University of Vermont Medical Center

Introduction: Pediatric extra-corporeal membrane oxygenation (ECMO) is an advanced therapy offered by few centers. Often, patients with severe cardiopulmonary failure undergo urgent transfer from pediatric intensive care units (PICUs) to an ECMO center for potential cannulation. Given the risks associated with ECMO and transport, it is crucial to identify patients most likely to benefit from transfer and ECMO support. Our objective was to determine the rates of and factors contributing to receipt of ECMO and survival of children urgently transferred to an ECMO center. Methods: We performed a multicenter retrospective cohort study of patients 0-18 years referred by 5 PICUs to a pediatric ECMO center in the U.S. Northeast from 2013-2022. We excluded patients already on ECMO at referral and those referred for procedures needing ECMO back-up (not imminently requiring support). Patients’ records were linked across referring PICUs and the ECMO center. We collected demographic data, referral/transfer characteristics, clinical data at various timepoints, and patient outcomes. Results: Preliminary results from completed reviews of 37 records showed that 36 (97%) referred patients were transferred to the ECMO center. One patient did not transfer due to clinical improvement. Mean referral time from PICU admission was 2.3 (SD 3.2) days and transfer occurred at a median of 6.5 (IQR 4.9, 8.6) hours from initial referral. Eight (22%) patients were cannulated onto ECMO at a median of 8.4 (IQR 4.4, 13.9) hours from ECMO center admission. Six (17%) patients died, all after transfer to the ECMO center, including 4 (50%) patients placed on ECMO. Unadjusted analysis showed that patients who received ECMO support were older (median 1.5 vs. 0.5 years), and at transfer, were more severely ill (median PRISM-III score 19.5 vs. 9) with greater life support needs (median OI 12.1 vs. 8.9 and median VIS 10 vs. 7.5). Conclusions: In a regional pediatric ECMO referral network, 22% of referred patients subsequently received ECMO support, with a 17% mortality rate among all referred patients. Factors associated with ECMO cannulation will be determined using cluster analysis once data for the entire cohort is complete. Findings can potentially inform ECMO referral and transfer practices across a referral network.

Adolescent and young adult (AYA) survivors of cancer are at elevated risk for financial challenges, food insecurity, and basic needs instability. However, little is known about their lived experiences. Hence, this study explored the lived experiences of financial toxicity, basic needs instability, and food insecurity among AYA survivors and described the impact of financial toxicity on the overall well-being of AYA survivors. Using a systematic content analysis approach, this study examined 3,868 Reddit items (original posts and associated comments) drawn from 26 Reddit communities from 2005 to July 2025. Reddit cancer community posts were screened to determine those made by someone who self-identified as an individual diagnosed with cancer between the ages of 15–39, completed primary treatment, and shared about financial or food access challenges. Posts were excluded if the age at diagnosis could not be ascertained. Posts were coded by two researchers into major themes and sub-themes using MAXQDA software. The most common cancer types reported in the Reddit data were breast, cervical, and colon. The data revealed four main themes: four main themes: (1) Distress caused and amplified by navigating broken systems; (2) Barriers to social support that worsen financial toxicity; (3) Spiraling consequences of financial toxicity: Food, housing, employment, and education instability; and (4) Healthcare system and policy barriers that exacerbate treatment burden and financial toxicity. Ongoing financial impacts of cancer, and associated psychosocial distress, created numerous challenges for AYAs in terms of managing the costs of treatment, medications, lodging, relocation, food, education, and retaining employment. Cancer centers, insurers, and community organizations need to prioritize multi-level safety net programs that ensure AYA survivors have access to resources that meet their basic necessities and other long-term survivorship needs.

To explore the safety and effectiveness of using two preventive calcitonin gene-related peptide (CGRP) antagonists in patients with chronic migraine. Although the literature supports concurrent use of CGRP antagonists for acute and preventive treatment of chronic migraine, it is unknown whether two concurrent preventive CGRP agents are safe and effective. Adults with chronic migraine who were prescribed two preventive CGRP antagonists, one monoclonal antibody (e.g., eptinezumab, erenumab, fremanezumab, galcanezumab) and one oral agent (gepant) (e.g., atogepant, rimegepant) were included in this retrospective cohort study. Patients served as their own controls in a pre-post analysis completed at the University of Vermont Health Network, including data from January 1, 2020 through December 31, 2024. Demographic, clinical, and medication data were recorded at baseline (immediately prior to the addition of a second CGRP antagonist) and after a minimum of 3 months of dual therapy. The primary outcome was the change in patient-reported headache in days per month. Secondary outcomes included changes in severe headache or migraine in days per month, adverse events, and the rate and reasons for discontinuation of dual preventive therapy. Of the 37 patients who were included, the average age was 54 years, and the population was primarily female (86%), White (94%), and commercially insured (57%). There was a significant decrease in headache days (median = 0; interquartile range = -5 to 0; p = 0.031) while on two CGRP antagonists, including 8 patients (22%) who achieved at least a 50% reduction in reported headache days. There was also a significant reduction in severe headache or migraine days (median = -2; interquartile range = -6 to 0; p < 0.001). There was no significant increase in adverse events with two CGRP antagonists (p = 0.219 sign test, p = 0.103 McNemar test). However, a single case of ischemic stroke was reported in a patient with multiple risk factors. Half of all patients (19, 51%) discontinued at least one CGRP antagonist by the end of the study period, primarily due to insurance restrictions or lack of perceived benefit. No patients discontinued due to reported side effects. Trialing two preventive CGRP antagonists may be an effective approach for some patients with chronic migraine who have exhausted other preventive treatment options, with some patients in this study experiencing a significant reduction in headache frequency and severity. Prospective studies with larger, more diverse populations should be completed to confirm these findings and investigate any potential stroke risks.