Predictors of Mortality in Patients With Refractory Cardiac Arrest Supported With VA-ECMO: A Systematic Review and a Meta-Analysis.

Cardiac arrest (CA) is associated with high mortality rate, ranging between 75% and 93%. Given its significance, venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been used for end-organs perfusion and to maintain adequate oxygenation as a life-saving option in refractory CA. The predictors for the success of VA-ECMO in this setting have not been established yet. In this meta-analysis, we aim to identify the variables associated with increased mortality in patients with CA supported with VA-ECMO. We conducted a systematic review and meta-analysis to evaluate mortality-predicting factors in patients with CA supported with VA-ECMO that were published between January 2000 and July 2022. To identify relevant articles, the MEDLINE (Pubmed, Ovid) and Cochrane Databases were queried with various combinations of our prespecified keywords, including VA-ECMO, CA, and mortality predictors. We performed a meta-analysis using a random-effects model to calculate the odds ratio (OR). We retrieved a total of 4476 records, out of which we included 10 observational studies in our study. A total of 931 patients were included in our study with the age range of 47-68 years, predominantly males (63.9%). The overall mortality was 69.4%. The predictors for mortality were age >65 (OR 4.61, 95% CI 1.63-13.03, P < 0.01), history of chronic kidney disease (OR 2.42, 95% CI 1.37-4.28, P < 0.01), cardiopulmonary resuscitation duration prior to ECMO > 40 minutes (OR 6.62 [95% CI 1.39, 9.02], P < 0.01), having an initial nonshockable rhythm (OR 2.62 [95% CI 1.85, 3.70], P < 0.01) and sequential organ failure assessment score >14 (OR 12.29, 95% CI 2.71-55.74, P <0.01). Regarding blood work, an increase in lactate by 5 mmol/L increased the odds of mortality by 121% (2 studies; OR 2.21 [95% CI 1.26, 3.86], P < 0.01; I2 = 0%) while the increase in lactate by 1 mmol/L increases odd of mortality by 15% (2 studies, OR 1.15 [95% CI 1.02, 1.31], P = 0.03, I = 0%), and an increase in creatinine by 1 mg/dL increased the odds of mortality by 225% (1 study; OR 3.25 [95% CI 1.22, 8.7], P = 0.02). Albumin was protective as for each 1 g/dL increase, the odds of mortality decreased by 68% (1 study; OR 0.32 [95% CI 0.14, 0.74], P < 0.01). Refractory CA requiring VA-ECMO has a high mortality. Predictors of mortality include age >65, history of chronic kidney disease, cardiopulmonary resuscitation duration prior to ECMO > 40 minutes, initial rhythm being non-shockable and Sequential Organ Failure Assessment score >14.

Breakfast skipping, late dinner intake and chronotype (eveningness-morningness) among medical students in Tabuk City, Saudi Arabia.

INTRODUCTION: There is an increasing awareness regarding meal timing and chronotype. The present study aimed to assess breakfast skipping, late dinner intake, and chronotype among Saudi medical students. METHODS: A cross-sectional study was conducted among 169 clinical phase medical students during the period from January to May 2017. A self-administered questionnaire was used to report the frequency and timing of breakfast and dinner. In addition, the previous cumulative grade average, bedtime, wake-up time, and sleep duration during working days and weekends were reported. The chronotype was calculated from mid-sleep and wakeup time during weekends and sleep dept. The student's weight and height were measured to assess the body mass index (BMI). Participants also completed a diary detailing their sleep habits for two weeks before filling out the questionnaire. The chi-square and Pearson's correlation were used for the statistical analysis. RESULTS: Out of 169 medical students (48.5% males), their age was 22.90±1.27 years, 42% were breakfast-skippers, while 49.7% were late dinner consumers. No correlation was found between the previous cumulative grades (GPA), BMI, chronotype, and time lag in wakeup and bedtime between weekdays and weekends (p>0.005). No significant statistical differences between breakfast-skippers and late dinner consumers and their counterparts regarding GPA and chronotype. CONCLUSION: Breakfast skipping and late dinner consumption were prevalent among medical students in Tabuk, Saudi Arabia, future large sample case-control studies to assess the impact of meal timing, and chronotype on academic performance are highly recommended.