Background Albeit low survival rates, resuscitative thoracotomy (RT) is considered standard for selected trauma patients. Because it has potential for rapid cardiopulmonary rescue, extracorporeal membrane oxygenation (ECMO) may augment RT. The aim of this study was to identify the impact of ECMO on trauma patients that recently underwent RT after injury. Study Design All patients who underwent RT were identified from the National Trauma Data Bank (2007-2017). Patients were excluded if they died within 60 minutes, underwent delayed ECMO, and/or had missing data. Delayed ECMO group was defined as those patients undergoing ECMO after 1 hour following RT. Results Out of 8 694 272 injured patients, 10 106 (.1%) underwent RT. Median age was 31 years [23-45], 86% male. Penetrating injury was the dominant mechanism (62%). Of these, .6% (23) underwent immediate ECMO. Extracorporeal membrane oxygenation patients were significantly younger (23[17-33] vs. 31[23-46], p .003) and had significantly higher chest abbreviated injury scale scores (5[4-5] vs. 3[3-4], P < .001). Extracorporeal membrane oxygenation patients achieved significantly higher rate of return of spontaneous circulation (96% vs. 70%, p .007) and had nonsignificant trend of improved mortality (52% vs. 63%, p .260). Conclusion Immediate ECMO may be a useful therapeutic modality after RT. It achieves higher ROSC rates with opportunity for improved survival. Future prospective study is warranted.
Objectives
To evaluate the presence of productivity goals among licensed rehabilitation clinicians and their relationship with observed unethical behavior.
Design
Exploratory, cross-sectional survey.
Setting
Online.
Participants
Licensed physical therapy clinicians (N=3446).
Intervention
Not applicable.
Main Outcome Measure
Participants completed an electronic survey regarding use of clinical productivity goals. They rated the frequency in which they observed 6 unethical behaviors on a 7-point Likert scale in their practice setting from 1=never to 7=always. An overall observed unethical behavior score was calculated by summing these scales.
Results
The response rate was 12.8% (N=3446), with analyses showing low risk of nonresponse bias. Many respondents (73.9%) had a formal productivity goal. Most (89.4%) reported observing some form of unethical behavior, but many (68.6%) reported it occurred “rarely” or “never.” Those in skilled nursing facility (SNF) settings reported higher frequencies of observance and were 4.1 times more likely to report more unethical behavior than the median compared with all other settings. A positive correlation existed between expected productivity rate and rate of unethical behaviors observed (ρ=0.225;
P
<.0001). Amounts of organizational emphases on ethical practice (ρ=−0.509;
P
<.0001) and evidence-based practice (ρ=−0.492;
P
<.0001) were negatively correlated with total observed unethical behavior.
Conclusions
Use of productivity goals in rehabilitation practice is significantly related with rate of unethical behavior observed. Frequency of observed unethical behavior in rehabilitation practice was very low overall. Organizational culture appears to be a greater predictor of observed unethical behavior than any individual clinician-related characteristics. The SNF setting displays the greatest areas of ethical concern.
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