Characteristics and outcomes of patients with COVID-19 admitted to the ICU in a university hospital in São Paulo, Brazil - study protocol

OBJECTIVES: We designed a cohort study to describe characteristics and outcomes of patients with coronavirus disease (COVID-19) admitted to the intensive care unit (ICU) in the largest public hospital in Sao Paulo, Brazil, as Latin America becomes the epicenter of the pandemic. METHODS: This is the protocol for a study being conducted at an academic hospital in Brazil with 300 adult ICU beds dedicated to COVID-19 patients. We will include adult patients admitted to the ICU with suspected or confirmed COVID-19 during the study period. The main outcome is ICU survival at 28 days. Data will be collected prospectively and retrospectively by trained investigators from the hospital's electronic medical records, using an electronic data capture tool. We will collect data on demographics, comorbidities, severity of disease, and laboratorial test results at admission. Information on the need for advanced life support and ventilator parameters will be collected during ICU stay. Patients will be followed up for 28 days in the ICU and 60 days in the hospital. We will plot Kaplan-Meier curves to estimate ICU and hospital survival and perform survival analysis using the Cox proportional hazards model to identify the main risk factors for mortality. ClinicalTrials.gov: NCT04378582. RESULTS: We expect to include a large sample of patients with COVID-19 admitted to the ICU and to be able to provide data on admission characteristics, use of advanced life support, ICU survival at 28 days, and hospital survival at 60 days. CONCLUSIONS: This study will provide epidemiological data about critically ill patients with COVID-19 in Brazil, which could inform health policy and resource allocation in low- and middle-income countries.

Time de resposta rápida e atendimento de paradas cardíacas extra-hospitalares / Rapid response Team and out-of-hospital cardiac arrest

Times de Resposta Rápida (TRR) são equipes multidisciplinares treinadas para atender indivíduos com intercorrências agudas e graves, incluindo parada cardiorrespiratória (PCR) súbita, nas unidades de internação. O objetivo deste trabalho é discutir as particularidades do emprego de um TRR hospitalar no atendimento de PCRs extra-hospitalares, utilizando a experiência do time do Instituto Central do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (ICHC-FMUSP) para elucidação. Metodologia: Estudo retrospectivo, descritivo, utilizando o banco de dados do TRR do ICHC-FMUSP. Foram levantados todos os casos classificados como PCR súbita atendidos em ambiente extra-hospitalar, nos anos de 2014 a 2016. Dados globais de cinco pacientes que evoluíram com alta hospitalar e nível neurológico preservado foram descritos e analisados em detalhes. Resultados: Entre 11 atendimentos, oito tiveram retorno da circulação espontânea (RCE) na cena (72,2%) e três morreram no local. Dos oito pacientes admitidos com vida no Departamento de Emergência, cinco tiveram alta hospitalar após o evento (45,5%). A média de tempo de resposta foi 3 ± 1,2 minutos e o intervalo chamada-choque foi de 7,25 ± 3,2 minutos. Os ritmos de parada foram fibrilação ventricular (80%) e atividade elétrica sem pulso (20%). Dois pacientes foram diagnosticados com doença coronariana grave e quatro receberam um cardiodesfibrilador implantável (CDI) para profilaxia secundária de morte súbita. Um paciente, entre os cinco que tiveram alta, faleceu em outro serviço. Conclusão: Apesar de pouco usual, o emprego de um TRR hospitalar no atendimento de PCRs extra-hospitalares pode ser benéfico. Os desfechos favoráveis provavelmente decorreram do treinamento da equipe e da rapidez na realização do atendimento. A investigação cardiológica dos sobreviventes identificou pacientes com doenças graves, que, portanto, mais se beneficiariam da assistência de um time especializado

Introduction: Rapid Response Teams (RRT) are multidisciplinary groups trained to treat individuals with severe and acute events, including sudden cardiac arrest (CA), in in-patient units. The aim of this report is to discuss the singularities of deploying a hospital RRT for out-of-hospital CA assistance, using the experience of the team at the Instituto Central of Hospital das Clínicas of the University of São Paulo School of Medicine (ICHC-FMUSP) as illustration. Methodology: A retrospective, descriptive analysis was conducted, using the RRT database of the ICHC-FMUSP. All cases classified as sudden CA treated outside of the hospital between 2014 and 2016 were surveyed. Global data for five patients who progressed to discharge from hospital free of neuro - logical impairment were described and analyzed in detail. Results: Of the 11 cases, 8 had return of spontaneous circulation (ROSC) at the scene (72.2%), and 3 died on site. Of the 8 patients admitted to the Emergency Department, 5 were discharged from the hospital after the event (45.5%). The average response time was 3±1.2minutes, and the call-to-shock time interval was 7.25±3.2minutes. The cardiac arrest rhythms were ventricular fibrillation (80%) and pulseless electrical activity (20%). Two patients were diagnosed with severe coronary disease and four received an implantable cardioverter-defibrillator (ICD) for secondary prophylaxis of sudden death. One patient, of the 5 discharged, died in another unit. Conclusion: Although unusual, the use of a hospital RRT for out-of-hospital CA assistance can be beneficial. The favorable outcomes likely resulted from the team's training and the speed with which the treatment was given. Cardiovascular evaluation of the survivors identified patents with severe diseases, which would, therefore, most benefit from the care of a specialized team