Northwestern Memorial Hospital

Patient: Female, 35-year-oldFinal Diagnosis: Acute cholecysititsSymptoms: Abdominal pain • nausea • vomitingClinical Procedure: Open cholecystectomySpecialty: SurgeryObjective: Congenital defects/diseasesBackgroundEisenmenger syndrome presents a unique challenge for the acute care surgeon. Even routine operations such as laparoscopic appendectomy or cholecystectomy become challenging due to the cardiopulmonary physiologic changes and anatomic anomalies associated with Eisenmenger syndrome. The care of these patients can be further complicated by the severity of disease, surgical complexity, and the abnormal anatomy associated with the syndrome.Case ReportA 35-year-old patient with Eisenmenger syndrome and abdominal heterotaxy presented with acute cholecystitis. She underwent percutaneous cholecystostomy tube placement during her index hospitalization, which was complicated by atrial fibrillation and a cerebrovascular accident due to air embolism. Three months after presentation, she underwent an uncomplicated open cholecystectomy. She was discharged on post-operative day 5, and her course was notable only for a superficial surgical site infection requiring incision and drainage and antibiotics.ConclusionsOur experience managing acute cholecystitis in a patient with Eisenmenger syndrome, abdominal heterotaxy with interrupted inferior vena cava, and bilateral superior vena cava, highlights critical aspects of care of such patients in the context of routine acute surgical care. Pre-operative planning should include optimization of cardiopulmonary function, an individualized anesthetic plan to maintain systemic vascular resistance, and bailout maneuvers in the event of cardiovascular collapse, such as planning for extracorporeal membrane oxygenation with axillary cannulation in the case of our patient.

Abstract Background Extracorporeal membrane oxygenation (ECMO) is a mechanical circulatory device that supports patients with pulmonary or cardiac failure. Patients on ECMO have a significant infection risk due to cannula insertion into large vessels with evidence suggesting that 20% of patients develop an infection. The COVID-19 pandemic led to increased ECMO utilization, though it is unclear if ECMO-related infection epidemiology has shifted. We performed a retrospective comparative analysis of infection epidemiology in ECMO patients pre- and post-pandemic.Table 1:Participant characteristicsTable 2:Bloodstream infections during ECMOAbbreviations: ECMO: extracorporeal membrane oxygenation Methods After institutional review board (IRB) approval, infection data was collected from the ELSO Registry and our Enterprise Data Warehouse. The pre-pandemic range was defined as 4/1/2018-2/29/2020 and the post-pandemic range was defined as 3/1/2020-2/1/2022.Table 3:Other Non-BSI Infections during ECMOAbbreviations: BSI: bloodstream infection; ECMO: extracorporeal membrane oxygenation Results We assessed 199 patients pre-pandemic and 228 patients post-pandemic. Most patients in both cohorts were male with a mean Charlson score of 5.2-5.6 and mean BMI of 28-30 (Table 1). There were no significant differences in race, ethnicity, ICU length of stay (LOS), or mortality pre- and post-pandemic; patients post-pandemic were younger overall. Incidence of bloodstream infections (BSIs) was similar in both groups (Table 2). Gram-positive bacteria comprised 65-75% of BSIs, with E. faecalis the most common organism in both groups. BSIs caused by Gram-negative bacteria comprised 14-24% of cases in both groups. BSIs caused by Candida spp. were observed in 11-12% of cases and most commonly due to C. auris. Multidrug-resistant organisms (MDROs) caused 14-18% of BSIs and typically were vancomycin-resistant Enterococci. Other non-BSI infections occurred in 20-25% of patients, and the frequency of non-BSI infections did not differ between groups (Table 3). MDRO colonization or infection did not differ between groups. Conclusion ECMO remains an important life-saving procedure for critically ill patients, and infectious complications occur in up to 20% of patients. This study demonstrated that amongst ECMO recipients at our institution, the post-pandemic state led to no differences regarding infection rate, MDRO colonization or infection, mortality, or ICU LOS. Disclosures All Authors: No reported disclosures

This cross-sectional survey study evaluates the influence of international observerships organised by the coalition of healthcare professionals from academic institutions-the Ukrainian Alliance for Medical Exchange and Development (UA-MED)-on the professional development, knowledge transfer and clinical practice improvement of Ukrainian healthcare professionals during the war. A total of 263 international observerships were facilitated for 204 Ukrainian medical professionals across the institutions in the USA, Canada, Europe and Australia during 2022-2024. To assess the impact of these observerships, a survey was administered focusing on overall satisfaction, procedural knowledge gained and challenges faced when implementing new techniques on return. The primary outcome was the success score, defined as a composite score of implementing new procedures, initiating quality improvement projects and knowledge dissemination efforts. A total of 128 medical professionals from 45 Ukrainian institutions who completed 138 observerships in 27 institutions abroad participated in the survey (response rate of 62.7%). Observers varied by profession: surgeons (32.8%), radiation oncologists (14.8%), medical oncologists (11.7%), anaesthesiologists (11.7%) and others. Observerships lasted a median of 4 weeks; 74.1% included conference attendance. The average success and satisfaction scores were 6.5/10 and 9.3/10, respectively.The majority (92.7%) reported a shift in perception of how to practise medicine and 75.5% implemented new procedures on returning to Ukraine. Encouraged to disseminate knowledge, participants provided informal training to colleagues (67.3%), prepared presentations for their institutions (65.5%) and national conferences (32.7%), incorporated learnt materials into educational lectures (39.1%) and engaged in all the activities above (15.5%). The international observerships played an important role in enhancing the reported skills and knowledge of Ukrainian healthcare professionals during the war. Improvements were reported in clinical practice, medical education and the implementation of new procedures. The success of these observerships underscores the potential for similar programmes in other low-income and middle-income countries/upper-middle-income countries.

Abstract Over the past decade, total neoadjuvant therapy (TNT) has become increasingly accepted and adopted as the initial treatment for locally advanced rectal cancer. Following TNT, treatment response is assessed using three main modalities: clinical exam, endoscopy, and imaging. In this article, we summarize the known advantages, disadvantages, and controversies associated with each method of assessment.