Garcia, S I

Cardiac arrest is a leading cause of global mortality, with low survival rates despite advances in resuscitation science. Reported survival ranges from 8% to 34% for out-of-hospital and in-hospital cardiac arrest. Extracorporeal cardiopulmonary resuscitation (ECPR) has emerged as a rescue therapy for patients unresponsive to conventional CPR, leveraging veno-arterial extracorporeal membrane oxygenation (ECMO) to provide artificial circulation, gas exchange, and maintenance of organ perfusion in the absence of spontaneous native circulation. Successful ECPR depends on minimizing time to ECMO initiation and selecting appropriate patients. While several aspects are consistent across countries, ECPR protocols vary in logistics, team composition, cannulation methods, and monitoring, which may influence patient-important outcomes such as survival and neurological recovery. This narrative review explores current global practices in ECPR, and identifies opportunities for standardization while recognizing elements that should remain context specific.

Abstract Introduction Nuclear protein in testis (NUT) carcinoma, formerly known as NUT midline carcinoma, is a rare and highly aggressive subtype of squamous cell carcinoma characterized by NUTM1 gene rearrangements. It typically affects children and young adults and shows a predilection for midline structures of the head, neck, and thorax. We describe a rare case of NUT carcinoma in an elderly patient presenting with central airway obstruction treated with tumor debulking, devascularization, and pulsed electric field (PEF) ablation. Case An 89-year-old woman on chronic anticoagulation for atrial fibrillation presented with respiratory distress and hemoptysis requiring intubation and mechanical ventilation. Chest CT revealed a developing right lower lobe infiltrate and bronchoscopy demonstrated a non-obstructing right lower lobe endobronchial lesion. Pathology of the lesion confirmed NUT carcinoma but the patient was lost to follow-up. Two months later, she presented with altered mental status and respiratory failure. Imaging revealed a 4.6 x 2.6 cm mass at the level of the cricoid cartilage causing approximately 75% tracheal obstruction with tracheal wall invasion. She underwent rigid bronchoscopy with tumor debulking and devascularization, achieving >80% tracheal patency post-procedure. EBUS-guided PEF ablation was then performed to target residual bulky tumor found in the paratracheal area. Given her age, comorbidities, and poor performance status, palliative chemotherapy was deferred and palliative radiotherapy was offered to limit tumor progression. Discussion NUT carcinoma is a rare and aggressive malignancy with a poor prognosis. This case demonstrates rapid tumor progression leading to respiratory failure within two months of initial diagnosis. Management options for malignant central airway obstruction in non-surgical candidates may include endobronchial debulking and ablative therapies. In this case, EBUS-guided PEF ablation, a non-thermal technique that delivers brief electric pulses to induce tumor apoptosis while sparing adjacent structures, was successfully used to treat residual disease with the goal of reducing marginal regrowth and maintain airway patency. PEF ablation has been described in percutaneous and bronchoscopic management of early stage non-small cell lung cancer; however, its application in central airway obstruction represents an innovative therapeutic approach. Although chemoradiation may be considered when feasible, no standard regimen exists for NUT carcinoma. It typically responds poorly to conventional therapies, underscoring the importance of complementary local treatment strategies in select patients. This case highlights the rapidly progressive course of NUT carcinoma and demonstrates the potential role of PEF ablation as a novel adjunct in the palliative management of malignant central airway obstruction. This abstract is funded by: None

Abstract Introduction Emergent endotracheal intubation in the intensive care unit (ICU) is a high-risk, time-sensitive procedure performed to maintain airway patency and ensure adequate oxygenation and ventilation, often complicated by hypotension, hypoxemia, or cardiac arrest. Successful outcomes depend on precise team coordination, communication, and situational awareness. Drawing inspiration from the demonstrated benefits of simulation-based cardiopulmonary resuscitation training in enhancing team performance, this study examines the feasibility of implementing in situ “mock intubation” in the ICU. The objective is to determine whether this approach can be seamlessly integrated into routine practice to improve teamwork, procedural readiness, and patient safety. Methodology A prospective interventional study was conducted in the medical ICU at Mayo Clinic Rochester over two months. ICU staff—including physicians, advanced practice providers (APP), nurses, and respiratory therapists—participated in eight scheduled 45-minute in situ mock intubation sessions integrated into routine clinical hours. Each session included five participants (one physician faculty, one physician trainee/APP, two nurses, and one respiratory therapist) and incorporated case-based scenarios requiring completion of the intubation and management of post-procedural complications. Structured debriefings followed each session to identify performance gaps, enhance team communication, and assess the educational value and feasibility of incorporating mock intubation into routine ICU practice. Results A total of eight mock intubations were conducted with 40 participants. Sessions were seamlessly integrated into the routine clinical workflow without disruption. Participants reported high satisfaction, unanimously agreeing that the sessions were valuable and should be continued. Feedback emphasized psychological safety and realism: “This offered a safe space to communicate,” one noted; another stated, “It’s important to practice where it’s easy to make mistakes,” and a third remarked, “Real-life experiences were brought into simulations.” These themes underscore participants’ desire for ongoing sessions and their perceived real-world relevance. Conclusion Mock intubation using in situ simulation provides a practical approach to training for emergent endotracheal intubation, enhancing team communication, coordination, and situational awareness in the ICU. This on-site format eliminates the need for off-unit scheduling and was well received by staff. The potential of in situ mock intubation to mirror the success of simulated cardiopulmonary resuscitation training highlights the importance of team-based procedural preparation in high-acuity environments. The intervention fosters procedural readiness, teamwork, and a culture of safety. Given its feasibility, clinical relevance, and positive reception, in situ mock intubation should be integrated into routine ICU practice as a team training tool for high-risk procedures. This abstract is funded by: None