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  1. Article ; Online: Beta-blockade in V-V ECMO.

    Bommiasamy, Aravind K / Zakhary, Bishoy / Ran, Ran

    Critical care (London, England)

    2024  Volume 28, Issue 1, Page(s) 139

    MeSH term(s) Extracorporeal Membrane Oxygenation/methods ; Humans ; Adrenergic beta-Antagonists/therapeutic use ; Male
    Chemical Substances Adrenergic beta-Antagonists
    Language English
    Publishing date 2024-04-25
    Publishing country England
    Document type Letter ; Case Reports ; Comment
    ZDB-ID 2041406-7
    ISSN 1466-609X ; 1364-8535
    ISSN (online) 1466-609X
    ISSN 1364-8535
    DOI 10.1186/s13054-024-04923-1
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    Zs.A 5517: Show issues Location:
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  2. Article ; Online: REBOA as an Adjunct to Resuscitation.

    Brenner, Megan / Zakhary, Bishoy / Coimbra, Raul / Scalea, Thomas / Moore, Laura / Moore, Ernest / Cannon, Jeremy / Spalding, Chance / Ibrahim, Joseph / Dennis, Bradley

    Journal of the American College of Surgeons

    2024  

    Language English
    Publishing date 2024-03-18
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1181115-8
    ISSN 1879-1190 ; 1072-7515
    ISSN (online) 1879-1190
    ISSN 1072-7515
    DOI 10.1097/XCS.0000000000001078
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  3. Article ; Online: Procedure Risk vs Frailty in Outcomes for Elderly Emergency General Surgery Patients: Results of a National Analysis.

    Zakhary, Bishoy / Coimbra, Bruno C / Kwon, Junsik / Allison-Aipa, Timothy / Firek, Matthew / Coimbra, Raul

    Journal of the American College of Surgeons

    2024  

    Abstract: Background: The direct association between procedure risk and outcomes in elderly emergency general surgery (EGS) patients has not been analyzed. Studies only highlight the importance of frailty. A comprehensive analysis of relevant risk factors and ... ...

    Abstract Background: The direct association between procedure risk and outcomes in elderly emergency general surgery (EGS) patients has not been analyzed. Studies only highlight the importance of frailty. A comprehensive analysis of relevant risk factors and their association with outcomes in elderly EGS patients is lacking. We hypothesized that procedure risk has a stronger association with relevant outcomes in elderly EGS patients compared to frailty.
    Study design: Elderly patients (age > 65) undergoing emergency general surgery operative procedures were identified in the NSQIP) database (2018 to 2020) and stratified based on the presence of frailty calculated by the Modified 5 Item Frailty Index (mFI-5; mFI 0 Non-Frail, mFI 1-2 Frail, and mFI ≥3 Severely Frail) and based on procedure risk. Multivariable regression models and Receiving Operative Curve (ROC) analysis were used to determine risk factors associated with outcomes.
    Results: A total of 59,633 elderly EGS patients were classified into non-frail (17,496; 29.3%), frail (39,588; 66.4%), and severely frail (2,549; 4.3%). There were 25,157 patients in the low-risk procedure group and 34,476 in the high-risk group.Frailty and procedure risk were associated with increased mortality, complications, failure to rescue, and readmissions. Differences in outcomes were greater when patients were stratified according to procedure risk compared to frailty stratification alone. Procedure risk had a stronger association with relevant outcomes in elderly EGS patients compared to frailty.
    Conclusions: Assessing frailty in the elderly EGS patient population without adjusting for the type of procedure or procedure risk ultimately presents an incomplete representation of how frailty impacts patient-related outcomes.
    Language English
    Publishing date 2024-04-25
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1181115-8
    ISSN 1879-1190 ; 1072-7515
    ISSN (online) 1879-1190
    ISSN 1072-7515
    DOI 10.1097/XCS.0000000000001079
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Does frailty impact failure-to-rescue in geriatric trauma patients?

    Kojima, Mitsuaki / Morishita, Koji / Shoko, Tomohisa / Zakhary, Bishoy / Costantini, Todd / Haines, Laura / Coimbra, Raul

    The journal of trauma and acute care surgery

    2024  Volume 96, Issue 5, Page(s) 708–714

    Abstract: Background: Failure-to-rescue (FTR), defined as death following a major complication, is a metric of trauma quality. The impact of patient frailty on FTR has not been fully investigated, especially in geriatric trauma patients. This study hypothesized ... ...

    Abstract Background: Failure-to-rescue (FTR), defined as death following a major complication, is a metric of trauma quality. The impact of patient frailty on FTR has not been fully investigated, especially in geriatric trauma patients. This study hypothesized that frailty increased the risk of FTR in geriatric patients with severe injury.
    Methods: A retrospective cohort study was conducted using the TQIP database between 2015 and 2019, including geriatric patients with trauma (age ≥65 years) and an Injury Severity Score (ISS) > 15, who survived ≥48 hours postadmission. Frailty was assessed using the modified 5-item frailty index (mFI). Patients were categorized into frail (mFI ≥ 2) and nonfrail (mFI < 2) groups. Logistic regression analysis and a generalized additive model (GAM) were used to examine the association between FTR and patient frailty after controlling for age, sex, type of injury, trauma center level, ISS, and vital signs on admission.
    Results: Among 52,312 geriatric trauma patients, 34.6% were frail (mean mFI: frail: 2.3 vs. nonfrail: 0.9, p < 0.001). Frail patients were older (age, 77 vs. 74 years, p < 0.001), had a lower ISS (19 vs. 21, p < 0.001), and had a higher incidence of FTR compared with nonfrail patients (8.7% vs. 8.0%, p = 0.006). Logistic regression analysis revealed that frailty was an independent predictor of FTR (odds ratio, 1.32; confidence interval, 1.23-1.44; p < 0.001). The GAM plots showed a linear increase in FTR incidence with increasing mFI after adjusting for confounders.
    Conclusion: This study demonstrated that frailty independently contributes to an increased risk of FTR in geriatric trauma patients. The impact of patient frailty should be considered when using FTR to measure the quality of trauma care.
    Level of evidence: Therapeutic/Care Management; Level IV.
    MeSH term(s) Humans ; Female ; Male ; Aged ; Retrospective Studies ; Wounds and Injuries/complications ; Frailty/complications ; Frailty/epidemiology ; Aged, 80 and over ; Failure to Rescue, Health Care/statistics & numerical data ; Injury Severity Score ; Trauma Centers/statistics & numerical data ; Frail Elderly/statistics & numerical data ; Geriatric Assessment/methods ; Risk Factors
    Language English
    Publishing date 2024-01-10
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2651070-4
    ISSN 2163-0763 ; 2163-0755
    ISSN (online) 2163-0763
    ISSN 2163-0755
    DOI 10.1097/TA.0000000000004256
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    Zs.A 127: Show issues Location:
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  5. Article ; Online: Optimal positive end-expiratory pressure reduces right ventricular dysfunction in COVID-19 patients on venovenous extracorporeal membrane oxygenation: A retrospective single-center study.

    Estoos, Ethan M / Jocham, Kevin P / Zhang, Chengda / Benson, Lauren M / Milas, Anamaria / Zakhary, Bishoy

    Journal of critical care

    2023  Volume 75, Page(s) 154274

    Abstract: While mechanical ventilation practices on venovenous extracorporeal membrane oxygenation (VV ECMO) are variable, most institutions utilize a lung rest strategy utilizing relatively low positive end-expiratory pressure (PEEP). The effect of PEEP titration ...

    Abstract While mechanical ventilation practices on venovenous extracorporeal membrane oxygenation (VV ECMO) are variable, most institutions utilize a lung rest strategy utilizing relatively low positive end-expiratory pressure (PEEP). The effect of PEEP titration using esophageal manometry during VV ECMO on pulmonary and cardiac function is unknown. This was a retrospective study of 69 patients initiated on VV ECMO between March 2020 through November 2021. Patients underwent standard PEEP (typically 10 cm H
    MeSH term(s) Humans ; Retrospective Studies ; Extracorporeal Membrane Oxygenation/adverse effects ; Ventricular Dysfunction, Right/therapy ; Ventricular Dysfunction, Right/complications ; Respiratory Distress Syndrome ; COVID-19/therapy ; COVID-19/complications ; Positive-Pressure Respiration/adverse effects
    Language English
    Publishing date 2023-02-08
    Publishing country United States
    Document type Journal Article
    ZDB-ID 632818-0
    ISSN 1557-8615 ; 0883-9441
    ISSN (online) 1557-8615
    ISSN 0883-9441
    DOI 10.1016/j.jcrc.2023.154274
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  6. Article ; Online: ECMO for all? Challenging traditional ECMO contraindications.

    Zakhary, Bishoy / Oppenheimer, Beno W

    Journal of critical care

    2018  Volume 48, Page(s) 451–452

    MeSH term(s) Contraindications ; Extracorporeal Membrane Oxygenation ; Humans ; Obesity ; Pneumonia ; Registries
    Language English
    Publishing date 2018-09-17
    Publishing country United States
    Document type Editorial ; Comment
    ZDB-ID 632818-0
    ISSN 1557-8615 ; 0883-9441
    ISSN (online) 1557-8615
    ISSN 0883-9441
    DOI 10.1016/j.jcrc.2018.09.020
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  7. Article ; Online: Epidemiology and Clinical Outcomes of

    Khan, Akram / Alzghoul, Hamza / Khan, Abdul Ahad / Allada, Gopal / Gronquist, Juliann M / Pak, Jonathan / Mukundan, Srini / Zakhary, Bishoy / Wusirika, Raghav / Sher, Nehan / Reddy, Raju

    Medicina (Kaunas, Lithuania)

    2024  Volume 60, Issue 2

    Abstract: Background and ... ...

    Abstract Background and Objectives
    MeSH term(s) Humans ; Retrospective Studies ; Soft Tissue Infections ; Fusobacterium Infections/drug therapy ; Fusobacterium Infections/epidemiology ; Fusobacterium Infections/diagnosis ; Fusobacterium ; Bacteremia/drug therapy ; Bacteremia/epidemiology
    Language English
    Publishing date 2024-01-31
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2188113-3
    ISSN 1648-9144 ; 1010-660X
    ISSN (online) 1648-9144
    ISSN 1010-660X
    DOI 10.3390/medicina60020248
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  8. Article ; Online: Response to "Impaired membrane lung CO2 elimination: is it dead space, V/Q ratio, or acidosis?"

    Zakhary, Bishoy / Sheldrake, Jayne / Pellegrino, Vincent

    Perfusion

    2020  Volume 35, Issue 8, Page(s) 878–879

    MeSH term(s) Acidosis ; Carbon Dioxide ; Extracorporeal Membrane Oxygenation ; Humans ; Lung ; Oxygenators ; Ventilation-Perfusion Ratio
    Chemical Substances Carbon Dioxide (142M471B3J)
    Language English
    Publishing date 2020-09-10
    Publishing country England
    Document type Letter ; Comment
    ZDB-ID 645038-6
    ISSN 1477-111X ; 0267-6591
    ISSN (online) 1477-111X
    ISSN 0267-6591
    DOI 10.1177/0267659120954602
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  9. Article ; Online: Novel method for left ventricular unloading utilizing percutaneous pulmonary artery drainage in cardiorespiratory failure due to COVID-19 infection.

    Kumar, Kris / Coonse, Kendra / Zakhary, Bishoy / Cigarroa, Joaquin E

    Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions

    2022  Volume 100, Issue 1, Page(s) 175–178

    Abstract: Left ventricular (LV) unloading is an important concept in patients undergoing peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO). We present a case of a 32-year-old male in acute cardiorespiratory collapse due to coronavirus disease ( ... ...

    Abstract Left ventricular (LV) unloading is an important concept in patients undergoing peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO). We present a case of a 32-year-old male in acute cardiorespiratory collapse due to coronavirus disease (COVID-19) who underwent VA-ECMO cannulation in the setting of cardiogenic shock and acute respiratory distress syndrome. Due to inability to utilize percutaneous LV assist device (pLVAD) for LV unloading due to small end diastolic dimension, alternative strategies were explored. A traditionally utilized right ventricular support device, the ProTek Duo (TandemLife, Pittsburgh, PA), was utilized to drain the pulmonary artery, leading to improvement in parameters for cardiogenic shock. To our knowledge, this is the first case in which a ProTek Duo has been utilized in conjunction with VA-ECMO to provide LV unloading in support of a patient in cardiogenic shock. This method can be employed in future challenging situations where pLVAD is not feasible.
    MeSH term(s) Adult ; COVID-19/complications ; Drainage/methods ; Heart Failure/therapy ; Heart Failure/virology ; Humans ; Male ; Pulmonary Artery ; Respiratory Insufficiency/therapy ; Respiratory Insufficiency/virology ; Shock, Cardiogenic/therapy ; Treatment Outcome
    Language English
    Publishing date 2022-04-21
    Publishing country United States
    Document type Case Reports
    ZDB-ID 1459995-8
    ISSN 1522-726X ; 1522-1946
    ISSN (online) 1522-726X
    ISSN 1522-1946
    DOI 10.1002/ccd.30212
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  10. Article ; Online: Extracorporeal membrane oxygenation and V/Q ratios: an ex vivo analysis of CO

    Zakhary, Bishoy / Sheldrake, Jayne / Pellegrino, Vincent

    Perfusion

    2020  Volume 35, Issue 1_suppl, Page(s) 29–33

    Abstract: While hypercapnia is typically well treated with modern membrane oxygenators, there are cases where respiratory acidosis persists despite maximal extracorporeal membrane oxygenation support. To better understand the physiology of gas exchange within the ... ...

    Abstract While hypercapnia is typically well treated with modern membrane oxygenators, there are cases where respiratory acidosis persists despite maximal extracorporeal membrane oxygenation support. To better understand the physiology of gas exchange within the membrane oxygenator, CO
    Language English
    Publishing date 2020-05-12
    Publishing country England
    Document type Journal Article
    ZDB-ID 645038-6
    ISSN 1477-111X ; 0267-6591
    ISSN (online) 1477-111X
    ISSN 0267-6591
    DOI 10.1177/0267659120906767
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