ABSTRACT
BACKGROUND AND OBJECTIVE Healthcare providers should use personal protective equipment (PPE) when performing aerosol generating medical procedures during highly infectious respiratory pandemics. We aimed to compare the timing of neonatal resuscitation procedures with or without PPE for prevention of SARS-CoV-2 transmission in a manikin model. METHODS A randomized controlled crossover (AB/BA) trial of resuscitation with or without PPE in a neonatal resuscitation scenario. Forty-eight participants were divided in 12 consultant-nurse teams and 12 resident-nurse teams (Figure 1). The primary outcome measure was the time of positive pressure ventilation (PPV) initiation. The secondary outcome measures were: duration of tracheal intubation procedure, time of initiation of chest compressions, correct use of PPE, and discomfort/limitations using PPE. RESULTS Timing of PPV initiation (consultant-nurse teams: mean difference 6.0 seconds, 95% confidence interval, CI 1.1-10.9;resident- nurse teams: mean difference 11.0 s, 95% CI 1.9-20.0), duration of tracheal intubation (consultant-nurse teams: mean difference 22.0 s, 95% CI 7.0-36.9;resident-nurse teams: mean difference 9.1 s, 95% CI 0.1-18.1) and chest compressions (consultant- nurse teams: mean difference 32.3 s, 95% CI 14.4-50.1;resident-nurse teams: mean difference 9.1 s, 95% CI 0.1-18.1). Twelve participants completed the dressing after entering the delivery room. PPE was associated with visual limitations (43/48 participants), discomfort in movements (42/48), limitations in communication (32/48) and thermal discomfort (29/48) (Table 1). DISCUSSION In our trial, the use of PPE increased the time of PPV initiation, the duration of tracheal intubation procedure and the initiation of chest compressions. In the simulation, all participants wore PPE (with some breaches of the dressing protocol) and more than half reported some PPE-related limitations or discomfort. The strengths of the study include the use of a high-fidelity manikin and the videorecording, the participation of both inexperienced and experienced healthcare providers, and the cross-over design. However, the reader should be aware of some limitations of the study. The simulation using a manikin implied that the procedures were performed under safe and secure conditions in a lower stress environment, although the trial simulated the exposure to a highly contagious neonate. CONCLUSIONS In a manikin model, using PPE delayed neonatal resuscitation procedures with potential clinical impact. Healthcare workers reported limitations and discomfort when wearing PPE.
ABSTRACT
Introduction: COVID-19 is thought to be more frequent and severe in patients with cancer. Lymphoma patients may be especially vulnerable, due to the immunodeficiency and immune dysregulation caused by the lymphoma itself and the antitumor treatments. This study describes the characteristics and outcomes of lymphoma patients after developing COVID-19. Methods: This is a retrospective multicentre study carried out in the hospitals of the GELTAMO group, which included patients with a histological diagnosis of lymphoma and confirmed SARS-COV-2 infection before June 30th, 2020. The primary outcome was overall survival (OS) 60 days after a COVID-19 diagnosis. Results: A total of 218 patients (median sage 69.5 [21-94] years, 54% male) were included;100 patients had an indolent B-cell non-Hodgkin's lymphoma (NHL), 67 aggressive B-cell NHL, 19 mantlecell lymphoma, 15 peripheral T-cell lymphoma, and 17 Hodgkin's lymphoma. Patients had received a median of 1 line (0-7) of therapy, and 44.9% were on active treatment at the time of COVID-19 diagnosis. Only 6.4%, 1.8% and 0.9% of patients had received previously autologous stem-cell transplantation, allogeneic SCT and CAR-T cell therapy, respectively. 89% of patients were hospitalized, 71% required oxygen, and 15% mechanical ventilation. With a median follow-up of 91.5 days (13-203), 65 patients have died (60 from COVID-19, 4 from lymphoma, 1 due to other causes), with an estimated 60-day OS of 68.6% (95% CI 62.1-75.1) (figure 1A). In univariate analysis, baseline characteristics associated with decreased OS were age ≥70 years, hypertension, diabetes, other cancer, active disease and hypogammaglobulinemia, but only age ≥70 years maintained independent influence in the multivariate analysis (HR 3.29, 95% CI 1.86-5.83, p < 0.001). Active treatment did not significantly impact OS (figure 1B). Univariate analysis revealed different prognostic factors, apart from age, for patients with DLBCL (N = 60) and FL (N = 69). While the presence of active disease had a prognostic impact on DLBCL (60-day OS 56% vs 79%, p = 0.038) but not on FL (60-day OS 65% vs 78%, p = 0.181) patients, the opposite occurred in the case of active treatment, which seemed to have a negative influence only in patients with FL, as shown in figures 1C and 1D. Conclusions: Our results confirm a high mortality in patients with lymphoma and COVID-19, especially in those ≥70 years old. In patients with DLBCL, disease control seems essential to reduce the risk of mortality in the event of contracting the infection. By contrast, in patients with FL, delaying the start of treatment until it is not strictly necessary should be considered, and these patients should be prioritized to be vaccinated before starting antitumor treatment. This study provides initial data to develop recommendations for the management of lymphoma patients during the COVID-19 pandemic.