Background: Predicting whether extracorporeal membrane oxygenation (ECMO) treatment duration affects prognosis is important both medically and economically. Methods: We conducted a retrospective, multicenter study to better understand the outcomes of patients treated with veno-venous (VV) ECMO over a prolonged duration, analyzing data from the Israel ECMO registry. The study included all adult patients treated with VV-ECMO due to COVID-19-induced respiratory failure. The primary outcomes were survival rates up to 180 days from cannulation. Results: One hundred and eighty-eight patients were included in the study. The median age was 50 years (IQR 42, 50), and 69% were male. Patients were mechanically ventilated for a median of 2.5 days before cannulation (IQR 0.5, 5). The mean ECMO support duration was 29.9 days, with a maximal duration of 189.9 days. The survival rate for 180 days was 56%. We found no change in survival for patients on ECMO for 14, 28, or 56 days. Every day of mechanical ventilation before cannulation correlated with an 11% greater risk for prolonged ECMO treatment (p = 0.01). Conclusions: COVID-19-induced ARDS patients treated with VV-ECMO for prolonged duration had the same prognosis as those treated for short periods of time. The longer the duration of mechanical ventilation before ECMO cannulation, the higher the risk for prolonged ECMO treatment.

Disinfection of drinking water prevents waterborne diseases but can lead to the formation of trihalomethanes (THMs), which are linked to an increased risk of cancer. This study examined the association between water source allocation and THM levels in Israel. A retrospective analysis of water quality reports, published by the Israeli Ministry of Health, was conducted, including only samples collected from the water distribution system between 2015 and 2024. To assess temporal and geographic variability, monthly and annual averages were calculated. Trends were evaluated using interrupted time series regression. Overall, 16,268 samples were included, with a study-wide mean THM level of 30.41 µg/L, mainly due to Bromoform. Elevated THM levels were observed in northern districts, particularly before 2020, with seasonal peaks in the summer months. After 2020, as surface water utilization increased, THM levels also rose in central Israel, with no discernible seasonal pattern. Southern regions, supplied mainly by desalinated water, showed consistently low levels. This analysis indicates that the water source influences THM formation, as increased surface-water use is associated with higher THM concentrations. Mixing surface and groundwater with desalinated water may reduce exposure in areas with high THM levels, highlighting the need for informed water management policies.

Background: Veno-venous extra-corporeal membrane oxygenation (ECMO) cannulations are mostly performed while patients are heavily sedated and mechanically ventilated. For patients with acute respiratory distress syndrome (ARDS), cannulating for ECMO while awake and spontaneously breathing, as well as treating without sedation and mechanical ventilation, has potential advantages. This study aimed to compare clinical outcomes between patients cannulated for ECMO while awake and patients cannulated while sedated and mechanically ventilated. Methods: A retrospective multicenter study. Data were accessed from the Israeli ECMO registry of patients with COVID-19-induced ARDS treated at eight ECMO centers in Israel. The study group comprised 24 patients who were cannulated while awake and spontaneously breathing. A control group comprised 96 patients who were cannulated after sedation and mechanical ventilation, matched 1:4 by age, sex, and body mass index. The primary outcome was six-month survival. Secondary outcomes were: the duration of ECMO therapy, the duration of invasive mechanical ventilation-free ECMO therapy, and the duration of invasive mechanical ventilation. Results: The mean age was 52 + 11 years; 78% were males. Fifteen patients (63%) in the study group were eventually intubated. The mean durations on ECMO and in the intensive care unit did not differ between the groups. The study group had a higher six-month survival (75% vs. 49%, p = 0.02) and fewer infectious complications such as pneumonia or bacteremia (21% vs. 40%, p < 0.001) compared to the control group. After adjusting for PO₂/FiO₂ ratio and for the COVID-19 variant, the hazard ratio was 0.45 (C.I 0.19–1.06, p = 0.069). Conclusions: Awake VV-ECMO cannulation in COVID-19-induced ARDS is feasible in selected patients and was associated with higher survival in unadjusted analyses. However, after adjustment for key covariates, this association was attenuated and did not reach statistical significance.

Objective: Veno-venous extra-corporeal membrane oxygenation (ECMO) cannulations are mostly done while patients are heavily sedated and mechanically ventilated. For patients with acute respiratory distress syndrome (ARDS), cannulating for ECMO while awake and spontaneously breathing, and treating without sedation and mechanical ventilation has potential advantages. This study aimed to compare clinical outcomes between patients cannulated for ECMO while awake and patients cannulated while sedated and mechanically ventilated. Design: A retrospective multicenter study. Setting: Data were accessed from the Israeli ECMO registry of patients with COVID-19-induced ARDS treated at eight ECMO centers in Israel. Patients: The study group comprised 24 patients who were cannulated while awake and spontaneously breathing. A control group comprised 96 patients who were cannulated after sedation and mechanical ventilation, matched 1:4 by age, sex, and body mass index. Interventions: None. Measurements: The primary outcome was six-month survival. Secondary outcomes were: the duration of ECMO therapy, the duration of invasive mechanical ventilation-free ECMO therapy, and the duration of invasive mechanical ventilation. Main Results: The mean age was 52 + 11 years; 78% were males. Fifteen (63%) of the study group were eventually intubated. The mean durations on ECMO and in the intensive care unit did not differ between the groups. The study group had a higher six-month survival (75% vs 49%, p=0.02), and fewer infectious complications such as ventilatory-induced pneumonia or bacteremia (21% vs 40%, p<0.001) compared to the control group. Conclusions: In patients with severe COVID-19-induced ARDS, awake cannulation for veno-venous ECMO may improve six-month survival compared to cannulation while sedated and mechanically ventilated.

Objective: Due to limited freshwater supplies, Israel increasingly depends on desalination to fulfill its drinking water requirements. However, this process reduces mineral levels such as magnesium (Mg²⁺), calcium (Ca²⁺), and fluoride (F⁻), which could pose health concerns. In this study, we analyze the mineral concentrations across various water sources nationwide. Materials and Methods: We analyzed a national database on drinking water quality for levels of Ca²⁺, Mg²⁺, and F⁻ from 2014 to 2024. District-level concentrations were calculated and compared with national means and across primary water sources. Water sources were classified as primarily DSW (DSW) or primarily groundwater-based according to their dominant composition. Results: Nationwide median concentrations were 52 mg/L for Ca²⁺, 12 mg/L for Mg²⁺, and 0.15 mg/L for F⁻. Ca²⁺ and Mg²⁺ showed marked regional variation, with significantly higher mean levels in the Northern District (Ca²⁺: 72 mg/L, p < 0.006; Mg²⁺: 34 mg/L, p < 0.001) and lowest levels in southern regions, particularly the Southern District (Ca²⁺: 39 mg/L, p < 0.001; Mg²⁺: 7 mg/L, p < 0.001) compared to the national average. Fluoride concentrations were generally low, with higher levels in northern regions (0.23 mg/L, p < 0.001) and lower levels in Tel Aviv (0.07 mg/L, p < 0.001) and Jerusalem (0.11 mg/L, p < 0.001). By predominant water source, Ca²⁺ and Mg²⁺ concentrations were lowest in DSW (Ca²⁺: 42 mg/L; Mg²⁺: 9 mg/L) and highest in groundwater supplies (Ca²⁺: 83 mg/L; Mg²⁺: 34 mg/L). Concentrations of F⁻ ranged from 0.12 mg/L in predominantly DSW to 0.23 mg/L in areas supplied primarily by groundwater. Conclusions: Ca²⁺ levels aligned with international reports, while Mg²⁺ levels, especially in desalination-reliant areas, remained consistently low. F⁻ concentrations stayed below both the recommended maximums and the optimal levels advised by the U.S. Public Health Service. As desalination efforts grow, concerns have been raised about the potential public health risks associated with low-mineral drinking water, particularly cardiovascular disease and bone disorders.

Background: Predicting whether extracorporeal membrane oxygenation (ECMO) treatment duration affects prognosis is important both medically and economically. We conducted a retrospective, multicenter study to better understand the outcomes of patients treated with VV ECMO for a prolonged duration, analyzing data from the Israel ECMO registry. The study included all adult patients treated with VV-ECMO due to COVID-19-induced respiratory failure. The primary outcomes were survival rates up to 180 days from cannulation. Results: One hundred and eighty-eight patients were included in the study. The median age was 50 years (IQR 42, 50) and 69% were male. Patients were mechanically ventilated for a median of 2.5 days before cannulation (IQR 0.5, 5). The mean ECMO support duration was 29.9 days, with a maximal duration of 189.9 days. Survival rate for 180 days was 56%. We found no change in survival for patients on ECMO for 14, 28, or 56 days. Every day of mechanical ventilation before cannulation correlated with an 11% greater risk for prolonged ECMO treatment (p=0.01). Conclusions: For COVID-19-induced ARDS patients treated with VV-ECMO, ECMO treatment duration did not affect mortality. The longer the duration of mechanical ventilation before ECMO cannulation, the higher the risk for prolonged ECMO treatment.