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de la Fontaine N, Silberg T, Fegert JM, Tsafrir S, Weisman H, Rubin N, Ashkenazi M, Nacasch N, Polliack ML, Chen W, Herman-Raz M, Wachsberg-Lachmanovich R, Pessach-Gelblum L, Ziv A, Moshkovitz A, Shilo N, Frenkel-Nir Y, Gothelf D, Pessach IM. Acute response to the October 7th hostage release: rapid development and evaluation of the novel ReSPOND protocol implementation within a children's hospital. Child Adolesc Psychiatry Ment Health 2024; 18:76. [PMID: 38902765 PMCID: PMC11191208 DOI: 10.1186/s13034-024-00767-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 06/10/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND The decision to allocate hospitals for the initial reception of hostages abducted on the October 7th Hamas attack introduced an array of unprecedented challenges. These challenges stemmed from a paucity of existing literature and protocols, lack of information regarding captivity conditions, and variability in hostage characteristics and circumstances. OBJECTIVE To describe the rapid development, implementation and evaluation of the Hostage-ReSPOND protocol, a comprehensive trauma-informed procedure for the care of hostages, including young children, their caregivers and families, immediately following their release from prolonged captivity. METHODS A multidisciplinary expert focus group conducted a comprehensive literature review to develop the ReSPOND protocol, consisting of: Readiness of teams via multifaceted trainings, utilizing live simulations and video debriefings; Specialized professional teams experienced in providing holistic trauma-informed care; Personalized care tailored to individualized and developmentally-informed needs; Optimal safety rooted in creating a secure environment and trauma-informed response to young children, adolescents, caregivers and families; and Navigating Discharge, through coordination with community-based care systems. RESULTS A designated facility at the Children's hospital was carefully prepared for receiving 29 hostages, aged 3.9-80 years, 28% under the age of 18. Implementation of the ReSPOND protocol, which prioritized holistic psychosocial interventions above urgent medical care, proved feasible and effective in managing the diverse and complex needs of returnees as per provider report. Finally, systemic assessment of returnee's immediate and long-term mental health needs proved highly challenging. CONCLUSIONS There is currently no literature addressing the response to released hostages, especially those involving infants, young children and families within a children's hospital facility. This study has the potential to fill a crucial gap in knowledge by introducing a novel protocol which could offer valuable insights for public health organizations tasked with providing acute care to diverse individuals and families experiencing extreme, multi-layered mass traumatization.
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Affiliation(s)
- Naama de la Fontaine
- The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Derech Sheba 2, Ramat Gan, 5262656, Israel.
- Child Study Center, Yale School of Medicine, New Haven, CT, USA.
| | - Tamar Silberg
- The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Derech Sheba 2, Ramat Gan, 5262656, Israel
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Jörg M Fegert
- Department for Child and Adolescent Psychiatry and Psychotherapy, University Medical Center, Competence Domain Mental Health Prevention, Ulm, Germany
| | - Shlomit Tsafrir
- The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Derech Sheba 2, Ramat Gan, 5262656, Israel
- The Faculty of Medical & Health Sciences, Tel-Aviv University, Tel Aviv, Israel
| | - Hana Weisman
- The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Derech Sheba 2, Ramat Gan, 5262656, Israel
| | - Noa Rubin
- The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Derech Sheba 2, Ramat Gan, 5262656, Israel
| | - Moshe Ashkenazi
- The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Derech Sheba 2, Ramat Gan, 5262656, Israel
- The Faculty of Medical & Health Sciences, Tel-Aviv University, Tel Aviv, Israel
| | - Nitsa Nacasch
- The Faculty of Medical & Health Sciences, Tel-Aviv University, Tel Aviv, Israel
- Sheba Medical Center, Ramat Gan, Israel
| | - Michael L Polliack
- The Faculty of Medical & Health Sciences, Tel-Aviv University, Tel Aviv, Israel
- Sheba Medical Center, Ramat Gan, Israel
| | - Wendy Chen
- The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Derech Sheba 2, Ramat Gan, 5262656, Israel
- Department of Social Services, Sheba Medical Center, Ramat Gan, Israel
| | - Meirav Herman-Raz
- The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Derech Sheba 2, Ramat Gan, 5262656, Israel
- Department of Social Services, Sheba Medical Center, Ramat Gan, Israel
| | | | - Liat Pessach-Gelblum
- MSR-Israel Center for Medical Simulation, Sheba Medical Center, Ramat Gan, Israel
| | - Amitai Ziv
- The Faculty of Medical & Health Sciences, Tel-Aviv University, Tel Aviv, Israel
- MSR-Israel Center for Medical Simulation, Sheba Medical Center, Ramat Gan, Israel
| | - Anat Moshkovitz
- The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Derech Sheba 2, Ramat Gan, 5262656, Israel
| | - Noya Shilo
- The Faculty of Medical & Health Sciences, Tel-Aviv University, Tel Aviv, Israel
- Sheba Medical Center, Ramat Gan, Israel
| | - Yael Frenkel-Nir
- The Faculty of Medical & Health Sciences, Tel-Aviv University, Tel Aviv, Israel
- Sheba Medical Center, Ramat Gan, Israel
| | - Doron Gothelf
- The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Derech Sheba 2, Ramat Gan, 5262656, Israel
- Sagol School of Neuroscience, The Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Itai M Pessach
- The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Derech Sheba 2, Ramat Gan, 5262656, Israel
- The Faculty of Medical & Health Sciences, Tel-Aviv University, Tel Aviv, Israel
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Gangadharan M, Hayanga HK, Greenberg R, Schwengel D. A Call to Action: Why Anesthesiologists Must Train, Prepare, and Be at the Forefront of Disaster Response for Mass Casualty Incidents. Anesth Analg 2024; 138:893-903. [PMID: 38109852 DOI: 10.1213/ane.0000000000006719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
Disasters, both natural and man-made, continue to increase. In Spring 2023, a 3-hour workshop on mass casualty incidents was conducted at the Society for Pediatric Anesthesia-American Academy of Pediatrics Annual conference. The workshop used multiple instructional strategies to maximize knowledge transfer and learner engagement including minididactic sessions, problem-based learning discussions in 3 tabletop exercises, and 2 30-minute disaster scenarios with actors in a simulated hospital environment. Three themes became evident: (1) disasters will continue to impact hospitals and preparation is imperative, (2) anesthesiologists are extensively and comprehensively trained and their value is often underestimated as mass casualty incident responders, and (3) a need exists for longitudinal disaster preparedness education and training over the course of a career. In this special article, we have sought to further define the problem and evidence, the capacity of anesthesiologists as leaders in disaster preparedness, and the rationale for preparation with current best practices to guide how best to move forward.
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Affiliation(s)
- Meera Gangadharan
- From the Department of Anesthesiology, Critical Care and Pain Medicine, UT Houston, McGovern Medical School, Houston, Texas
| | - Heather K Hayanga
- Department of Anesthesiology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Robert Greenberg
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Deborah Schwengel
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, Maryland
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Gauss T, de Jongh M, Maegele M, Cole E, Bouzat P. Trauma systems in high socioeconomic index countries in 2050. Crit Care 2024; 28:84. [PMID: 38493142 PMCID: PMC10943799 DOI: 10.1186/s13054-024-04863-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 03/06/2024] [Indexed: 03/18/2024] Open
Abstract
Considerable political, structural, environmental and epidemiological change will affect high socioeconomic index (SDI) countries over the next 25 years. These changes will impact healthcare provision and consequently trauma systems. This review attempts to anticipate the potential impact on trauma systems and how they could adapt to meet the changing priorities. The first section describes possible epidemiological trajectories. A second section exposes existing governance and funding challenges, how these can be met, and the need to incorporate data and information science into a learning and adaptive trauma system. The last section suggests an international harmonization of trauma education to improve care standards, optimize immediate and long-term patient needs and enhance disaster preparedness and crisis resilience. By demonstrating their capacity for adaptation, trauma systems can play a leading role in the transformation of care systems to tackle future health challenges.
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Affiliation(s)
- Tobias Gauss
- Division Anesthesia and Critical Care, University Hospital Grenoble Alpes, Grenoble, France.
- Grenoble Institute for Neurosciences, Inserm, U1216, Grenoble Alpes University, Grenoble, France.
| | - Mariska de Jongh
- Network Emergency Care Brabant (NAZB), ETZ Hospital, Tilburg, The Netherlands
| | - Marc Maegele
- Department of Traumatology and Orthopedic Surgery, Cologne-Merheim Medical Center, University Witten-Herdecke, Cologne, Germany
| | - Elaine Cole
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
| | - Pierre Bouzat
- Division Anesthesia and Critical Care, University Hospital Grenoble Alpes, Grenoble, France
- Grenoble Institute for Neurosciences, Inserm, U1216, Grenoble Alpes University, Grenoble, France
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Igra NM, Schmulevich D, Geng Z, Guzman J, Biddinger PD, Gates JD, Spinella PC, Yazer MH, Cannon JW. Optimizing Mass Casualty Triage: Using Discrete Event Simulation to Minimize Time to Resuscitation. J Am Coll Surg 2024; 238:41-53. [PMID: 37870239 DOI: 10.1097/xcs.0000000000000894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
BACKGROUND Urban areas in the US are increasingly focused on mass casualty incident (MCI) response. We simulated prehospital triage scenarios and hypothesized that using hospital-based blood product inventories for on-scene triage decisions would minimize time to treatment. STUDY DESIGN Discrete event simulations modeled MCI casualty injury and patient flow after a simulated blast event in Boston, MA. Casualties were divided into moderate (Injury Severity Score 9 to 15) and severe (Injury Severity Score >15) based on injury patterns. Blood product inventories were collected from all hospitals (n = 6). The primary endpoint was the proportion of casualties managed with 1:1:1 balanced resuscitation in a target timeframe (moderate, 3.5 U red blood cells in 6 hours; severe, 10 U red blood cells in 1 hour). Three triage scenarios were compared, including unimpeded casualty movement to proximate hospitals (Nearest), equal distribution among hospitals (Equal), and blood product inventory-based triage (Supply-Guided). RESULTS Simulated MCIs generated a mean ± SD of 302 ± 7 casualties, including 57 ± 2 moderate and 15 ± 2 severe casualties. Nearest triage resulted in significantly fewer overall casualties treated in the target time (55% vs Equal 86% vs Supply-Guided 91%, p < 0.001). These differences were principally due to fewer moderate casualties treated, but there was no difference among strategies for severe casualties. CONCLUSIONS In this simulation study comparing different triage strategies, including one based on actual blood product inventories, nearest hospital triage was inferior to equal distribution or a Supply-Guided strategy. Disaster response leaders in US urban areas should consider modeling different MCI scenarios and casualty numbers to determine optimal triage strategies for their area given hospital numbers and blood product availability.
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Affiliation(s)
- Noah M Igra
- From the Department of Surgery, Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (Igra, Geng, Cannon)
- School of Medicine, Tel Aviv University, Tel Aviv, Israel (Igra, Yazer)
| | | | - Zhi Geng
- From the Department of Surgery, Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (Igra, Geng, Cannon)
| | - Jessica Guzman
- Department of Surgery, University of California Davis Medical Center, Sacramento, CA (Guzman)
| | - Paul D Biddinger
- Center for Disaster Medicine, Massachusetts General Hospital, Boston, MA (Biddinger)
| | | | - Philip C Spinella
- Departments of Surgery (Spinella), University of Pittsburgh Medical Center, Pittsburgh, PA
- Critical Care Medicine (Spinella), University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Mark H Yazer
- School of Medicine, Tel Aviv University, Tel Aviv, Israel (Igra, Yazer)
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA (Yazer)
| | - Jeremy W Cannon
- From the Department of Surgery, Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (Igra, Geng, Cannon)
- Department of Surgery, Uniformed Services University F Edward Hébert School of Medicine, Bethesda, MD (Cannon)
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Dutton RP, Varon AJ. Five Decades of Trauma Anesthesiology. Anesth Analg 2023; 136:949-956. [PMID: 37058732 DOI: 10.1213/ane.0000000000006099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
We present a brief history of the scientific and educational development of trauma anesthesiology. Key milestones from the past 50 years are noted, as well as the current standing of the subspecialty and prospects for the future.
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Affiliation(s)
- Richard P Dutton
- From the Department of Anesthesiology, Texas A&M College of Medicine, Dallas, Texas
| | - Albert J Varon
- Department of Anesthesiology, Perioperative Medicine, and Pain Management, University of Miami Miller School of Medicine/Ryder Trauma Center, Miami, Florida
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Friberg FF, Nilsson H, Leonardsen ACL. When disaster strikes: staff recall and the use of staff recall systems during mass patient influx at Norwegian emergency primary health care centers - a cross-sectional study. BMC Emerg Med 2023; 23:25. [PMID: 36907847 PMCID: PMC10008708 DOI: 10.1186/s12873-023-00802-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 03/06/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND In Norway, planning for disasters has been specifically emphasized since the incidents on July 22nd, 2011. Every municipality is now legislated to have a contingency plan that includes plans for staff recall during situations with mass influx of patients. Whether the primary health care services in Norway are prepared for mass influx of patients remains unclear. AIMS OF THE STUDY The aims of this study were (1) to assess the experiences of head doctors at emergency primary health care centers (EPHCC) in Norway with mass influx of patients, (2) to explore mass influx and staff recall procedures in use, (3) to assess head doctors' experiences with staff recall systems, and (4) to assess their perspective on automatized staff recall systems. We also wanted to assess whether there were differences between small and large EPHCCs regarding whether they had plans in place. METHODS The study had a cross-sectional, multicenter design, using a self-developed questionnaire. The questionnaire was developed utilizing recommendations from the Delphi technique, including an expert group and piloting. A purposive sampling strategy was used, including head doctors from Norwegian EPHCCs (n = 169). Data were analyzed using the Statistical Package for the Social Sciences, and included descriptive statistics, Chi-Square tests and Shapiro-Wilks. Free-text answers were analyzed by content analysis. RESULTS A total of 64 head doctors responded to the questionnaire. The results show that 25% of the head doctors had experienced mass influx of patients at their EPHCC. In total 54.7% of Norwegian EPHCCs did not have disaster plans that consider mass influx situations. The majority of EPHCCs plan to recall staff one by one (60.3%) or through Short-Message-Systems (34.4%). Most EPHCCs had available telephone "alarm" lists (81.4%), that are updated regularly (60.9%). However, only 17.2% had plans that consider loss of mobile phone connection or internet. In total, 67,2% of the head doctors reported to have little experience with automatized staff recall systems, and 59,7% reported to have little knowledge about such systems. There were no significant difference between small and large EPHCCs in having plans or not. CONCLUSION Even though our results show that few EPHCCs experience mass influx of patients, it is important to be prepared when such incidents do occur. Our results indicate that it is still potential for improvement regarding plans for staff recall and implementation of staff recall systems at Norwegian EPHCCs. Involving national disaster medicine experts in the process of generating tools or checklists could aid when constructing disaster plans. Education and implementation of training for mass influx situations at all levels should always be highlighted.
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Affiliation(s)
- Fredrik Femtehjell Friberg
- Department of Anesthesiology and Intensive Care, Oslo University Hospital, Ullevål, NO-0450, Oslo, Norway. .,Department of Anesthesiology and Intensive Care, Ostfold Hospital Trust, NO-1714, Grålum, Norway.
| | - Heléne Nilsson
- The Swedish Civil Contingencies Agency, SE-65181, Karlstad, Sweden.,Faculty of Medicine and Health Science, University of Linköping, SE-58183, Linköping, Sweden
| | - Ann-Chatrin Linqvist Leonardsen
- Ostfold University College, NO-1757, Halden, Norway.,Department of Anesthesiology and Intensive Care, Ostfold Hospital Trust, NO-1714, Grålum, Norway
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Smart Glasses: A New Tool for Assessing the Number of Patients in Mass-Casualty Incidents. Prehosp Disaster Med 2022; 37:480-484. [PMID: 35757837 PMCID: PMC9280067 DOI: 10.1017/s1049023x22000929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Introduction: Mass-casualty incidents (MCIs) are events in which many people are injured during the same period of time. This has major implications in regards to practical concerns and planning for both personnel and medical equipment. Smart glasses are modern tools that could help Emergency Medical Services (EMS) in the estimation of the number of potential patients in an MCI. However, currently there is no study regarding the advantage of employing the use of smart glasses in MCIs in Thailand. Study Objective: This study aims to compare the overall accuracy and amount of time used with smart glasses and comparing it to manual counting to assess the number of casualties from the scene. Methods: This study was a randomized controlled trial, field exercise experimental study in the EMS unit of Srinagarind Hospital, Thailand. The participants were divided into two groups (those with smart glasses and those doing manual counting). On the days of the simulation (February 25 and 26, 2022), the participants in the smart glasses group received a 30-minute training session on the use of the smart glasses. After that, both groups of participants counted the number of casualties on the simulation field independently. Results: Sixty-eight participants were examined, and in the smart glasses group, a total of 58.8% (N = 20) of the participants were male. The mean age in this group was 39.4 years old. The most experienced in the EMS smart glasses group had worked in this position for four-to-six years (44.1%). The participants in the smart glasses group had the highest scores in accurately assessing the number of casualties being between 21-30 (98.0%) compared with the manual counting group (89.2%). Additionally, the time used for assessing the number of casualties in the smart glasses group was shorter than the manual counting group in tallying the number of casualties between 11-20 (6.3 versus 11.2 seconds; P = .04) and between 21-30 (22.1 versus 44.5 seconds; P = .02). Conclusion: The use of smart glasses to assess the number of casualties in MCIs when the number of patients is between 11 and 30 is useful in terms of greater accuracy and less time being spent than with manual counting.
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Mass casualty medicine: time for a 21st century refresh. Br J Anaesth 2021; 128:e65-e67. [PMID: 34949438 DOI: 10.1016/j.bja.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/01/2021] [Accepted: 12/05/2021] [Indexed: 11/20/2022] Open
Abstract
Mass casualty events are on the rise globally, as we face increasing pressures from scarcity of resources, population growth, systemic inequalities, geopolitical instabilities, and polarised discourse. Although they are rare events for an individual practitioner, they are going to happen to someone, somewhere, this week, this month, this year. And whilst they are often the last consideration for healthcare systems under constant pressures from daily routine work, individuals, departments, hospitals, and systems have to step up effectively in times of crisis. Failure to do so can lead to suboptimal outcomes for casualties, and even perceived failures can have crippling consequences on staff, families, and communities for years.
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Tankel J, Einav S. Preparing for mass casualty events despite COVID-19. Br J Anaesth 2021; 128:e104-e108. [PMID: 34903361 PMCID: PMC8590937 DOI: 10.1016/j.bja.2021.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 11/17/2022] Open
Abstract
Preparedness for mass casualty events is essential at local, national, and global levels. Much more needs to be done by all stakeholders to avoid unnecessary morbidity and mortality despite the challenges that COVID-19 continues to present. In this editorial, we highlight the challenges and solutions for mass casualty incident preparations.
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Affiliation(s)
- James Tankel
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital - McGill University Health Centre, Montreal, QC, Canada
| | - Sharon Einav
- General Intensive Care Unit of the Shaare Zedek Medical Centre and the Hebrew University Faculty of Medicine, Jerusalem, Israel.
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