisions
Different clinicians use similar-sounding terms. Families may make decisions based on how the clinician presents a situation. It is critical for medical providers to choose their words carefully.
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Some ED Patients Undergo Unwanted End-of-Life Care
Despite uncertainty, it is possible to provide value-concordant care in the ED. Identify those patients, and initiate decisions based on goals of care, not just by a default reflexive pathway. This could help improve patients’ experiences and outcomes broadly, by targeting the right treatments to the right patients.
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Multiple Legal Issues with ED End-of-Life Care
An attorney argues missing the opportunity to respect autonomy in care decision-making for a patient who no longer desires curative care should be considered a poor outcome.
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Malpractice Lawsuits Allege Wrongful Prolongation of Life
The top problems in these cases are charting and communication among caregivers.
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Apixaban for Venous Thromboembolism in Patients with End-Stage Kidney Disease
There is a lower risk of bleeding for those taking apixaban during venous thromboembolism treatment compared to warfarin in patients with end-stage kidney disease.
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Controversy Erupts Over Expansion of Medical Assistance in Dying
Ethical controversy has erupted over Canada’s expansion of eligibility criteria for medical assistance in dying.
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‘Informed Assent’ for CPR Is Reasonable Approach for Some Hospitalized Patients
This concept was developed to satisfy the right of physicians to initiate DNR orders in futile situations and their duty to communicate to patients and lawful surrogates. Through informed assent, physicians state they will write a DNR order because it would be futile and harmful to the patient to attempt CPR in their current serious illness.
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Adults with Developmental Disabilities at Risk for Poor End-of-Life Care
Policies should specify that the wishes of these patients should be known. They should be able to access all medically appropriate care, without bias, and have the right to avoid medical interventions they wish to refuse.