This study provides an important exception to the commonly observed gain-framed advantage for preventive health behaviors. Loss-framed appeals appear to be particularly effective in promoting interest in low-frequency prevention behaviors such as HPV vaccination.

Background The benefit of extracorporeal membrane oxygenation (ECMO) for patients with severe acute respiratory distress from COVID-19 refractory to medical management and lung-protective mechanical ventilation has not been adequately determined. Methods We reviewed the clinical course of 37 patients with laboratory-confirmed SARS-CoV-2 infection supported by venovenous ECMO at four ECMO referral centers within a large healthcare system. Patient characteristics, progression of hemodynamics and inflammatory markers, and clinical outcomes were evaluated. Results The patients had median age of 51 years (interquartile range [IQR] 40-59), and 73% were male. Peak plateau pressures, vasopressor requirements, and arterial PaCO 2 all improved with ECMO support. In our patient population, 24/37 patients (64.8%) survived to decannulation and 21/37 patients (56.8%) survived to discharge. Among patients discharged alive from the ECMO facility, 12 patients were discharged to a long-term acute care or rehabilitation facility, 2 were transferred back to the referring hospital for ventilatory weaning, and 7 were discharged directly home. For patients who were successfully decannulated, median length of time on ECMO was 17 days (IQR 10-33.5). Conclusions Venovenous ECMO represents a useful therapy for patients with refractory severe acute respiratory distress syndrome from COVID-19.

Background Extracorporeal membrane oxygenation (ECMO) can be effective for refractory acute respiratory distress syndrome (ARDS) in patients with influenza, but its utility in patients with COVID-19 is uncertain. We compared outcomes of patients with refractory ARDS from COVID-19 and Influenza placed on ECMO. Methods We conducted a retrospective analysis of 120 patients with refractory ARDS due to COVID-19 or Influenza placed on ECMO at two referral centers from 1/2013 to 10/2020. Patient characteristics and clinical outcomes were compared. The primary endpoint was survival to discharge. Results Baseline characteristics and comorbidities were similar. During the study period, 53 patients with COVID-19 and 67 patients with Influenza were supported. Veno-venous ECMO was the predominant initial cannulation strategy in both groups (COVID 92.5% vs Influenza 95.5%; p=0.5). Survival to hospital discharge was 62.3% (33/53 patients) in the COVID-19 group and 64.2% (43/67) in the Influenza group (p=0.8). In patients successfully decannulated, median length of time on ECMO was longer in COVID-19 patients (14 days [IQR 9-30] vs. Influenza 10.5 [IQR 6.8-14.3] days, p=0.004). Among patients discharged alive, COVID-19 patients had longer overall length of stay (COVID 37 [IQR 27-62] vs Influenza 13.5 [IQR 9.3-24] days; p=0.007). Conclusions In patients with refractory ARDS from COVID-19 or Influenza placed on ECMO, there was no significant difference in survival to hospital discharge. In patients surviving to decannulation, the duration of ECMO support and total length of stay were longer in COVID-19 patients.

Background Adaptive mutations of the severe acute respiratory syndrome‐related coronavirus (SARS‐CoV‐2) virus have emerged throughout the coronavirus disease 2019 (COVID‐19) pandemic. The characterization of outcomes in patients requiring extracorporeal membrane oxygenation (ECMO) for severe respiratory distress from COVID‐19 during the peak prevalence of different variants is not well known. Methods There were 131 patients with laboratory‐confirmed SARS‐CoV‐2 infection supported by ECMO at two referral centers within a large healthcare system. Three predominant variant phase time windows (Pre‐Alpha, Alpha, and Delta) were determined by a change‐point analyzer based on random population sampling and viral genome sequencing. Patient demographics and outcomes were compared. Results The average age of patients was 46.9 ± 10.5 years and 70.2% (92/131) were male. Patients cannulated for ECMO during the Delta variant wave were younger compared to earlier Pre‐Alpha (39.3 ± 7.8 vs. 48.0 ± 11.1 years) and Alpha phases (39.3 ± 7.8 vs. 47.2 ± 7.7 years) ( p < .01). The predominantly affected race in the Pre‐Alpha phase was Hispanic (52.2%; 47/90), while in Alpha (61.5%; 16/26) and Delta (40%; 6/15) variant waves, most patients were White ( p < .01). Most patients received a tracheostomy (82.4%; 108/131) with a trend toward early intervention in later phases compared to Pre‐Alpha ( p < .01). There was no significant difference between the duration of ECMO, mechanical support, intensive care unit (ICU) length of stay (LOS), or hospital LOS over the three variant phases. The in‐hospital mortality was overall 41.5% (54/131) and was also similar. Six‐month survival of patients who survived to discharge was 92.2% (71/77). Conclusions There was no significant difference in survival or time on ECMO support in patients during the peak prevalence of the three variants.

Background: Currently, no absolute contraindications to the use of extracorporeal membrane oxygenation (ECMO) support exist. However, the presence of penetrating traumatic injuries is often considered a relative contraindication to ECMO support. In this study, we aim to assess whether penetrating traumatic injuries should be considered a contraindication to the use of ECMO support, and how to better select patients who may benefit from this therapy. Materials and Methods:In this paper, we present the findings of a retrospective review of all patients at a large, level 1 trauma center who received ECMO support following penetrating traumatic injuries. We describe the use of ECMO in these patients along with the complications associated with this therapy. Conclusion:In this study we show penetrating traumatic injuries should not be considered a contraindication to ECMO support, and how ECMO can be a useful treatment strategy in selected patients with these injuries.