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Successful prolongation of limb survival using ex situ perfusion methods provides with more time for revascularization of an extremity.

Purpose The treatment of extreme prematurity remains an unsolved problem. We developed an artificial placenta (AP) based on extracorporeal life support (ECLS) that simulates the intrauterine environment and provides gas exchange without mechanical ventilation (MV), and compared it to the current standard of neonatal care. Methods Extremely premature lambs (110-120d; term=145d) were used. AP lambs (n=9) were cannulated (jugular drainage, umbilical vein reinfusion) for ECLS .Control lambs (n=7) were intubated, ventilated, given surfactant, and transitioned to high-frequency oscillatory ventilation. All lambs received parenteral nutrition, antibiotics, and steroids. Hemodynamics, blood gases, hemoglobin, and circuit flows were measured. Results Four premature lambs survived for 1 week on the AP; one survived 6 days. Adequate oxygenation and ventilation were provided by the AP. The MV lambs survived 2-8 hours. Each of these lambs experienced a transient improvement with surfactant, but developed progressive hypercapnea and hypoxia despite high airway pressures and HFOV. Conclusions Extremely premature lambs were supported for 1 week with the AP with hemodynamic stability and adequate gas exchange; mechanically ventilated lambs succumbed within 8 hours. Further studies will assess control of fetal circulation and organ maturation on the AP.

Interactive computerized modules have been linked to improved retention of material in clinical medicine. This study examined the effects of a new series of interactive learning modules for preclinical medical education, specifically in the areas of quiz performance, perceived difficulty of concepts, study time, and perceived stress level. We randomly allocated 102 medical student volunteers into control and experimental groups. All participants studied selected anatomical and physiologic concepts using existing material (lecture notes, textbooks, etc.), while those in the experimental groups used the new interactive modules as well. All participants completed a quiz to test their knowledge of the assigned concepts and a survey to assess their subjective experiences in studying with the modules. We found a trend toward higher quiz scores in the experimental group relative to the control group, though it did not reach statistical significance (P = 0.31). Perceived concept difficulty was significantly reduced among those who studied with the modules (P < 0.001), and the number of hours spent studying the concepts was significantly increased (P = 0.028). Of those who used the modules, 83% rated them as "very helpful" or "extremely helpful." No significant differences existed between participants' reported stress levels during the course of the study (P = 0.44). Our data suggest that medical students may learn more effectively and feel less intimidated by difficult concepts when interactive modules supplement traditional instruction.

Objective To determine characteristics, outcomes and clinical factors associated with death in patients with coronavirus disease 2019 (COVID-19) requiring ECMO support. Methods A multicenter, retrospective cohort study was conducted. The cohort consisted of adult patients (≥18 years old) requiring ECMO in the period from March 1, 2020 to September 30, 2020. The primary outcome was in-hospital mortality after ECMO initiation assessed through a time to event analysis at 90 days. Multivariable Cox proportional regression was utilized to determine factors associated with in-hospital mortality. Results Overall, 292 patients from 17 centers comprised the study cohort. Patients were 49 (IQR: 39-57) years old and 81 (28%) were female. At the end of the follow up period, 19 (6%) patients were still on ECMO, 25 (9%) were off ECMO but remained hospitalized, 135 (46%) were discharged or transferred alive and 113 (39%) expired during the hospitalization. The cumulative in-hospital mortality at 90-days was 42% (95% CI: 36-47%). Factors associated with in-hospital mortality were age (aHR: 1.31, 95% CI: 1.06-1.61 per 10 years), renal dysfunction as measured by serum creatinine (aHR: 1.21, 95% CI 1.01-1.45) and cardiopulmonary resuscitation prior to ECMO placement (aHR: 1.87, 95% CI 1.01-3.46). Conclusions In patients with severe COVID-19 necessitating ECMO support, in-hospital mortality occurred in fewer than half of the cases. ECMO may serve as a viable modality for terminally ill patients with refractory COVID-19.

We demonstrated the potential to preserve limb allograft using ex vivo circulation. This approach promises to extend the narrow time frame for revascularization of procured extremities in limb transplantation.