The Use of Extracorporeal Membrane Oxygenation in Severely Burned Patients: A Survey of North American Burn Centers

2021 ◽  
Author(s):  
Sebastien Hebert ◽  
Mete Erdogan ◽  
Robert S Green ◽  
Jack Rasmussen
Keyword(s):  
Respiratory Failure ◽  
Perioperative Management ◽  
Case Reports ◽  
The United States ◽  
Burn Patients ◽  
Burn Centers ◽  
Burn Care ◽  
Consensus Statements ◽  
The Status ◽  
Ecmo Therapy

Abstract Respiratory failure and acute respiratory distress syndrome can occur in burn patients with or without inhalational injury, and can significantly increase mortality. For patients with severe respiratory failure who fail conventional therapy with mechanical ventilation, the use of veno-venous extracorporeal membrane oxygen (ECMO) may be a lifesaving salvage therapy. There have been a series of case reports detailing the use of ECMO in burn patients over the last twenty years, but very little is currently known about the status of ECMO use at burn centers in North America. Using a web-based survey of burn center directors in Canada and the United States, we examined the rate of usage of ECMO in burn care, barriers to its use, and the perioperative management of burn patients receiving ECMO therapy. Our findings indicate that approximately half of burn centers have used ECMO in the care of burn patients, but patient volume is very low on average (less than 1 per year). Of centers that do use ECMO in burn care, only 40% have a specified protocol for doing so. Approximately half have operated on patients being actively treated with ECMO therapy, but perioperative management of anticoagulation varies widely. A lack of experience and institutional support, and a perceived lack of evidence to support ECMO use in burn patients were the most commonly identified barriers to more widespread uptake. Better collaboration between burn centers will allow for the creation of consensus statements and protocols to improve outcomes for burn patients who require ECMO.

Sedation and Analgesia for Adult Outpatient Burn Dressing Change: A Survey of American Burn Association Centers

2019 ◽  
Vol 41 (2) ◽  
pp. 322-327 ◽  
Author(s):  
Jordan K Voss ◽  
Jeanette Lozenski ◽  
Jennifer K Hansen ◽  
Shannon Salerno ◽  
Aaron Lackamp ◽  
...  
Keyword(s):  
The United States ◽  
Outpatient Setting ◽  
Burn Patients ◽  
Medication Regimen ◽  
Burn Centers ◽  
Pain Medications ◽  
Oral Pain ◽  
Wide Variability ◽  
Sedation And Analgesia ◽  
Dressing Change

Abstract The management of pain and sedation during burn dressing change is challenging. Previous reviews and studies have identified wide variability in such practices in hospitalized burn patients. This survey-based study aimed to determine the most commonly utilized sedation and analgesia practices in adult burn patients treated in the outpatient setting. The goal was to identify opportunities for improvement and to assist burn centers in optimizing sedation procedures. A 23-question survey was sent to members of the American Burn Association. Nonpharmacological interventions including music, television, games, and virtual reality were used by 68% of survey respondents. Eighty-one percent reported premedicating with oral opioids, 32% with intravenous opioids, and 45% with anxiolytics. Fifty-nine percentage of respondents indicated that the initial medication regimen for outpatient dressing changes consisted of the patient's existing oral pain medications. Forty-three percent indicated that there were no additional options if this regimen provided inadequate analgesia. Fifty-six percentage of respondents felt that pain during dressing change was adequately controlled 75% to 100% of the time, and 32% felt it was adequately controlled 50% to 75% of the time. Nitrous oxide was used by 8%. Anesthesia providers and an acute pain service are available in a minority of cases (13.7% and 28%, respectively) and are rarely consulted. Procedural burn pain remains significantly undertreated in the outpatient setting and the approach to treatment is variable among burn centers in the United States. Such variation likely represents an opportunity for identifying and implementing optimal practices and developing guidelines for burn pain management in the outpatient setting.

scholarly journals In Search of a Common Agenda for Planned Home Birth in America

2012 ◽  
Vol 21 (2) ◽  
pp. 67-71 ◽  
Author(s):  
Saraswathi Vedam
Keyword(s):  
United States ◽  
Patient Autonomy ◽  
Home Birth ◽  
The United States ◽  
Seamless Care ◽  
Consensus Statements ◽  
The Status ◽  
Obstetric Intervention ◽  
Planned Home Birth ◽  
Common Agenda

Leading maternity provider organizations in North America have been in conflict about birth at home and birth centers, debating issues related to safety, access, the value of obstetric intervention, and patient autonomy. In today’s environment, childbirth educators and doulas are often required to explain to parents why physiological birth and evidence-based, low-technology methods of labor and birth care are not available in every setting, and why maternity providers disagree about birth place. There are very few regions in the United States where home birth providers are integrated into interprofessional provider networks that allow for seamless care across birth settings. In October 2011, multidisciplinary leaders met at a Home Birth Consensus Summit in Warrenton, Virginia, to discuss the status of home birth within the greater context of maternity care in the United States. This article describes the intent and outcomes of the summit. Four of the nine consensus statements developed at the summit are of particular interest and importance to mothers and families and, hence, to childbirth educators and advocates. Consumers, educators, and birth advocates are encouraged to widen the circle, identify communications experts, lead individual projects, or serve as advisors.

Neonatal Extracorporeal Membrane Oxygenation

PEDIATRICS ◽  
1988 ◽  
Vol 82 (2) ◽  
pp. 276-277
Author(s):  
STEVEN M. DONN
Keyword(s):  
United States ◽  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
The United States ◽  
Membrane Oxygenation ◽  
Widespread Acceptance ◽  
Long Term Follow Up ◽  
Ecmo Therapy

The number of centers providing extracorporeal membrane oxygenation (ECMO) therapy to newborns with intractable respiratory failure has grown dramatically. The ECMO registry now includes 37 institutions in the United States,1 and there may be additional centers offering ECMO but not participating in the registry. To date, more than 1,400 patients have been treated with ECMO with a survival rate exceeding 80%. Widespread acceptance of ECMO therapy has been accomplished despite a paucity of controlled clinical trials2 and without the benefit of long-term follow-up of survivors. Initial fervor about neonatal ECMO has stemmed from the excellent survival statistics cited by most of the earlier investigators.2-4

89 The Effect of Trauma Center Status and Burn Verification Process on Burn Patient Outcomes

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S61-S62
Author(s):  
Manuel Castillo-Angeles ◽  
Christopher J Burns ◽  
John C Kubasiak ◽  
Anupama Mehta ◽  
Robert Riviello ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Patient Outcomes ◽  
Trauma Center ◽  
Burn Patients ◽  
Trauma Centers ◽  
Burn Centers ◽  
Adjusted Analysis ◽  
Burn Care ◽  
Burn Center ◽  
Burn Patient

Abstract Introduction Burn center verification was implemented to ensure burn patients receive the best quality of care. As part of the of the organized burn care system, trauma centers that do not have a burn center within the hospital should refer burn patients to a designated burn center. However, more than 30% of burn patients are still being taken care of in non-verified burn centers. Our aim was to determine if trauma center status conferred a benefit in outcomes in a national sample of burn patients. Methods This is a retrospective study using State Inpatient Databases of 22 states in 2014. The inclusion criteria were all patients admitted for burn injury (ICD-9 codes 940–949). Hospitals were categorized as ABA verified centers (VBC) and non-verified burn centers (NVBC), as well as trauma centers (TC) and non-trauma centers (NTC) based on verification status at the time of admission. Main Outcomes were in-hospital mortality and length of hospitalization (LOS). Stratifying by burn center verification status, multivariable regression was used to identify the association between trauma center status and the outcomes. Results A total of 15,982 burn patients were identified. The overall in-hospital mortality rate was 2.45%. In our sample, we only had 26 hospitals that were both a TC and VBC (Table 1). The majority of patients (54%) were treated at a NVBC/TC. In unadjusted analysis, amongst verified centers, there was no difference in mortality between TC and NTCs (3.2% vs. 3.0%, p=0.877), but NTCs had longer LOS (14.7 vs. 10 d, p< 0.001). Amongst non-verified centers, TCs had higher mortality when compared with NTCs (2.4% vs. 1.1%, p< 0.001), but TCs had longer LOS (8.3 vs. 7.2 d, p=0.007). After adjusted analysis, within VBC, TC status was associated with shorter LOS (Coef -3.28, 95% CI -5.37 – -1.19, p=0.002), but not associated with mortality (OR 1.21, 95% CI 0.50 – 2.89, p=0.667). After adjusted analysis, within NVBC, TC status was associated with longer LOS (Coef 2.37, 95% CI 1.70 – 3.04, p< 0.001) and with mortality (OR 3.70, 95% CI 2.10 – 6.51). Conclusions Trauma center status does not confer any benefit for burn patient outcomes within the burn care verification system. Despite the regionalization of burn care through the development of verified burn centers, the majority of burn patients are receiving care at trauma centers with a non-verified burn center within the hospital.

87 Identification of Critical Burn Knowledge Gaps within the USA Population: A Survey and Education on Burn Prevention and Preparedness

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S60-S61
Author(s):  
Helen Xun ◽  
Laura M Mafla ◽  
Carrie A Cox ◽  
Carisa Cooney ◽  
Eliana Duraes ◽  
...  
Keyword(s):  
Burn Injury ◽  
The United States ◽  
First Aid ◽  
Knowledge Gaps ◽  
Burn Centers ◽  
Burn Care ◽  
Burn Prevention ◽  
Personal Experiences ◽  
The Us ◽  
Survey Responses

Abstract Introduction Associations, institutions, and providers have made enormous efforts to educate the United States public on burn injury in the hopes of preventing burns. However, there are no reports to-date describing the level of public burn knowledge in the U.S. This study characterized the public knowledge of burn prevention and preparedness in the US. It also aimed to assess if our interactive quiz is an appropriate educational tool. Methods QualtricsTM surveys designed to test knowledge and educate about burns were crowdsourced to laypersons via Amazon MTurk. Demographics were self-reported. In section 1, respondents were presented six questions asking about causes and care for burns, in a quiz style with explanations provided immediately. In section 2, respondents self-reported personal experiences with burns, burn education, and knowledge of verified burn centers. In section 3, they reported attitudes towards burn care. Survey responses were analyzed using two-tailed Student’s t tests and chi square analyses. Results We received 402 completed survey responses, and 331 total were included for analysis; studies were excluded if they were completed in < 5 minutes or had incorrect attention check questions. The mean age was 39.4 ± 12.08, and 51% male. 1. Knowledge: The average quiz score was 51% ± 8; while 65% of respondents knew to run scald burns under cool water, only 41% knew the optimal time of more than 20 minutes. The majority of respondents (92%) reported the quiz improved their burn knowledge. Also, while majority (63%) of respondents had heard of verified burn centers, only 44% knew where the closest one was. 2. Experiences: 72% of respondents had personally experienced a burn, of which 62% were treated in the emergency room. 57% of respondents had witnessed a burn injury occur, of which 92% applied first aid using cool running water (26%), ice (18%), burn gel (17%), and gauze (11%). Only 61% of respondents have participated in burn precautions at home. 56% of respondents have received formal burn training, such as from CPR class (21.4%) and recent first aid training (32.9%). Informal sources include from friends and family (66%), personal burn experience (63%), or social media (47.4%). 3. Attitudes: The majority of respondents agreed there should be more public education on risks/prevention (85%) and treatment of burns (78.6%). Only 63% believe acute burn care should be covered by insurance. Conclusions Our study demonstrates that despite personal experiences with burns and formalized courses, there remain gaps in public burn knowledge in the US. Further studies are required to characterize more detailed knowledge gaps and intervention strategies.

scholarly journals The Predictive Capacity of American Society of Anesthesiologists Physical Status (ASA PS) Score in Burn Patients

2020 ◽  
Vol 41 (4) ◽  
pp. 803-808 ◽  
Author(s):  
Katherine J Choi ◽  
Christopher H Pham ◽  
Zachary J Collier ◽  
Melissa Mert ◽  
Ryan K Ota ◽  
...  
Keyword(s):  
Burn Injury ◽  
Severity Index ◽  
The United States ◽  
Burn Severity ◽  
Burn Patients ◽  
Physical Status ◽  
Burn Care ◽  
Status Score ◽  
American Society ◽  
American Society Of Anesthesiologists

Abstract Advances in burn care continues to improve survival rates and patient outcomes. There are several burn prognostic tools used to predict mortality and outcomes; however, none include patient comorbidities. We used the American Society of Anesthesiologists physical status score as a surrogate measure for comorbidities, and evaluated its role in predicting mortality and outcomes in adult burn patients undergoing surgery. A retrospective analysis was performed on data collected from a single burn center in the United States, which was comprised of 183 patients. We evaluated the American Society of Anesthesiologists physical status score as an independent predictor of mortality and outcomes, including intensive care unit (ICU) length of stay (LOS), hospital LOS, mechanical ventilator (MV) days, and complications. We compared the American Society of Anesthesiologists physical status score to other prognostic models which included the revised Baux score, Belgian Outcome in Burn Injury, and the Abbreviated Burn Severity Index. Our results demonstrated that the revised Baux and American Society of Anesthesiologists physical status scores could be used to determine the mortality risk in adult burn patients. The revised Baux was the best predictor of mortality, ICU LOS, and MV days, while the Abbreviated Burn Severity Index was the best predictor of total LOS.

Multicultural Assessment of Personality and Psychopathology in the United States: Still Art, Not Yet Science, and Controversial

1998 ◽  
Vol 14 (1) ◽  
pp. 62-70 ◽  
Author(s):  
Richard H. Dana
Keyword(s):  
United States ◽  
Racial Identity ◽  
The United States ◽  
Therapeutic Assessment ◽  
Culturally Competent ◽  
Research Attention ◽  
The Status ◽  
Training Research ◽  
Multicultural Assessment ◽  
Personality Description

This paper describes the status of multicultural assessment training, research, and practice in the United States. Racism, politicization of issues, and demands for equity in assessment of psychopathology and personality description have created a climate of controversy. Some sources of bias provide an introduction to major assessment issues including service delivery, moderator variables, modifications of standard tests, development of culture-specific tests, personality theory and cultural/racial identity description, cultural formulations for psychiatric diagnosis, and use of findings, particularly in therapeutic assessment. An assessment-intervention model summarizes this paper and suggests dimensions that compel practitioners to ask questions meriting research attention and providing avenues for developments of culturally competent practice.

Varied Responses to Human-Induced Seismicity in the City of Azle, Texas

2019 ◽  
Vol 3 (1) ◽  
pp. 1-8
Author(s):  
Sarmistha R. Majumdar
Keyword(s):  
State Government ◽  
Induced Seismicity ◽  
Oil And Gas ◽  
The United States ◽  
The State ◽  
Prior History ◽  
Small Community ◽  
Regulatory Policies ◽  
The Status

Fracking has helped to usher in an era of energy abundance in the United States. This advanced drilling procedure has helped the nation to attain the status of the largest producer of crude oil and natural gas in the world, but some of its negative externalities, such as human-induced seismicity, can no longer be ignored. The occurrence of earthquakes in communities located at proximity to disposal wells with no prior history of seismicity has shocked residents and have caused damages to properties. It has evoked individuals’ resentment against the practice of injection of fracking’s wastewater under pressure into underground disposal wells. Though the oil and gas companies have denied the existence of a link between such a practice and earthquakes and the local and state governments have delayed their responses to the unforeseen seismic events, the issue has gained in prominence among researchers, affected community residents, and the media. This case study has offered a glimpse into the varied responses of stakeholders to human-induced seismicity in a small city in the state of Texas. It is evident from this case study that although individuals’ complaints and protests from a small community may not be successful in bringing about statewide changes in regulatory policies on disposal of fracking’s wastewater, they can add to the public pressure on the state government to do something to address the problem in a state that supports fracking.

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