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Insurance-based Disparities in Outcomes and Extracorporeal Membrane Oxygenation Utilization for Hospitalized COVID-19 Patients. 基于保险的 COVID-19 住院患者疗效和使用 ECMO 的差异。
IF 9.1 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-07-01 DOI: 10.1097/ALN.0000000000004985
Laurent G Glance, Karen E Joynt Maddox, Michael Mazzeffi, Ernie Shippey, Katherine L Wood, E Yoko Furuya, Patricia W Stone, Jingjing Shang, Isaac Y Wu, Igor Gosev, Stewart J Lustik, Heather L Lander, Julie A Wyrobek, Andres Laserna, Andrew W Dick

Background: The objective of this study was to examine insurance-based disparities in mortality, nonhome discharges, and extracorporeal membrane oxygenation utilization in patients hospitalized with COVID-19.

Methods: Using a national database of U.S. academic medical centers and their affiliated hospitals, the risk-adjusted association between mortality, nonhome discharge, and extracorporeal membrane oxygenation utilization and (1) the type of insurance coverage (private insurance, Medicare, dual enrollment in Medicare and Medicaid, and no insurance) and (2) the weekly hospital COVID-19 burden (0 to 5.0%; 5.1 to 10%, 10.1 to 20%, 20.1 to 30%, and 30.1% and greater) was evaluated. Modeling was expanded to include an interaction between payer status and the weekly hospital COVID-19 burden to examine whether the lack of private insurance was associated with increases in disparities as the COVID-19 burden increased.

Results: Among 760,846 patients hospitalized with COVID-19, 214,992 had private insurance, 318,624 had Medicare, 96,192 were dually enrolled in Medicare and Medicaid, 107,548 had Medicaid, and 23,560 had no insurance. Overall, 76,250 died, 211,702 had nonhome discharges, 75,703 were mechanically ventilated, and 2,642 underwent extracorporeal membrane oxygenation. The adjusted odds of death were higher in patients with Medicare (adjusted odds ratio, 1.28 [95% CI, 1.21 to 1.35]; P < 0.0005), dually enrolled (adjusted odds ratio, 1.39 [95% CI, 1.30 to 1.50]; P < 0.0005), Medicaid (adjusted odds ratio, 1.28 [95% CI, 1.20 to 1.36]; P < 0.0005), and no insurance (adjusted odds ratio, 1.43 [95% CI, 1.26 to 1.62]; P < 0.0005) compared to patients with private insurance. Patients with Medicare (adjusted odds ratio, 0.47; [95% CI, 0.39 to 0.58]; P < 0.0005), dually enrolled (adjusted odds ratio, 0.32 [95% CI, 0.24 to 0.43]; P < 0.0005), Medicaid (adjusted odds ratio, 0.70 [95% CI, 0.62 to 0.79]; P < 0.0005), and no insurance (adjusted odds ratio, 0.40 [95% CI, 0.29 to 0.56]; P < 0.001) were less likely to be placed on extracorporeal membrane oxygenation than patients with private insurance. Mortality, nonhome discharges, and extracorporeal membrane oxygenation utilization did not change significantly more in patients with private insurance compared to patients without private insurance as the COVID-19 burden increased.

Conclusions: Among patients with COVID-19, insurance-based disparities in mortality, nonhome discharges, and extracorporeal membrane oxygenation utilization were substantial, but these disparities did not increase as the hospital COVID-19 burden increased.

Editor’s perspective:

研究背景本研究的目的是探讨COVID-19住院患者在死亡率、非家庭出院和ECMO使用方面基于保险的差异:利用美国学术医疗中心及其附属医院的国家数据库,评估了死亡率、非家庭出院和 ECMO 使用与(1)保险类型(私人保险、医疗保险、医疗保险和医疗补助双重参保、无保险)和(2)每周医院 COVID-19 负担(0-5.0%;5.1-10%,10.1-20%,20.1-30%,30.1%-)之间的风险调整关联。我们扩大了建模范围,加入了付款人状况与每周医院 COVID-19 负担之间的交互作用,以研究随着 COVID-19 负担的增加,缺乏私人保险是否与差异的增加有关:在 760,846 名 COVID-19 住院患者中,214,992 人拥有私人保险,318,624 人拥有医疗保险,96,192 人同时加入了医疗保险和医疗补助计划,107,548 人拥有医疗补助计划,23,560 人没有任何保险。总计有 76250 人死亡,211702 人非居家出院,75703 人接受了机械通气,2642 人接受了 ECMO。医疗保险患者的调整后死亡几率更高(aOR:1.28;[95% CI:1.21,1.35];PC结论:在 COVID-19 患者中,基于保险的死亡率、非家庭出院和 ECMO 使用率差异很大,但这些差异并没有随着医院 COVID-19 负担的增加而增加。
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引用次数: 0
Effects of an Early Intensive Blood Pressure-lowering Strategy Using Remifentanil and Dexmedetomidine in Patients with Spontaneous Intracerebral Hemorrhage: A Multicenter, Prospective, Superiority, Randomized Controlled Trial. 使用瑞芬太尼和右美托咪定的早期强化降压策略对自发性脑出血患者的影响:一项多中心、前瞻性、优越性随机对照试验。
IF 9.1 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-07-01 DOI: 10.1097/ALN.0000000000004986
Rui Dong, Fen Li, Bin Li, Qiming Chen, Xianjian Huang, Jiehua Zhang, Qibing Huang, Zeli Zhang, Yunxing Cao, Mingbiao Yang, Jianwei Li, Zhanfu Li, Cuiyu Li, Guohua Liu, Shu Zhong, Guang Feng, Ming Zhang, Yumei Xiao, Kangyue Lin, Yunlong Shen, Huanzhang Shao, Yuan Shi, Xiangyou Yu, Xiaopeng Li, Lan Yao, Xinyu Du, Ying Xu, Pei Kang, Guoyi Gao, Bin Ouyang, Wenjin Chen, Zhenhua Zeng, Pingyan Chen, Chunbo Chen, Hong Yang

Background: Although it has been established that elevated blood pressure and its variability worsen outcomes in spontaneous intracerebral hemorrhage, antihypertensives use during the acute phase still lacks robust evidence. A blood pressure-lowering regimen using remifentanil and dexmedetomidine might be a reasonable therapeutic option given their analgesic and antisympathetic effects. The objective of this superiority trial was to validate the efficacy and safety of this blood pressure-lowering strategy that uses remifentanil and dexmedetomidine in patients with acute intracerebral hemorrhage.

Methods: In this multicenter, prospective, single-blinded, superiority randomized controlled trial, patients with intracerebral hemorrhage and systolic blood pressure (SBP) 150 mmHg or greater were randomly allocated to the intervention group (a preset protocol with a standard guideline management using remifentanil and dexmedetomidine) or the control group (standard guideline-based management) to receive blood pressure-lowering treatment. The primary outcome was the SBP control rate (less than 140 mmHg) at 1 h posttreatment initiation. Secondary outcomes included blood pressure variability, neurologic function, and clinical outcomes.

Results: A total of 338 patients were allocated to the intervention (n = 167) or control group (n = 171). The SBP control rate at 1 h posttreatment initiation in the intervention group was higher than that in controls (101 of 161, 62.7% vs. 66 of 166, 39.8%; difference, 23.2%; 95% CI, 12.4 to 34.1%; P < 0.001). Analysis of secondary outcomes indicated that patients in the intervention group could effectively reduce agitation while achieving lighter sedation, but no improvement in clinical outcomes was observed. Regarding safety, the incidence of bradycardia and respiratory depression was higher in the intervention group.

Conclusions: Among intracerebral hemorrhage patients with a SBP 150 mmHg or greater, a preset protocol using a remifentanil and dexmedetomidine-based standard guideline management significantly increased the SBP control rate at 1 h posttreatment compared with the standard guideline-based management.

Editor’s perspective:

背景:尽管已经证实血压升高及其变化会恶化自发性脑出血的预后,但在急性期使用降压药仍缺乏有力的证据。鉴于瑞芬太尼和右美托咪定具有镇痛和抗交感神经作用,使用瑞芬太尼和右美托咪定的降压方案可能是一种合理的治疗选择。这项优越性试验的目的是验证在急性脑出血患者中使用瑞芬太尼和右美托咪定这种降压策略的有效性和安全性:在这项多中心、前瞻性、单盲、优势随机对照试验中,收缩压(SBP)≥150 mmHg的脑出血患者被随机分配到干预组(使用瑞芬太尼和右美托咪定的标准指南管理预设方案)或对照组(基于标准指南的管理)接受降压治疗。主要结果是 SBP 控制率(结果:共有 338 名患者被分配到干预组(167 人)或对照组(171 人)。干预组在治疗开始后 1 小时的 SBP 控制率高于对照组(101/161,62.7% vs. 66/166,39.8%,差异 23.2%,95% CI,12.4 至 34.1%,P <0.001)。次要结果分析表明,干预组患者能有效减少躁动,同时获得较轻的镇静效果,但临床结果未见改善。在安全性方面,干预组心动过缓和呼吸抑制的发生率较高:结论:在SBP≥150 mmHg的脑出血患者中,使用基于瑞芬太尼和右美托咪定的标准指南管理的预设方案与标准指南管理相比,能显著提高治疗后1 h的SBP控制率。(ClinicalTrials.gov编号:NCT03207100,注册日期:2017年6月30日)。
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引用次数: 0
Liposomal Bupivacaine for Peripheral Nerve Blockade: A Randomized, Controlled, Crossover, Triple-blinded Pharmacodynamic Study in Volunteers. 用于外周神经阻滞的脂质体布比卡因:一项针对志愿者的随机、对照、交叉、三重对照药效学研究。
IF 9.1 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-07-01 DOI: 10.1097/ALN.0000000000004988
Markus Zadrazil, Peter Marhofer, Philipp Opfermann, Werner Schmid, Daniela Marhofer, Mira Zeilberger, Lena Pracher, Markus Zeitlinger

Background: Little is known about the pharmacodynamic characteristics of liposomal bupivacaine. Hypothesizing that they would not identify pharmacodynamic differences from plain bupivacaine during the initial period after administration, but would find better long-term pharmacodynamic characteristics, the authors designed a randomized, controlled, triple-blinded, single-center study in volunteers.

Methods: Volunteers aged 18 to 55 yr (body mass index, 18 to 35 kg/m2) received two ulnar nerve blocks under ultrasound guidance. Using a crossover design with a washout phase of 36 days or more, one block was performed with liposomal and one with plain bupivacaine. Which came first was determined by randomization. Sensory data were collected by pinprick testing and motor data by thumb adduction, either way in comparison with the contralateral arm. Endpoints included success, time to onset, and duration of blockade. Residual efficacy was assessed by the volunteers keeping a diary. Statistical analysis included Wilcoxon signed-rank and exact McNemar's tests, as well as a generalized estimation equation model.

Results: Successful sensory blockade was noted in 8 of 25 volunteers (32%) after liposomal and in 25 of 25 (100%) after plain bupivacaine (P < 0.0001). Significant differences emerged for time to onset, defined as 0% response to pinpricking in four of five hypothenar supply areas (P < 0.0001), and for time from onset to 80% or 20% in one of five areas (P < 0.001; P < 0.001). Carryover effects due to the randomized sequencing were unlikely (estimate, -0.6286; sequence effect, 0.8772; P = 0.474). Self-assessment greater than 3.5 days did reveal, for liposomal bupivacaine only, intermittent but unpredictable episodes of residual sensory blockade.

Conclusions: The results show that liposomal bupivacaine is not a suitable "sole" drug for intraoperative regional anesthesia. Findings of its limited long-term efficacy add to existing evidence that a moderate effect, at best, should be expected on postoperative pain therapy.

Editor’s perspective:

背景:人们对脂质体布比卡因的药效学特性知之甚少。我们假设,在用药后的最初阶段,我们不会发现与普通布比卡因的药效学差异,但会发现更好的长期药效学特征,因此我们设计了一项在志愿者中进行的随机、对照、三盲、单中心研究:年龄在 18 至 55 岁之间的志愿者(体重指数:18 至 35 kg/m²)在超声引导下接受了两次尺神经阻滞治疗。采用交叉设计,冲洗期≥ 36 天,一次用脂质体阻滞,一次用普通布比卡因阻滞。先用哪一种由随机决定。感觉数据通过针刺测试收集,运动数据通过拇指内收收集,无论哪种方式都要与对侧手臂进行比较。终点包括成功率、起效时间和阻滞持续时间。剩余疗效由志愿者记日记进行评估。统计分析包括 Wilcoxon 符号秩检验、精确 McNemar 检验以及广义估计方程模型:结果:8/25(32%)名志愿者使用脂质体后成功阻断了感觉,25/25(100%)名志愿者使用普通布比卡因后成功阻断了感觉(P < 0.0001)。在 4/5 个腓肠肌下供血区,起效时间定义为针刺反应为 0%(P < 0.0001);在 1/5 个供血区,起效时间定义为针刺反应为 80% 或 20%(P < 0.001; 0.001)。由于随机排序而产生的带入效应不太可能发生(估计值:-0.6286;SE:0.8772;P = 0.474)。3.5天的自我评估显示,只有脂质体布比卡因出现了间歇性但不可预测的残余感觉阻滞:我们的研究结果表明,脂质体布比卡因并不是术中区域麻醉的 "唯一 "药物。我们的研究结果表明,脂质体布比卡因并不是术中区域麻醉的 "唯一 "药物,其有限的长期疗效补充了现有的证据,即对术后疼痛治疗最多只能起到适度的效果。
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引用次数: 0
Fibrinolysis as a Causative Mechanism for Bleeding Complications on Extracorporeal Membrane Oxygenation: A Pilot Observational Prospective Study. 纤溶作为 ECMO 出血并发症的致病机制:一项前瞻性试点观察研究。
IF 9.1 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-07-01 DOI: 10.1097/ALN.0000000000004980
Julie Helms, Anaïs Curtiaud, François Severac, Marine Tschirhart, Hamid Merdji, Matthieu Bourdin, Geneviève Contant, François Depasse, Ramy Abou Rjeily, Laurent Sattler, Ferhat Meziani, Eduardo Angles-Cano

Background: Extracorporeal membrane oxygenation (ECMO) is associated with a high risk of bleeding complications. The specific impact of ECMO on fibrinolysis remains unexplored. The objective of the current pilot observational prospective study was to investigate the longitudinal dynamics of fibrinolytic markers-i.e., changes over time-in the context of bleeding events in patients on ECMO.

Methods: Longitudinal dynamics of contact phase components (kininogen and bradykinin) and fibrinolysis markers (tissue plasminogen activator [tPA], plasminogen activator inhibitor-1 [PAI-1], their complexes [tPA•PAI-1], plasmin-antiplasmin complexes, plasminogen, and D-dimer) were measured in patients undergoing venovenous and venoarterial ECMO, before implantation, at 0, 6, and 12 h after implantation, and daily thereafter.

Results: The cohort consisted of 30 patients (214 ECMO days). The concentrations of tPA, D-dimer, plasmin-antiplasmin complexes, PAI-1, and tPA•PAI-1 complexes were increased, whereas plasminogen decreased compared to normal values. A noteworthy divergence was observed between hemorrhagic and nonhemorrhagic patients: in bleeding patients, D-dimer, plasmin-antiplasmin, tPA, PAI-1, and tPA•PAI-1 followed an increasing kinetics before hemorrhage and then decreased to their baseline level; conversely, nonbleeding patients showed a decreasing kinetics in these markers. Also, D-dimer and tPA followed an increasing kinetics in bleeding patients compared to nonbleeding patients (median values for D-dimer dynamics: 1,080 vs. -440 ng/ml, P = 0.05; tPA dynamics: 0.130 vs. 0.100 nM, P = 0.038), and both markers significantly increased the day before hemorrhage. A tPA concentration above 0.304 nM was associated with bleeding events (odds ratio, 4.92; 95% CI, 1.01 to 24.08; P = 0.049).

Conclusions: Contact activation induces fibrinolysis in ECMO patients, especially in patients experiencing bleeding. This finding supports the role of this mechanism as a possible causal factor for hemorrhages during ECMO and open new avenues for novel therapeutic perspectives.

Editor’s perspective:

背景:体外膜肺氧合(ECMO)与出血并发症的高风险相关。ECMO 对纤维蛋白溶解的具体影响仍有待研究。本试验性前瞻性观察研究的目的是调查 ECMO 患者出血事件中纤维蛋白溶解标志物的纵向动态变化,即随时间推移而发生的变化:接触相成分(激肽原和缓激肽)和纤溶标志物(组织型纤溶酶原激活剂 [t-PA]、纤溶酶原激活剂抑制剂-1 [PAI-1]、它们的复合物 [t-PA-PAI-1])的纵向动态变化、在植入前、植入后 0、6 和 12 小时以及之后的每天,对接受静脉和静脉-动脉 ECMO 的患者的组织型纤溶酶原激活剂 [t-PA-PAI-1]、纤溶酶原-抗纤溶酶原复合物、纤溶酶原和 D-二聚体)进行了测量。结果组群包括 30 名患者(214 个 ECMO 日)。与正常值相比,t-PA、D-二聚体、凝血酶-抗凝血酶复合物、PAI-1 和 t-PA-PAI-1 复合物的浓度升高,而纤溶酶原的浓度降低。值得注意的是,出血和非出血患者之间存在差异:出血患者的 D-二聚体、凝血酶原-抗凝血酶、t-PA、PAI-1 和 t-PA-PAI-1 在出血前呈上升趋势,随后降至基线水平;相反,非出血患者的这些指标呈下降趋势。此外,与非出血患者相比,出血患者的 D-二聚体和 t-PA 呈上升趋势(D-二聚体动态中位值:1080 vs. -440 ng/mL,p=0.05;t-PA 动态中位值:0.130 vs. 0.100 nM,p=0.038),并且这两种标记物在出血前一天显著增加。t-PA浓度超过0.304 nM与出血事件有关(OR 4.92,95% CI [1.01-24.08],p=0.049):结论:接触性激活可诱导 ECMO 患者,尤其是出血患者发生纤溶。这一发现支持了这一机制作为 ECMO 期间出血的可能致病因素的作用,并为新的治疗前景开辟了新途径:由于多种因素,体外膜肺氧合(ECMO)与出血并发症的高风险相关。虽然导致 ECMO 期间纤维蛋白溶解的原因有多种,但他们的研究表明,出血患者的接触性激活增加,可能会受益于通过这种途径抑制止血激活的新型治疗药物。
{"title":"Fibrinolysis as a Causative Mechanism for Bleeding Complications on Extracorporeal Membrane Oxygenation: A Pilot Observational Prospective Study.","authors":"Julie Helms, Anaïs Curtiaud, François Severac, Marine Tschirhart, Hamid Merdji, Matthieu Bourdin, Geneviève Contant, François Depasse, Ramy Abou Rjeily, Laurent Sattler, Ferhat Meziani, Eduardo Angles-Cano","doi":"10.1097/ALN.0000000000004980","DOIUrl":"10.1097/ALN.0000000000004980","url":null,"abstract":"<p><strong>Background: </strong>Extracorporeal membrane oxygenation (ECMO) is associated with a high risk of bleeding complications. The specific impact of ECMO on fibrinolysis remains unexplored. The objective of the current pilot observational prospective study was to investigate the longitudinal dynamics of fibrinolytic markers-i.e., changes over time-in the context of bleeding events in patients on ECMO.</p><p><strong>Methods: </strong>Longitudinal dynamics of contact phase components (kininogen and bradykinin) and fibrinolysis markers (tissue plasminogen activator [tPA], plasminogen activator inhibitor-1 [PAI-1], their complexes [tPA•PAI-1], plasmin-antiplasmin complexes, plasminogen, and D-dimer) were measured in patients undergoing venovenous and venoarterial ECMO, before implantation, at 0, 6, and 12 h after implantation, and daily thereafter.</p><p><strong>Results: </strong>The cohort consisted of 30 patients (214 ECMO days). The concentrations of tPA, D-dimer, plasmin-antiplasmin complexes, PAI-1, and tPA•PAI-1 complexes were increased, whereas plasminogen decreased compared to normal values. A noteworthy divergence was observed between hemorrhagic and nonhemorrhagic patients: in bleeding patients, D-dimer, plasmin-antiplasmin, tPA, PAI-1, and tPA•PAI-1 followed an increasing kinetics before hemorrhage and then decreased to their baseline level; conversely, nonbleeding patients showed a decreasing kinetics in these markers. Also, D-dimer and tPA followed an increasing kinetics in bleeding patients compared to nonbleeding patients (median values for D-dimer dynamics: 1,080 vs. -440 ng/ml, P = 0.05; tPA dynamics: 0.130 vs. 0.100 nM, P = 0.038), and both markers significantly increased the day before hemorrhage. A tPA concentration above 0.304 nM was associated with bleeding events (odds ratio, 4.92; 95% CI, 1.01 to 24.08; P = 0.049).</p><p><strong>Conclusions: </strong>Contact activation induces fibrinolysis in ECMO patients, especially in patients experiencing bleeding. This finding supports the role of this mechanism as a possible causal factor for hemorrhages during ECMO and open new avenues for novel therapeutic perspectives.</p><p><strong>Editor’s perspective: </strong></p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140179190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Sweeping Away Dyspnea. 扫除呼吸困难
IF 9.1 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-07-01 DOI: 10.1097/ALN.0000000000005010
Nikolaos J Skubas, Martin J London
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引用次数: 0
Rethinking Coagulation Activation during Extracorporeal Membrane Oxygenation: Insights from the Case of Mr. Hageman. 重新思考体外膜氧合过程中的凝血活化:哈格曼先生病例的启示。
IF 9.1 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-07-01 DOI: 10.1097/ALN.0000000000005003
Kenichi A Tanaka, Michael A Mazzeffi, Jerrold H Levy
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引用次数: 0
The Exceptions: Nancy Hopkins, MIT, and the Fight for Women in Science 例外:南希-霍普金斯、麻省理工学院和为科学界女性而战
IF 8.8 1区 医学 Q1 Medicine Pub Date : 2024-06-12 DOI: 10.1097/aln.0000000000005011
K. McGoldrick
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引用次数: 0
Morton’s Letheon: The Sweet Promise of Surgical Oblivion 莫顿的莱西恩手术遗忘的甜蜜承诺
IF 8.8 1区 医学 Q1 Medicine Pub Date : 2024-06-06 DOI: 10.1097/aln.0000000000005066
{"title":"Morton’s Letheon: The Sweet Promise of Surgical Oblivion","authors":"","doi":"10.1097/aln.0000000000005066","DOIUrl":"https://doi.org/10.1097/aln.0000000000005066","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":null,"pages":null},"PeriodicalIF":8.8,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141380333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Dr. John Severinghaus’s Imagination Inspired by Dr. Stanley Sarnoff 约翰-塞弗林豪斯博士的想象力受到斯坦利-萨尔诺夫博士的启发
IF 8.8 1区 医学 Q1 Medicine Pub Date : 2024-06-06 DOI: 10.1097/aln.0000000000005067
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引用次数: 0
Don’t Sweep It Under the Rug: Increased Sweep to Treat Dyspnea during ECMO 不要掩耳盗铃:增加 ECMO 期间呼吸困难的扫查次数
IF 8.8 1区 医学 Q1 Medicine Pub Date : 2024-06-06 DOI: 10.1097/aln.0000000000005055
H. Ende, J. Wanderer
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引用次数: 0
期刊
Anesthesiology
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