One year after ECMO, the modality is the prognosis

The edition in brief

A systematic review of 163 studies and 78,053 adults pooled mortality at or beyond six months after extracorporeal membrane oxygenation. At one year, pooled mortality was 37.2% (95% CI 30.0 to 45.1) for venovenous ECMO, 55.2% (50.2 to 60.1) for venoarterial, and 74.4% (71.4 to 77.2) after extracorporeal cardiopulmonary resuscitation. Only 38 of 163 studies reported any functional outcome, using inconsistent instruments — most often the Cerebral Performance Category — so what survival looks like remains poorly described. A four-arm randomised dose-finding study in two emergency departments gave 220 patients with moderate or severe headache a transnasal sphenopalatine ganglion block with 0.5% bupivacaine, unilateral or bilateral, at 1 ml or 3 ml per side. Sustained relief at 48 hours without rescue analgesia ranged from 19% to 35% with no dose-response: 3 ml bilateral versus 1 ml unilateral differed by 13% (95% CI -4% to 29%). Of 2,494 screened, 1,612 declined because they did not want a nasal route. A retrospective series of 20 adolescents aged 12 to 17 given dexmedetomidine infusion as bridge sedation for severe agitation found 45% (95% CI 26% to 66%) still needed additional sedatives; median infusion 21 hours at up to 1.6 mcg/kg/hr. One desaturation resolved with repositioning and oxygen; five went to paediatric intensive care. A scoping review of 145 publications on medical screening of adult psychiatric presentations found most society recommendations discourage routine laboratory testing, though none met National Academy of Medicine or GRADE standards for trustworthy guidance, and the underlying evidence is mostly retrospective.