International Journal of Medical Students
https://ijms.info/IJMS
<p>The <em>International Journal of Medical Students </em>(<em>IJMS</em>) is an open-access, peer-reviewed scientific journal (ISSN <a href="https://portal.issn.org/resource/ISSN/2076-6327" target="_blank" rel="noopener">2076-6327</a>) that publishes original research and experiences in all fields of medicine. The <em>IJMS</em> was created in 2009 to share scientific production and experiences where there is at least one author enrolled as a medical student (including MBBS students, MD students, DO students, MD/MSc students, and MD/PhD students) in any medical school in the world or a recently graduated physician. These early-career scientists must be accompanied by a senior researcher that must be also responsible for the research, guaranteeing the quality of the work. The <em>IJMS</em> aims to be the leading publication platform for early-career scientists' medical research. Read more in the <a href="https://ijms.info/IJMS/about" target="_blank" rel="noopener">About the Journal section</a>.</p>University Library System, University of Pittsburghen-USInternational Journal of Medical Students2076-6327<p id="copyright">Authors who publish with this journal agree to the following terms:</p> <ol> <li class="show">The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.</li> <li class="show">Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.</li> <li class="show">The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a <a href="http://creativecommons.org/licenses/by/4.0/" target="_blank" rel="noopener">Creative Commons Attribution 4.0 International License</a> or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions: <ol> <li class="show">Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site; with the understanding that the above condition can be waived with permission from the Author and that where the Work or any of its elements is in the public domain under applicable law, that status is in no way affected by the license.</li> <li class="show">The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgment of its initial publication in this journal.</li> <li class="show">Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.</li> <li class="show">Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.</li> <li class="show">The Author represents and warrants that:<br> <ol> <li class="show">the Work is the Author’s original work;</li> <li class="show">the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;</li> <li class="show">the Work is not pending review or under consideration by another publisher;</li> <li class="show">the Work has not previously been published;</li> <li class="show">the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and</li> <li class="show">the Work contains no libel, invasion of privacy, or other unlawful matter.</li> </ol> </li> <li class="show">The Author agrees to indemnify and hold Publisher harmless from the Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.</li> </ol> </li> </ol> <p><em>Enforcement of copyright</em></p> <p>The IJMS takes the protection of copyright very seriously.</p> <p>If the IJMS discovers that you have used its copyright materials in contravention of the license above, the IJMS may bring legal proceedings against you seeking reparation and an injunction to stop you using those materials. You could also be ordered to pay legal costs.</p> <p>If you become aware of any use of the IJMS' copyright materials that contravenes or may contravene the license above, please report this by email to <a href="mailto:contact@ijms.org">contact@ijms.org</a></p> <p> </p> <p><em>Infringing material</em></p> <p>If you become aware of any material on the website that you believe infringes your or any other person's copyright, please report this by email to <a href="mailto:contact@ijms.org">contact@ijms.org</a></p>The Silent Casualties: War's Impact on Medical Students and Medical Education
https://ijms.info/IJMS/article/view/2476
Berjo D. TakoutsingMihnea-Alexandru GămanJuan C. PuyanaFrancisco J. Bonilla-Escobar
Copyright (c) 2023 Berjo Dongmo Takoutsing, Mihnea-Alexandru Găman, Juan C. Puyana, Francisco J. Bonilla-Escobar
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2023-12-212023-12-2111425425810.5195/ijms.2023.2476Time to Treat the Climate and Nature Crisis as One Indivisible Global Health Emergency
https://ijms.info/IJMS/article/view/2319
Kamran AbbasiParveen AliVirginia BarbourThomas BenfieldKirsten Bibbins-DomingoStephen HancocksRichard HortonLaurie Laybourn-LangtonRobert MashPeush SahniWadeia Mohammad ShariefPaul YongaChris Zielinski
Copyright (c) 2023 Kamran Abbasi, Parveen Ali, Virginia Barbour, Thomas Benfield, Kirsten Bibbins-Domingo, Stephen Hancocks, Richard Horton, Laurie Laybourn-Langton, Robert Mash, Peush Sahni, Wadeia Mohammad Sharief, Abdullah Shehab, Paul Yonga, Chris Zielinski
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2023-10-252023-10-2511425926110.5195/ijms.2023.2319The Life of an Editor: Dr. Russell Van Gelder, MD, Ph.D., Editor in Chief of Ophthalmology, the Journal of the American Academy of Ophthalmology
https://ijms.info/IJMS/article/view/2450
<p>In this insightful interview article, we delve into the life and role of Dr. Russell Van Gelder, MD, Ph.D., Chair of the Ophthalmology Department at the University of Washington and Editor in Chief of Ophthalmology, the Journal of the American Academy of Ophthalmology. Driven by a profound passion for literature, he emphasizes the enduring impact of scientific publications as fundamental to knowledge. He views curating this literature as a privileged responsibility, ensuring its enduring quality. Dr. Van Gelder acknowledges the complexities of predictive editing and the challenges of identifying impactful papers. He let us dig into the editorial process at Ophthalmology as we learn about its rigor, involving meticulous screening, comprehensive reviews, and constructive feedback. For aspiring editors, he underscores the importance of a genuine love for literature and the value of constructive criticism. Dr. Van Gelder addresses common misconceptions about the editor's role, highlights the ethical aspects of publishing, and advocates for a focus on content quality, especially in a world marked by predatory practices. He shares a memorable encounter with the work of Clyde Keeler, a scientist from the early 20th century, underlining the timeless nature of literature as a repository of knowledge that transcends generations. In essence, Russ, as affectionately referred to by colleagues, offers a deep understanding of the life of an editor dedicated to preserving the integrity and excellence of scientific publications in the field of ophthalmology. His perspective is distinctively important for medical students and early careers physicians, underscoring the crucial role that editors play in the advancement of scientific knowledge.</p>Malina CernatescuJuan C. PuyanaFrancisco J. Bonilla-Escobar
Copyright (c) 2023 Malina Cernatescu, Francisco J. Bonilla-Escobar
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2023-12-212023-12-2111433033610.5195/ijms.2023.2450From Symptoms to Diagnosis: A Medical Student’s Experience in Solving Her Own Mystery
https://ijms.info/IJMS/article/view/2078
<p>While studying medicine, students may find themselves worrying that they have a disease just because they have been closely learning about it. However, what happens when a medical student is actually experiencing symptoms that are familiar to them? This essay highlights the experience of a third-year medical student who found the answers she was looking for regarding her own health while on clinical rotations.</p>Madeline Franke
Copyright (c) 2023 Madeline Franke
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2023-09-142023-09-1411433733910.5195/ijms.2023.2078My Experience Building a Water System in a Small Rural Community in the Dominican Republic
https://ijms.info/IJMS/article/view/2212
<p>Clean water is vital for physical, social, and mental health, however, water insecurity is a public health threat for many countries. Sabana Larga is a rural community made up of approximately 230 families located in the province of Dajabon on the Northwest region of the Dominican Republic. Building a new water system has been a priority for the community for many years, however the reason for the delay in the process is the lack of funds and assistance in building such a water system. In 2016, as a Peace Corps volunteer living in the community, I asked the Saint Cloud Rotary club for financial support to build a new water system. The objective of this paper is to share my experience of building a water system in a rural community in the Dominican Republic with the Saint Cloud Rotary Club, the Dajabon Rotary Club, local engineers, and the local community. Between April 2017 and June 2017, the new water system in Sabana Larga was successfully implemented. The water system improved access to clean and safe drinking water for all families, leading to a healthier community and better quality of life. Many lessons were learned throughout the process including the importance of community involvement, understanding local customs and traditions, establishing a Water Committee, and gaining various skills.</p>Rosemary Wright
Copyright (c) 2023 Rosemary Wright
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2023-11-132023-11-1311434034210.5195/ijms.2023.2212Mitigating Physician Emigration in Nigeria by Improving the Internship Experience
https://ijms.info/IJMS/article/view/2255
<p>Nigeria faces a critical shortage of health workers, exacerbated by a growing of physician emigration. This study explored the negative internship experiences that drive Nigerian interns to migrate abroad, with a focus on the COVID-19 pandemic's impact. Interns cite excessive workload and burnout, lack of professional development opportunities, challenging work environment, and mistreatment as key reasons for considering emigration. The COVID-19 pandemic has exacerbated these challenges, leading to shortages of personal protective equipment, limited screening services, and poor hazard allowances. The paper emphasizes the importance of adopting policies that make destination countries attractive to emigrating interns. These includes creating a supportive work environment with fair compensation, professional development opportunities, and adequate resources to retain interns in the country. It also highlights the significance of addressing mistreatment and bullying in the workplace. Collaboration between healthcare organizations, policy reforms, and increased healthcare financing are suggested as potential strategies to mitigate the brain drain and ensure a sustainable healthcare system in Nigeria. Improving internship conditions and addressing the shortcomings of managing the COVID-19 pandemic are essential to retaining Nigerian doctors and combatting physician emigration. This requires a coordinated effort from healthcare systems, policymakers, and stakeholders.</p>Faithful Miebaka DanielEmmanuel Aniekan EssienMonica Anurika GbuchieBonaventure Micheal UkoakaVictoria Ezinne Emeruwa
Copyright (c) 2023 Faithful Miebaka Daniel, Emmanuel Aniekan Essien, Monica Anurika Gbuchie, Bonaventure, Victoria
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2023-11-212023-11-2111434334610.5195/ijms.2023.2255Pulmonary Thromboembolism in Multidrug-Resistant Tuberculosis: A Case Series Highlighting the Importance of Early Diagnosis and Management
https://ijms.info/IJMS/article/view/1996
<p><strong>Background:</strong> Pulmonary tuberculosis (PTB) is an established cause of arterial and venous thrombosis. With the rising incidence of multidrug-resistant tuberculosis (MDR TB), which has a prolonged treatment course, pulmonary thromboembolism in such cases further complicates the treatment outcome in terms of mortality and morbidity. TB causes systemic hypercoagulability, which may lead to both arterial and venous thrombosis. Therefore, it is important for treating physicians to be aware of the entity and have a sharp watch for the development of Pulmonary thromboembolism in cases of MDR TB.</p> <p><strong>The Case:</strong> We present the association of pulmonary thromboembolism (PTE) with MDR TB in three young males who developed pulmonary thromboembolism during the treatment of MDR TB, along with their management using anticoagulant agents.</p> <p><strong>Conclusion:</strong> PTE in cases of TB is rare but fatal. High suspicion of PTE in patients with MDR TB will help in diagnosing the dreaded condition early and aid in reducing preventable mortality with PTE. Early recognition, prompt diagnosis, and management is the key to saving the lives of those with this fatal complication.</p>Vikas Marwah Gaurav Bhati Robin Chaudhary Anmol Sharma
Copyright (c) 2023 Vikas Marwah , Gaurav Bhati , Robin Chaudhary , Anmol Sharma
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2023-12-212023-12-2111432132510.5195/ijms.2023.1996A Case-Based Discussion Supporting Ethics Education in Medical Schools
https://ijms.info/IJMS/article/view/2046
<p><strong>Background</strong>: Ethics education in medical schools lacks uniformity, yielding uncertainty when providers are faced with ethically complex patients. Without streamlined ethics training, providers are less confident in their ability to provide ethically appropriate care for all patients, particularly for those most ethically vulnerable. This case report seeks to elucidate ethical concerns when treating an ethically complex patient. Subsequently, the need for early ethics education is substantiated.</p> <p><strong>The Case</strong>: A 58-year-old unhoused patient with no known medical history presented to the emergency department (ED) for evaluation of an infected foot wound. Imaging confirmed acute gas gangrene osteomyelitis. The patient refused the recommended below-the-knee amputation (BKA) but was amenable to intravenous antibiotic therapy. He was subsequently determined by psychiatry to lack decisional capacity and met the DSM-5 criteria for schizoaffective psychosis. Subsequently, the patient’s brother deferred decision-making to the patient, who he believed should make his own medical decisions. Following an ethics consultation, the brother’s decision, and by proxy the patient’s, was respected.</p> <p><strong>Conclusion</strong>: In this case, the patient’s autonomy was prioritized, despite his high level of ethical vulnerability. Ethically conscious treatment was provided despite the implicit stigmatization of homelessness and psychiatric illness. However, an ethics consultation was necessary for this to occur. Ultimately, this paper should serve as a call to action for standardization and prioritization of ethics education during and beyond medical training.</p> <p> </p>Liliana R. LadnerMark G. SwopePhyllis Whitehead
Copyright (c) 2023 Liliana Ladner, Mark G. Swope, Phyllis Whitehead
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2023-12-212023-12-2111432632910.5195/ijms.2023.2046A Review of Palliative Care Service Delivery Models and Patient Outcomes for Adults with Cancer in Selected East and Southeast Asian Countries
https://ijms.info/IJMS/article/view/1919
<p>Cancer is one of the key leading causes of deaths worldwide, with a disproportionately high burden in Asia in terms of incidence and mortality. Guidelines and recommendations published by the World Health Organization (WHO) state palliative care as an essential service for patients with cancer and other chronic diseases. Currently, there is extensive evidence regarding different models of palliative care delivery. However, development of palliative care services remains fragmented in Asia, and more research is needed to synthesize available models of care in this region and provide the latest evidence-based information for healthcare providers. This narrative review identified 11 peer-reviewed studies published after 2017 that reported both on models of palliative care service delivery and outcomes for adult patients with cancer in selected East and Southeast Asian countries. This review is beneficial by providing a detailed summary of the models of care adopted by these countries, and their impact on patient outcomes. It is hoped that the evidence will also generate momentum for continued conversation around palliative care development in Asia.</p>Chun-Yi TsengNatalia Calanzani
Copyright (c) 2023 Chun-Yi Tseng, Natalia Calanzani
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2023-08-102023-08-1011429431110.5195/ijms.2023.1919A Narrative Review on Quality Improvements for Radiology Clerkships from Medical Student
https://ijms.info/IJMS/article/view/1987
<p>Radiology clerkships have the potential to give medical students a better appreciation of a radiologist’s responsibilities toward patient care while raising interest and improving student confidence in diagnostic imaging skills. Unfortunately, many radiology clerkships across the US have developed a reputation for being unorganized and unengaging. This narrative review is focused on summarizing various clerkship practices performed across the US that have been well received by students, as well as specific weaknesses of the traditional clerkship format from the student perspective, with the aim of effective approaches to revamping electives to showcase the realities of the specialty while also attracting bright and motivated students. This narrative review examined 28 studies that gathered survey responses from medical students who completed radiology clerkships to determine their perceptions towards the clerkship. Major findings to be discussed in detail include weaknesses with the traditional format related to passive learning through observing, unclear expectations for medical students, and certain challenges that clerkship directors may face while attempting to implement changes to their clerkship. This narrative review will also discuss specific well-received practices involving more active learning, including interactive workstations, interactive simulators, flipped classrooms, case banks, and online learning modules.</p>Star ChenMaruti Kumaran
Copyright (c) 2023 Star Chen, Maruti Kumaran
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2023-09-142023-09-1411431232010.5195/ijms.2023.1987Cover, Credits, & Content
https://ijms.info/IJMS/article/view/2474
Executive Committee of IJMS
Copyright (c) 2023 Executive Committee of IJMS
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2023-12-212023-12-2111424625310.5195/ijms.2023.2474Awareness, Coverage, and Barriers to COVID-19 Vaccination among Undergraduate Students in Nigeria
https://ijms.info/IJMS/article/view/1908
<p><strong>Background:</strong> With the resumption of physical learning activities across Nigeria's higher education institutions, tertiary-level students, a priority group in the deployment of the COVID-19 vaccines according to the WHO SAGE, face circumstances that necessitate widespread vaccination coverage among them. This study aimed to assess Nigerian undergraduate students' knowledge, coverage, and barriers to COVID-19 vaccination.</p> <p><strong>Method:</strong> A cross-sectional survey of Nigerian undergraduates was conducted in October 2021, using an online questionnaire and a combined simple random and snowballing sampling technique. The questionnaire included sections on respondents' demographic characteristics, COVID-19 vaccine awareness, coverage, barriers, and recommendations. A total of 326 respondents electronically completed and returned the informed consent form along with the questionnaire. The data obtained were analyzed using the statistical package for the social sciences (SPSS) version 25.</p> <p><strong>Results: </strong>The overall awareness of COVID-19 vaccines among the sampled students was high; with 62.3%, 20.9%, and 16.9% having good, average, and poor levels of knowledge respectively. However, a majority of the respondents (81.3%) had not received the vaccines. The most prominent barrier to vaccination was misinformation about vaccine safety (23.6%). Opening vaccination centers on campuses (18.6%), demonstrating vaccine effectiveness and safety (18.7%), and organizing awareness campaigns (17.2%) were the most frequently recommended actions.</p> <p><strong>Conclusion:</strong> Most respondents were aware of the availability and potential benefits of COVID-19 vaccines; however, coverage remained extremely low. Our findings emphasize the importance of addressing vaccination barriers by public health stakeholders to achieve optimal COVID-19 vaccine coverage.</p>Fortune Benjamin EffiongIbrahim Adebayo HassanDimeji Abdulsobur Olawuyi Chiemela Prosper Ogbonna Jeremiah Babatunde AraoyeEsther Edet BasseyKenneth Emeka EnweremYusuff Adebayo Adebisi
Copyright (c) 2023 Fortune B. Effiong, Ibrahim A Hassan, Dimeji A Olawuyi , Chiemela P Ogbonna , Jeremiah B Araoye, Esther E Bassey, Kenneth E Enwerem , Yusuff A Adebisi
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2023-12-032023-12-0311426227010.5195/ijms.2023.1908The Effect of Spaced Repetition Learning Through Anki on Medical Board Exam Performance
https://ijms.info/IJMS/article/view/1549
<p><strong>Background:</strong> Spaced repetition learning is a method of learning that relies on a fixed formula for spacing out flashcards to ensure long term retention of a topic. Anki is one such application available online that utilizes spaced repetition learning. This retrospective cohort study analyzed incorporating Anki with medical school curriculum and its effect on board examination scores. The hypothesis is that students who engaged in spaced repetition learning through Anki scored higher on licensing board exams and achieved higher GPAs than students who did not engage with this method.</p> <p><strong>Methods:</strong> The hypothesis was tested through comparison of USMLE Step 1 scores, COMLEX Level 1 scores, and GPA. The samples were selected from the Rocky Vista University Class of 2023 and split between 35 students in the Anki Cohort and 268 students in the non-Anki cohort.</p> <p><strong>Results:</strong> 1 (2.8%) student failed USMLE Step 1 in the Anki cohort compared to 28 (10.94%) students who failed Step 1 in the non-Anki cohort (p > 0.05) The Anki cohort achieved a higher mean USMLE Step 1 (223.71 versus 222.58) and COMLEX Level 1 (569.51 versus 559.99). The non-Anki cohort had a higher GPA (85.60) than the Anki cohort (83.82) (p < 0.01).</p> <p><strong>Conclusion:</strong> This is the first study to evaluate for a correlation between COMLEX level 1 scores with use of spaced repetition learning. Although this study was unable to find any significant correlation between Anki use and licensing exam scores, further investigations with better control and sample size are needed.</p>Spencer CooperNicole TwardowskiMichael VogelDaniel PerlingRebecca Ryznar
Copyright (c) 2023 Spencer Cooper, Nicole Twardowski, Michael Vogel, Daniel Perling, Rebecca Ryznar
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2023-12-212023-12-21114271275Evaluating Medical Students' Knowledge of Medical Malpractice: A Pilot Study
https://ijms.info/IJMS/article/view/1576
<p><strong>Introduction:</strong> Although medical malpractice lawsuits are common and have a tremendous financial and psychological impact on physicians, education about medical malpractice is almost non-existent in most medical school curricula around the world. Nonetheless, medical students are concerned about looming legal lawsuits during their careers and have expressed desire to become educated. The objective of the present study is to evaluate and gauge baseline medico-legal knowledge of medical students.</p> <p><strong>Methods</strong>: A survey with 25 multiple-choice quiz questions regarding malpractice risks, standards of care, and malpractice premiums was prepared with information obtained from peer-reviewed articles after a thorough literature review failed to produce a validated questionnaire for medical students. The survey was distributed to medical students across 5 consecutive years at our medical school, totaling 420 students. Data from the survey was collected via Qualtrics before undergoing statistical analysis.</p> <p><strong>Results</strong>: The completion rate for the survey was 110/420 (26.2%). The results showed that no group of students scored greater than 50% correct on the survey, with an overall median score of 40% correct for all students combined. Fourth year medical students correctly answered 1.77 more questions, on average, than first year medical students. There were no statistically significant differences in survey score between students with a personal or familial medical malpractice involvement.</p> <p><strong>Discussion</strong>: The results are an indication that students are not well-educated about medical malpractice, and that medical malpractice education should be implemented in medical school to help prepare future physicians to protect their patients and hopefully avoid malpractice lawsuits.</p>Nia NikkhahmaneshPaul KangEric vanSonnenberg
Copyright (c) 2023 Nia Nikkhahmanesh, Paul Kang, Eric vanSonnenberg
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2023-12-212023-12-2111427628410.5195/ijms.2023.1576Prognostic Factors of Survival in Veno-Arterial ECMO Patients: A Multivariable Logistic Regression Analysis
https://ijms.info/IJMS/article/view/1557
<p><strong>Background: </strong>Several models exist to predict mortality in patients on Veno-arterial (VA) extracorporeal membrane oxygenation (ECMO). Whether expanded demographic data points have prognostic implications is less understood. This study assessed the prognostic value of demographics in patients on VA-ECMO.</p> <p><strong>Methods: </strong>This retrospective cohort study investigated 410 patients who received VA-ECMO. Survival to hospital discharge, survival to intensive care unit discharge and survival to ECMO explantation were examined. A multivariable logistic regression was performed incorporating 11 demographic variables.</p> <p><br /><strong>Results: </strong>44% (181/410) of patients survived to ECMO explant, 37% (152/410) of patients survived to ICU discharge, and 36% (146/410) of patients survived to hospital discharge. There was an increase in odds of survival to hospital discharge in patients who were less than 55 years old (Odds Ratio (OR) = 3.91 [95% Confidence Interval (CI) 2.35-6.49]). There was a decrease in odds of survival to hospital discharge in patients who had a prior cardiac arrest (OR = 0.35 [95% CI 0.20-0.63]). Patients who survived to hospital discharge less frequently had a history of smoking (51% vs 65%, respectively; p=0.008), and were younger compared to those who did not survive (51.4+/- 14.03 vs 57.3+/- 16.54).</p> <p><strong>Conclusion: </strong>Age less than 55 years old was a prognostic indicator of survival to hospital discharge following VA-ECMO, while history of smoking, history of dialysis, and history of cardiac arrest were associated with mortality. Sex, BMI, atrial fibrillation, hypertension, DM, and COPD were not significant indicators. These data may help guide optimal patient selection for VA-ECMO support.</p>Andrew JonesGeorge Olverson IVWayne WongRohun BhagatClauden Louis
Copyright (c) 2023 Andrew S Jones, George Olverson IV, Wayne Wong, Rohun Bhagat, Clauden Louis
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2023-12-042023-12-0411428529310.5195/ijms.2023.1557