Calcium Channel Blocker Overdose: What Role Does Extracorporeal Membrane Oxygenation Have in Support? A Systematic Review of the Literature.

Extracorporeal membrane oxygenation (ECMO) has had increasing prevalence and indications in the last decade. Calcium channel blocker overdose (CCBOD) can lead to significant cardiopulmonary dysfunction and has also increased in recent years. CCBOD results in cardiac depression, vasoplegia, and hyperglycemia. Expert consensus recommends treatment with calcium, high-dose insulin, inotropes, and vasopressors. Our systematic review evaluated when to initiate ECMO in the CCBOD population and the mortality rate associated with use. Electronic literature review identified all relevant studies for CCBOD and ECMO. PRISMA guidelines for systematic review were followed. Three independent authors reviewed abstracts and full texts, and only CCB ingestion without polypharmacy was included. Two authors independently collected data, which included demographics, current medical treatments, ECMO type, and survival. From 314 abstracts, 25 papers were included with a median publication year of 2019. Twenty-six patients were included with an average age of 32.7 years and 42%/58% male/female. Average time on ECMO 4.3 days. VA and VV ECMO use were 92.3% and 7.7%, respectively, and 84.6% of patients survived to hospital discharge. Before ECMO, most patients received 4-5 medical treatments (53.8%). Our systematic review demonstrates ECMO is a newly used, yet valuable therapy for CCBOD when medical treatment fails. Survival to discharge after ECMO for CCBOD is substantially higher than standard VV or VA ECMO. Medical management is still the mainstay therapy for CCBOD, but we show that a persistently unstable patient may benefit from prompt evaluation at an ECMO center for treatment.

Food Insecurity in the Elective Enhanced Recovery After Surgery Colorectal Surgical Population: Prevalence and Implications for Surgical Outcomes.

BACKGROUND: Food insecurity is defined as having limited or uncertain availability of nutritionally adequate food. Approximately 10.5% of U.S. households are food-insecure. Our study aimed to determine the prevalence and postoperative implications of food insecurity in a diverse group of colorectal surgery patients admitted to a hospital in an area with a higher-than-average median income. METHODS: The 6-question Household Food Security Survey was added to the colorectal surgery ERAS program preoperative paperwork. Patient demographics, comorbidities, operative parameters, length of stay, and postoperative outcomes were collected by review of electronic medical records. RESULTS: A total of 294 ERAS patients (88.8%) completed the survey over an 11-month period. Thirty-three patients (11.2%) were identified as food-insecure. Food-insecure patients were more likely to be non-white (P = .003), younger (P = .009), smokers (P = .004), chronic narcotic users (P < .001), unmarried (P = .007), and have more comorbidities (P = .004). The food-insecure population had more frequent postoperative ileus (P = .044). Hospital length of stay was significantly longer in food-insecure patients (8.6 days vs 5.4 days, P < .001). Food-insecure patients also had higher rates of >30-day mortality (P = .049). DISCUSSION: Food insecurity was found to occur in patients that lived in communities deemed both affluent and distressed. These patients had longer hospital stays and higher mortality. A food insecurity questionnaire can easily identify patients at risk. Further investigations to mitigate these complications are warranted.

United Network for Organ Sharing Rule Changes and Their Effects on Kidney and Liver Transplant Outcomes.

OBJECTIVES: Recent national organ distribution rule changes could have implications on distance between donor and recipient hospitals and cold ischemia time. With cold ischemia time being an unavoidable detriment to organ quality, any strategies that minimize it should maximize organ quality. This study evaluated the significance of the kidney allocation system and the Share 35 rule changes on kidney and liver transplant outcomes. MATERIALS AND METHODS: This retrospective study included deceased liver and kidney donor and their recipient data from the Organ Procurement and Transplantation Network. Variables were analyzed using propensity score matching and Cox hazards model distance (from donor hospital to organ recovery center), and effects on survival outcomes of trans-planted livers and kidneys in the context of the recent rule changes were analyzed. RESULTS: Transplanted organs have significantly better outcomes when the distance is 0 miles versus median distances for locally transported organs of 18 and 22 miles for kidney and liver, respectively. Cold ischemia time, when corrected, accounts for this finding, thus suggesting that cold ischemia time is the factor most responsible for viability of a transplanted organ. This significance remains evident for liver transplants even after the Share 35 rule change but not for kidney transplants following the December 2014 kidney allocation system change. CONCLUSIONS: Liver transplants showed a higher risk of lower viability with travel, and the Share 35 rule did not appear to change this result. Kidney transplant outcomes appear to have improved after the kidney allocation system change. Potential strategies for minimizing cold ischemia time and improving outcomes include more free-standing organ recovery centers in centralized locations.