Objectives The 1.5 million Medicare beneficiaries who survive intensive care each year have a high post‐hospitalization mortality rate. We aimed to determine whether mortality after critical illness is higher for Medicare beneficiaries with Medicaid compared with those with commercial insurance. Design A retrospective cohort study from 2010 through 2014 with 1 year of follow‐up using the New York Statewide Planning and Research Cooperative System database. Setting A New York State population‐based study of older (age ≥65 y) survivors of intensive care. Participants Adult Medicare beneficiaries age 65 years or older who were hospitalized with intensive care at a New York State hospital and survived to discharge. Intervention None. Measurement Mortality in the first year after hospital discharge. Results The study included 340 969 Medicare beneficiary survivors of intensive care with a mean (standard deviation) age of 77 (8) years; 20% died within 1 year. There were 152 869 (45%) with commercial insurance, 78 577 (23%) with Medicaid, and 109 523 (32%) with Medicare alone. Compared with those with commercial insurance, those with Medicare alone had a similar 1‐year mortality rate (adjusted hazard ratio [aHR] = 1.01; 95% confidence interval [CI] = .99‐1.04), and those with Medicaid had a 9% higher 1‐year mortality rate (aHR = 1.09; 95% CI = 1.05‐1.12). Among those discharged home, the 1‐year mortality rate did not vary by insurance coverage, but among those discharged to skilled‐care facilities (SCFs), the 1‐year mortality rate was 16% higher for Medicaid recipients (aHR = 1.16; 95% CI = 1.12‐1.21; P for interaction <.001). Conclusions Older adults with Medicaid insurance have a higher 1‐year post‐hospitalization mortality compared with those with commercial insurance, especially among those discharged to SCFs. Future studies should investigate care disparities at SCFs that may mediate these higher mortality rates. J Am Geriatr Soc 67:2497–2504, 2019

The use of a do-not-resuscitate (DNR) order is a powerful tool in outlining end-of-life care. This study explores sociodemographic factors associated with selection of a DNR order and assigning a healthcare proxy in the Surgical Intensive Care Unit (SICU). A retrospective chart review of 312 patients who expired in the SICU over a 7-year period was conducted. We analyzed the association of sociodemographic factors to selection of a DNR order and assignment of a healthcare proxy. Year of admission, age, religion, and proxy were independently associated with selection of DNR. In particular, the relative chance of a DNR selection in 2019 compared to 2012 was 3.538 (95% CL = 2.001–6.255, P < .01). There are significant sociodemographic factors that influence DNR utilization, highlighting the need to consider the social and religious backgrounds when engaging patients and their families in end-of-life care. Future studies will need to be conducted on whether these sociodemographic factors influence surviving patients as this study’s findings can only be applied to those who have expired.

Background: Coronaviruses are important emerging human and animal pathogens. SARS-CoV-2, the virus that causes COVID-19, is responsible for the current global pandemic. Early in the course of the pandemic, New York City became one of the world's "hot spots" with more than 250,000 cases and more than 15,000 deaths. Although medical providers in New York were fortunate to have the knowledge gained in China and Italy before it came under siege, the magnitude and severity of the disease were unprecedented and arguably under appreciated. The surge of patients with significant COVID-19 threatened to overwhelm health care systems, as New York City health systems realized that the number of specialized critical care providers would be inadequate. A large academic medical system recognized that rapid redeployment of noncritical providers into such roles would be needed. An educational gap was therefore identified: numerous providers with minimal critical care knowledge or experience would now be required to provide critical-level patient care under supervision of intensivists. Safe provision of such high level of patient care mandated the development of "educational crash courses."

A 62-year-old woman was initially transferred from an outside hospital for workup and management of a pericardial effusion. The patient had daily transthoracic echocardiograms which showed an effusion without tamponade physiology (Video 1). Subsequently, the patient developed respiratory distress associated with syncope and went into pulseless electrical activity (PEA) arrest. A code was called during which a point of care ultrasound (POCUS) was performed (Video 2) and showed a large pericardial effusion with evidence of tamponade and pseudo PEA-a state of severe shock in which the cardiac output is insufficient for perfusion. While setting up for emergent pericardial drainage, after 13 min of CPR, the patient achieved return of spontaneous circulation (ROSC) (Narration Video). Question: Based on the cardiac echocardiogram before, during, and after ROSC, what is the likely cause for the patient's cardiac arrest?