French multicentre observational study on SARS-CoV-2 infections intensive care initial management: the FRENCH CORONA study.

AIM: Describing acute respiratory distress syndrome patterns, therapeutics management, and outcomes of ICU COVID-19 patients and indentifying risk factors of 28-day mortality. METHODS: Prospective multicentre, cohort study conducted in 29 French ICUs. Baseline characteristics, comorbidities, adjunctive therapies, ventilatory support at ICU admission and survival data were collected. RESULTS: From March to July 2020, 966 patients were enrolled with a median age of 66 (interquartile range 58-73) years and a median SAPS II of 37 (29-48). During the first 24 h of ICU admission, COVID-19 patients received one of the following respiratory supports: mechanical ventilation for 559 (58%), standard oxygen therapy for 228 (24%) and high-flow nasal cannula (HFNC) for 179 (19%) patients. Overall, 721 (75%) patients were mechanically ventilated during their ICU stay. Prone positioning and neuromuscular blocking agents were used in 494 (51%) and 460 (48%) patients, respectively. Bacterial co-infections and ventilator-associated pneumonia were diagnosed in 79 (3%) and 411 (43%) patients, respectively. The overall 28-day mortality was 18%. Age, pre-existing comorbidities, severity of respiratory failure and the absence of antiviral therapy on admission were identified as independent predictors of 28-day outcome. CONCLUSION: Severity of hypoxaemia on admission, older age (> 70 years), cardiovascular and renal comorbidities were associated with worse outcome in COVID-19 patients. Antiviral treatment on admission was identified as a protective factor for 28-day mortality. Ascertaining the outcomes of critically ill COVID-19 patients is crucial to optimise hospital and ICU resources and provide the appropriate intensity level of care.

Outcomes of COVID-19-Related ARDS Patients Hospitalized in a Military Field Intensive Care Unit.

INTRODUCTION: Little evidence of outcome is available on critically ill Coronavirus Disease 2019 (COVID-19) patients hospitalized in a field hospital. Our purpose was to report outcomes of critically ill COVID-19 patients after hospitalization in a field intensive care unit (ICU), established under military tents in a civil-military collaboration. METHODS: All patients with COVID-19-related acute respiratory distress syndrome (ARDS) admitted to the Military Health Service Field Intensive Care Unit in Mulhouse (France) between March 24, 2020, and May 7, 2020, were included in the study. Medical history and clinical and laboratory data were collected prospectively. The institutional review board of the French Society Anesthesia and Intensive Care approved the study. RESULTS: Forty-seven patients were hospitalized (37 men, median age 62 [54-67] years, Sequential Organ Failure Assessment score 7 [6-10] points, and Simplified Acute Physiology Score II score 39 [28-50] points) during the 45-day deployment of the field ICU. Median length of stay was 11 [6-15] days and median length of ventilation was 13 [7.5-21] days. At the end of the deployment, 25 (53%) patients went back home, 17 (37%) were still hospitalized, and 4 (9%) died. At hospital discharge, 40 (85%) patients were alive. CONCLUSION: In this study, a military field ICU joined a regional civil hospital to manage a large cluster of COVID-19-related ARDS patients in Mulhouse, France. This report illustrates how military teams can support civil authorities in the provision of advanced critical care. Outcomes of patient suggest that this field hospital deployment was an effective adaptation during pandemic conditions.

SARS Cov2 outbreak management on a landing helicopter dock: An observational retrospective study.

OBJECTIVES: Even though SARS Cov2 outbreak management has been well-described, scant information is available in military settings. We aimed to describe a SARS Cov2 outbreak and its management on the Dixmude, a French landing helicopter dock. PATIENTS AND METHODS: We performed an observational retrospective and monocentric study in a ship. Role 1 was reinforced by additional roles 1 and 2. Our analysis included all infected crew personnel. We described demographic data, outbreak course, and biological samples including Covid-19 diagnosis. All infected patients were monitored for 10 days. RESULTS: Between February 16th 2021 and March 12th 2021, 54 patients (10% of the entire crew) were included. No patient had previously been vaccinated against SARS Cov2. The global mission was maintained. The crew members were healthy, male, and young (median age 28 years) with no medical history. Ranks of every status were concerned. Covid-19 disease was mainly diagnosed by real-time reverse-transcriptase polymerase chain reaction (rt-PCR). Thirty-two patients (59%) were symptomatic, four (8%) were presymptomatic and 18 (33%) remained asymptomatic. CONCLUSIONS: The present work describes specific SARS Cov2 outbreak management in an austere military environment. Early individual and global measures were set and implemented on board.

Study protocol for a multicentre, 2×2 factorial, randomised, controlled trial evaluating the interest of intravenous iron and tranexamic acid to reduce blood transfusion in hip fracture patients (the HiFIT study).

INTRODUCTION: Blood transfusion and anaemia are frequent and are associated with poor outcomes in patients with hip fracture (HF). We hypothesised that preoperative intravenous iron and tranexamic acid (TXA) may reduce the transfusion rate in these patients. METHODS AND ANALYSIS: The HiFIT study is a multicentre, 2×2 factorial, randomised, double-blinded, controlled trial evaluating the effect of iron isomaltoside (IIM) (20 mg/kg) vs placebo and of TXA (intravenously at inclusion and topically during surgery) versus placebo on transfusion rate during hospitalisation, in patients undergoing emergency surgery for HF and having a preoperative haemoglobin between 95 and 130 g/L. 780 patients are expected. The primary endpoint is the proportion of patients receiving an allogenic blood transfusion of packed red blood cells from the day of surgery until hospital discharge (or until D30 if patient is still hospitalised). Enrolment started on March 2017 in 11 French hospitals. The study was stopped between July 2017 and August 2018 (because of investigation of serious AEs with IIM in Spain) and slowed down since March 2020 (COVID-19 crisis). The expected date of final follow-up is May 2022. Analyses of the intent-to-treat and per-protocol populations are planned. ETHICS AND DISSEMINATION: The HiFIT trial protocol has been approved by the Ethics Committee of Comité de Protection des Personnes Ouest II and the French authorities (ANSM). It will be carried out according to the principles of the Declaration of Helsinki and the Good Clinical Practice guidelines. The results will be disseminated through presentation at scientific conferences and publication in peer-reviewed journals. The HiFIT trial will be the largest study evaluating iron and TXA in patients with HF. TRIAL REGISTRATION NUMBER: clinicalTrials.gov identifier: NCT02972294; EudraCT Number 2016-003087-40.