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Objectives: To present an unusual complication related to prolonged ECMO support in a patient with COVID19 induced acute respiratory syndrome (ARDS). Method(s): Clinical chart review of the care process after obtaining the informed consent from the patient. Result(s): A 48-year-old female with COVID-19 infection during second wave of pandemic in August 2021 progressed to severe ARDS. She was put on VV-ECMO support after failing conventional therapy for refractory hypoxemia. Her cannulation configuration included a 25 F venous drainage cannula in the right femoral vein and a 21 F venous return cannula in the right Internal Jugular (IJ) vein. Cannulations were performed using the ;Seldinger technique;under USG guidance, and no difficulties or complications were reported. Her hospital course was notable for delirium, and intermittent bleeding from the cannula sites. After 80 days of support, she showed adequate respiratory improvement which allowed ECMO decannulation. She continued to show improvement, and was eventually discharged after 102 days of total hospital stay. During her 6 weeks follow-up clinic visit a palpable thrill was noted at the jugular ECMO cannula site. A CT angiogram of the neck demonstrated a large venous varix connecting the right IJ and the left common carotid artery with filling from the left common carotid artery. ECMO cannulation site complications such as aneurysm, clots, infections and stenosis are well known. What was unusual in this case is the nature of the aneurysm given that there were no arterial procedures performed on the left side of the neck. She was managed by an ;Amplatzer plug;to the carotid artery at the level of the connection to the varix without any complications. Conclusion(s): Longer duration of ECMO support needs careful follow-up for timely recognition and management of vascular complications. (Figure Presented).
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Objectives: More than 200 patients have benefited from lung transplantation who failed to recover from COVID-19-induced acute respiratory distress (ARDS) with conventional ventilatory support and/ or extracorporeal membrane oxygenation support (ECMO) in USA. We aim to share our experience and lessons learned at our institute through this case series. Method(s): After IRB approval, we performed a retrospective chart review and identified 37 patients who received ECMO for COVID-19 induced ARDS between May 2020 through January 2022. Out of these, 12 received a formal consultation from the transplant team. We studied patient characteristics, interventions during ECMO support, and evaluation outcomes. Result(s): Most of our patients had single organ failure i.e., lung, except for two who required dialysis after ECMO initiation. Six out of the 12 patients received bilateral lung transplant. One patient received the transplant before ECMO initiation. However, the patient required two runs of ECMO after the transplant due to postop complications from suspected COVID19 reinfection and deceased on postoperative day 101. All the patients after transplant had an expedited recovery except one who required prolonged hospitalization before starting physical therapy. The median length of hospital stay for the transplant group was 148 (89- 194) days and for the non-transplant group was 114 (58-178) days. The 30-day survival rate was 100% for the transplant group. At a median follow-up of 207 (0- 456) days after discharge, 5(83.3%) patients in the transplant group and 3(50%) patients in the nontransplant group were alive. In the non-transplant group, 4 patients received ECMO support for more than 75 days and at last follow-up 2 were alive and functioning well without needing new lungs. This asks for an objective prospective study to define the timeline of irreversibility of the lung injury. Conclusion(s): Lung transplantation is a viable salvage option in patients with COVI-19 induced irreversible lung injury. However, the irreversibility of the lung injury and the timing of lung transplant remains to be determined case-by-case. (Figure Presented).
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Introduction: Indicators that assess relationships among leukocytes may inform more and/or earlier than those measured in isolation. Method(s): Blood leukocyte differential counts collected from 101 Mayo Clinic COVID-19 patients were related to later outcomes following two approaches: (i) as unstructured data (e.g., lymphocyte percentages) and (ii) as data structures that assess intercellular interactions. Analyzing the same primary data, it was asked whether information contents differed among methods and/or when two sets of structured indicators are used. Result(s): While unstructured data did not distinguish survivors from non-survivors (Fig. 1, rectangle A), one data structure (here identified with letters expressed in italics) exhibited one perpendicular inflection that differentiated two patient groups (B). Two survivor-related observations were also distinguished from the remaining data points (B). A second data structure also revealed a single line of observations and a perpendicular data inflection (C), while more (four) patient groups were identified (D). Four validations were conducted: (i) increasing mortality levels among contiguous data subsets (0, 7.1, 16.2, or 44.4%) suggested construct validity (D);(ii) internal validity was indicated because 22 of the 45 survivors detected by the first data structure were also captured by the second one;(iii) the analysis of patients that differed in address, co-morbidities and other aspects supported external validity;and (iv) quasi non-overlapping data intervals predicted statistical validity (E, F). The structured approach also uncovered new and/ or dissimilar information: different leukocyte-related ratios explained the clusters identified in these analyses (E, F). Conclusion(s): Structured data may yield more information than methods that do not assess multicellular interactions. Possible applications include daily, longitudinal, and personalized analysis of hospital data.
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Article 157 of the Brazilian Civil Code states that "lesion occurs when a person, under grounds of necessity, or due to inexperience, agrees to perform an overtly disproportional obligation in face of the value of the opposite obligation”. By analyzing such article, it is certain that there is no mention of either an intention to commit fraud by one of the parties or to economically exploit their counterpart (dolo de aproveitamento), an aspect that is usually neglected by legal scholarship and precedents in Brazil. In this sense, the purpose of this paper is to criticize the literal interpretation of such provision, while taking into consideration the legal scholarship views that include such malicious intent as a requirement to the occurrence of lesion. This paper shall focus on the study of "lesion” as defined in the Brazilian Civil Code and shall not analyze "lesion” as established under the Brazilian Consumer Law. The paper shall also bring examples of situations, including some of those which have risen in the context of Covid-19 pandemic. In order to set the proper framework for the analysis, the paper shall investigate the legal framework of lesion in contract law in several jurisdictions, specially in Italy, France, the US, Austria, Germany and Portugal, as well as UNIDROIT regulations. In sequence, the paper shall promote an analysis of lesion under the lens of law and economics, with an economic perspective on the contract holdup doctrine. Finally, the paper concludes that there are two possible alternatives for the understanding of lesion in Brazilian law. Both alternatives have in common the need for well-defined ownership rights in the Brazilian legal system, while overcoming the interpretation set forth on Statement (Enunciado) 150 of the Brazilian Federal Justice Council or demanding legislative initiative to rewrite article 157 in order to address the issue analyzed herein. © 2022, Thomson Reuters Brasil Conteudo e Tecnologia. All rights reserved.
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The purpose of the study was to evaluate how AC dislocation epidemiology and postoperative outcomes have changed during COVID-19 pandemic, in order to take advantage of this peculiar period to better understand risk-and prognostic-factors. A retrospective analysis was performed between the patients surgically treated for acute AC dislocation between March and December of either the 2017, 2018, and 2020. Patients' characteristics and postoperative outcome was compared. Comparing the one-year Constant-Murley and DASH scores we found that COVID-19 period presented significant worst results. We found a significant decrease of rate of sport injury in COVID-19 period, and a significant increase of rate of road injury. The most common mechanisms were motorcycle accidents (23,81%) and cases of bicycle accidents (23,81%). No differences were found between age, sex, and failure rate. COVID-19 outbreak changed the epidemiology and the outcome of AC dislocation showing a strong correlation to two-wheel vehicle road accident, and a worst outcome of the patient treated during outbreak. © EuroMediterranean Biomedical Journal 2022.
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The health emergency that emerged more than a year ago known as Covid-19, which has triggered other variants, has put citizens, governments and organizations in checkmate. Trying to find or make the best decisions in this emerging case is a real challenge for everyone. In this context, the research work focuses on universities and how the training of senior managers can influence the improvement of decision making in relation to the health emergency. The objective of the study was to know the percep-tion about the importance of training for the adequa-te decision making and management of the sanitary crisis in the city of Babahoyo. Theoretical methods such as synthetic analytical, inductive deductive, historical logical and systemic were used, as well as empirical methods such as bibliographic research, survey and the IADOV technique. Government ma-nagers and specialists in charge of decision making were chosen as a sample, and as a result, an appro-ximation of the perception of the current situation in relation to the management of the health crisis was obtained. With the application of IADOV, it was found that government managers and specialists attach importance to the training of decision-makers in or-der to improve the management of this situation.
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The ESTRO vision statement for 2030 is “Radiation Oncology. Optimal Health for All, Together”. It is becoming increasingly clear that optimal health for all should include the health of caregivers, too. This is exemplified by the high level of burnout amongst radiation oncology professionals across the disciplines, as published recently by Franco et al. (1) Sadly, the COVID pandemic has had a negative impact on mental health of these professionals. (2) The young ESTRO committee (yESTRO) has aligned its activities to the ESTRO vision by setting up an ESTRO mentoring program in order to increase professional well-being for its young members. Mentorship benefits both mentor and the mentee. A review on mentorship in the medical field reported it to have an ‘important influence on personal development, career guidance, career choice, and research productivity, including publication and grant success’. (3) For mentors the benefits lie in enhancement of knowledge, leadership skills, educational skills and increased job satisfaction. With the yESTRO mentoring pilot program, yESTRO specifically aims to satisfy unmet needs for mentorship among young ESTRO members. Fifteen young members were selected as mentees based on their curriculum and personal motivation. The program had its official kickoff at ESTRO 2021 in Madrid with an onsite and an online speed dating session between mentors and mentees. Matches were made and mentor-mentee couples committed to meet at least every three months for the duration of one year. We will present the mid-term evaluation of the pilot at ESTRO 2022. The final evaluation takes place one year after the program started, after which it will be decided whether the program will continue. Yet the ambition of yESTRO is larger. This session will also provide practical advice for those considering to set up a mentoring program at their own institute. Or those seeking a mentor. In this ambition, we will be helped by the experiences shared by Daniel Portik, one of the mentees in the yESTRO mentoring program pilot.
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Rationale: The early recognition of COVID-19 patients at high risk of clinical deterioration is important to help triage, allocate resources, and improve patient care. In this study, we aimed to compare the performance of the Charlson Comorbidity Index (CCI), mSOFA, MEWS, qCSI, and PRIEST COVID-19 Clinical Severity scores in predicting risk of admission to the intensive care unit (ICU) and in-hospital mortality. Methods: This was a multicenter retrospective cohort study which included a random sample of confirmed COVID-19 patients admitted to three academic medical centers. All patients were admitted in July 2021. Patients with a positive COVID-19 polymerase chain reaction at time of admission were included. All scores were calculated within the first 24 hours of admission to the hospital. A univariate and backward multivariate logistic regression analysis were used to evaluate correlation of CCI, mSOFA, MEWS, qCSI, and PRIEST COVID-19 Clinical Severity score to the primary outcome, ICU admission, and secondary outcome, death (in-hospital). Results: One-hundred and three patients were included in this study with a median age of 59 years old (IQR 51-70). The majority were male (64.1%, n = 66) and Caucasian (81.6%, n = 84). Twenty-six patients (25.2%) required ICU admission with an in-hospital death occurring in nine patients (8.7%). In the multivariate analysis, patients admitted to the ICU were more likely to be African-American (12.96 OR;95% CI 1.49, 155.91), and of the five scores assessed, mSOFA (1.61 OR;95% CI 1.13, 2.41), MEWS (1.74 OR;95% CI 1.06, 3.09), and qCSI (1.52 OR;95% CI 1.12, 2.16) scores were associated with ICU admission. However, only mSOFA score (1.93 OR;95% CI 1.34, 3.11) was associated with in-hospital mortality. Conclusions: There are multiple scores for COVID-19 clinical deterioration that are accurate in predicting the need for ICU admission. Despite the ability to predict clinical deterioration, other scores were not associated with an increased in-hospital mortality. Interestingly, the CCI was not associated with an increased in-hospital mortality. This study provides evidence to use the mSOFA, along with other scores to accurately triage patients to a higher level of care.
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Objectives. Internal Medicine physician trainees faced unique challenges as the primary frontline physicians at a tertiary COVID-19 government referral center during the COVID-19 pandemic. This study examined the prevalence of burnout and resilience of these physician trainees during the early period of the pandemic, the determinants of burnout, and their sources of anxiety and coping mechanisms. Methods. Using a mixed-methods approach, we conducted an online cross-sectional survey to measure burnout and resilience among 196 Internal Medicine physician trainees using the Maslach Burnout Index Human Services Survey for Medical Personnel and the Connor-Davidson Resiliency questionnaires, respectively. We then conducted virtual focus group discussions and in-depth key informant interviews to explore the trainees’ sources of anxiety and coping mechanisms until thematic saturation was satisfied. Results. Out of 146 respondents (from 196 eligible participants, 74% response rate), four percent of physician trainees fit the frank burnout profile, 40% were engaged, while the majority had intermediate profiles (23% ineffective, 28% overextended, and 4% disengaged). The mean resilience score was 72.9 (SD 12.4). Resilience was a significant negative predictor for burnout (Beta Coefficient = -0.73, p<0.001). Its protective effect decreases in those with more exposure to patient deaths (Beta Coefficient = 6.767, p<0.05). Significant sources of anxiety included changes in the practice of medicine (changes in workflow, working in full personal protective equipment, telemedicine and zoom fatigue, constant threat of acquiring the infection) and having competing demands between service and training. Coping mechanisms included preserving a haven, maintaining social relationships, and self-care. Conclusion. In the largest government hospital in the Philippines, four percent of Internal Medicine physician trainees had burnout, 40% were engaged, and the majority were at-risk for burnout a few months into the COVID-19 pandemic in 2020. Resilience reduces the risk for burnout. However, its protective effect decreased with exposure to a higher number of patient deaths per week. © 2022 University of the Philippines Manila. All rights reserved.
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For the past several years, museums have widely embraced virtual exhibits - certainly before COVID-19, but especially after the virus's outbreak, which has required cultural institutions to temporarily close their physical sites to audiences. Indeed, even once these institutions reopen and the world returns to a new normal, virtual exhibits will remain a defining feature of museums: partly as a means to expand audiences, and partly as a way to increase revenue generation. This paper describes a case study in which a variety of soundscapes were presented accompanying a number of VR objects from the British Museum, in order to determine whether there was any appreciable improvement in viewer engagement with different types of soundscape. Soundscapes were created using synthesis, combinations of foley style effects, spoken word narration, and musique concrete based on a palette drawn from the International Affective Sounds Database. Participants (N=95) were asked to rate their engagement in an online experiment - engagement was highest in the foley-style soundscape condition. This work has implications for future targeted soundscape design, in order to target individual engagement and to facilitate exhibit evaluation, a field we describe as "neuro-curation". © 2021 ACM.
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Purpose or Objective A questionnaire among 543 radiation oncology (RO) professionals involved in research demonstrated that approximately half of them were forced to work full-time from home due to the COVID-19 pandemic (Dhont et al, ctRO, 2020). At the same time, those still working on location had to adjust to a new working environment. Both groups and especially early-career researchers experienced a substantial impact on mental health and work productivity. The aim of the current qualitative study was to assess in-depth the specific challenges faced by young researchers in RO and what constitutes helpful support in case of continuing or future adverse situations. Materials and Methods This study was conducted jointly by researchers in the field of RO and experts in qualitative research. Data was collected using online Focus Groups (oFGs) facilitated by qualitative research experts. Three oFGs were held with 7-11 young RO professionals (total N=25), in which data saturation was reached. Invitations to participate in the oFGs were sent out 30 days prior through the ESTRO newsletter, social media and personal networks. Inclusion criteria to participate were (1) working in RO, (2) in a European institution, and (3) with less than 10 years of research experience. Efforts were made to ensure a diverse panel. The design of the oFGs (Figure 1) comprised two main steps: (1) Deepening the understanding of experienced impacts during the COVID-19 pandemic, and (2) formulating solutions that could positively address the identified impacts. The oFGs were recorded and transcribed verbatim. Transcripts were analyzed via the qualitative analysis software Atlas (2019) through inductive coding. The coded segments were then translated into themes. $Φg Results In addition to years of research experience, seven other variables were identified as potentially impacting on the work or personal sphere in a positive and/or negative manner. In total ten main impacts were identified in the personal (2) and work sphere (8), which were either affected directly by the variables or indirectly through other impacts. It was for example found that job title could negatively impact the type of work the researcher had to perform during the pandemic, which in turn negatively impacted his/her mental health. All variables, impacts and how they relate are illustrated in Figure 2. Proposed solutions were mostly technical, illustrating that the most pressing issue was to ensure the possibility to perform one's work. Proposed solutions for social isolation (e.g. virtual social events) were often countered by the presence of “zoom fatigue”. $Φg Conclusion Different variables, their impacts and a complex interplay between them have been identified to determine how early-career RO professionals experienced working during the COVID-19 pandemic. Beyond technical solutions to enable remote working, the distinct personal situations must be considered when proposing solutions to support mental health in these situations.
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The analysis of the measuring accuracy of coordinate measuring machines (CMMs), requires a profound knowledge about the existing error sources. In this work a new error index named equivalent error (EE) was defined to facilitate the evaluation of CMM performance, and an EE-based stochastic model for predicting the CMM measuring accuracy was proposed. The present study was focused on the analysis of position, straightness and part errors, and 3-axis CMMs with FXYZ structural configuration. Both a traditional method with separate error sources and this new EE-based model have been applied. The EE-based model was proved to enhance the modelling of CMM measuring accuracy from the position, straightness and part errors, and to be helpful for industrial applications such as the dimensional verification of manufactured products. A remarkable improvement of a 19.69% was achieved in the linear modelling of CMM performance by the EE-based model in comparison with a traditional method.
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In this work, β-cyclodextrin (β-CD) based inclusion complexes containing curcumin (CURC), a yellow pigment from Curcuma longa plants, were obtained through the Supercritical AntiSolvent (SAS) process. Curcumin has been widely used for its antioxidant, antimicrobial, antibiotic and antiviral properties. Recently, curcumin has been proposed as a potential treatment option for patients with coronavirus disease (CoVID-19). In order to protect the active compound, the supercritical antisolvent process was used, to induce the formation of inclusion complexes using β-CD as the carrier. The effect of different parameters, such as pressure, overall concentration of solutes in the liquid solution, and CURC/β-CD molar ratio, on the morphology and size of the composite particles, was investigated. Well-defined microparticles at 1/1 and 1/2 CURC/β-CD molar ratios were produced. The dissolution rate curve of the obtained inclusion complexes was compared to the one of the unprocessed CURC. Copyright © 2021, AIDIC Servizi S.r.l.
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Burnout is a longstanding problem for years, and the Covid-19 pandemic has exacerbated the problem. In a survey of NEJM Catalyst Insights Council members in October 2020, 70% of respondents say that they anticipate health care provider burnout at their organization will get worse in the next two to three years, a period in which Covid-19's impact is likely to be greatly reduced (Weiner 2021). Only 9% say they expect things will get better, the data suggests that burnout will continue unless comprehensive organizational and systemic changes are made. According to responses from Insights Council members (Weiner 2021) who are clinicians, clinical leaders, and executives at organizations around the world that are directly involved in care delivery, phy sicians (according to 90% of respondents), nurses (89%), and advanced practice providers (79%) have more serious or moderate problems with burnout than do clinical leaders (58%) or executives (43%). The psychological traumatic impact of COVID-19 in frontline and non-frontline health care provider is a great issue, as emerged by almost all world studies (Kang et al., 2020;Tan et al., 2020). Particularly, being female, younger, a frontline worker, a nurse, having less work experience, exposure to infected people, poor social support, difficult access to psychological material, insomnia and physical symptoms are all risk factors for traumatic symptoms.(Chew et al., 2020;Kang et al., 2020). According to Insights Council members, the top two factors driving burnout are administrative burden and infrastructure, which includes information technology such as electronic medical records. These are well-known contributors to burnout, and they continue to be resistant The top three manifestations in the survey that increased due to Covid-19 are anxiety and sadness, isolation, and difficulty concentrating (Romeo et al. 2020;Shah et. al. 2020.). A clinical leader writes, I think the biggest factor that drives burnout in physicians is the lack of autonomy/ control over our lives. The second biggest factor is the way the administrative tasks of medicine have fallen to clinicians. In what other field does IT decrease productivity? Only 5% of respondents say there is no way to mitigate Covid-19 burnout other than to wait for a vaccine, showing that 95% think that burnout can be remedied to some degree. A higher incidence of executives (69%) and clinical leaders (64%) than clinicians (54%) indicate teamwork and coordinated care as top ways to mitigate burnout. Burnout is a syndrome resulting from chronic work-related stress, which consists of three sequential components: emotional exhaustion, depersonalisation, and low personal accomplishment. Burnout is negatively correlated to professional quality of life (QoL) and has been linked to reduced quality of care, more errors, job withdrawal, and absenteeism (Shanafelt et al. 2020), so, the organization should focus on fixing the system that is causing the burnout. This includes reducing administrative overhead, creating a team structure to help distribute the tasks, so the physician is not the one burdened and to reduce the overall burden. The literature suggests that people exposed to trauma can experiment with positive responses, reconsidering their values and appreciating their lives more as well as their work in emergency situations. These aspects can be fostered by psychological interventions (Brooks et al., 2020). Personal characteristics may play a key role in determining how individuals react and deal with stressful situations, as it may be the case for oncologists in radiation oncology. Among these factors, there is growing evidence that difficulties in adequately recognizing one's own emotions (i.e. alexithymia) are associated with a variety of interpersonal issues, including social isolation and maladaptive behaviours. Alexithymic individuals typically show limited capacity to process emotional information, with resulting difficulties in identifying, understanding, and expressing their own feelings. In the working environment, t ese characteristics may lead to difficulties in coping with highly stressful and challenging situations, which in turn may increase the risk of occupational burnout for the individuals themselves. Similarly, empathy, defined as the ability to experience and understand what others feel without confusing oneself with others (Franco et.al., 2020), is a core dimension of social functioning, enabling individuals to understand, share, and respond to the emotions, gestures, thoughts, and experiences of others. Growing evidence suggests a potential direct link between empathy and burnout. For instance, it has been shown that empathy was positively associated with personal accomplishment, but inversely related to burnout in a group of medical students. Based on these observations, the PROject on Burn-Out in RadiatioN Oncology (PRO BONO) was carried out to assess the professional QoL, including burnout, amongst radiation oncology professionals and to explore the potential relationships with alexithymia and empathy (Franco et.al.,2020). The current findings highlight the importance of enhancing emotional competencies, in order to promote the positive dimensions of professional QoL and reduce the levels of distress and burnout experienced in the clinical practice. Dyadic (one-to-one) peer or group (Balint group) support could be a useful option in this context, to enhance emotional, informational and practical functioning of the professional, with assistance provided by a peer trained supporter.
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INTRODUCTION: Frontline healthcare workers who perform aerosol-generating procedures (AGP) are at increased risk of exposure to SARS-CoV-2 causing COVID-19. In order to continue to care for patients with COVID-19, minimizing exposure is paramount and barrier devices are potentially the answer. Using an intubation manikin with two different barrier devices (Plexiglas intubation box and a modified horizontal drape), we evaluated the operators' experience and satisfaction with these two devices and no device METHODS: This was a single-center study that prospectively intubated a manikin three different ways, no device, Plexiglas intubation box, and horizontal drape (Snaport). Each operator completed a survey about ease of use, likelihood to use each device in the future, and any comments following all three intubations. A separate survey was sent to all providers that perform intubations in the hospital about using barrier devices while intubating RESULTS: Fifty-six participants completed the pre-survey. The majority had not previously used a barrier during AGP (64.3%), during bronchoscopy (88.5%), or transporting a patient (87.5%). Most participants would use Snaport during an AGP (85.7%) Thirty participants completed barrier testing and post-survey. The average age was 39.7 years, average years in practice 11.5, and with an average of 22.6 intubations per month. There were no intubation failures. First pass intubation success was achieved for all except for one with Snaport and two with the Plexiglas intubation box. On average, participants found that it was ?easy? to intubate with Snaport (2.3, range 1-5), that it provided enough visibility during intubation (2.8, range 1-3), and did not hinder maneuverability (1.7, range 1-2). Eighteen participants preferred Snaport (60%), seven preferred the Plexiglas box (23%), three preferred to use nothing (10%), and one participant preferred to use Snaport only if the arm slits were redesigned to allow more maneuverability CONCLUSIONS: Snaport was the provider preferred method of barrier protection for intubation. Most participants felt it provided enough visibility without compromising maneuverability. The materials to assemble Snaport are inexpensive and the design is easy to assemble. Snaport is a good option in resource-limited healthcare settings.
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The pandemic generated by COVID-19 has led to the implementation of policies aimed at social isolation. However, there are always people who do not comply with established policies, requiring police intervention. Criminal law establishes that offenders are brought before a judge of criminal guarantees to resolve their legal situation. The objective of this research is to carry out a study on legitimate decisions of the competent authority in the health emergency caused by COVID-19 in Ecuador. A method for recommending the application of legitimate decisions is presented. © 2020, University of Cienfuegos, Carlos Rafael Rodriguez. All rights reserved.
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PURPOSE: Pulmonary embolism (PE) in COVID-19 patients can play a key role in precipitating clinical conditions. We aimed to evaluate PE distribution on CTA and to investigate any possible association with D-dimer (DD), pulmonary stage of disease and prognosis. METHOD: COVID-19 patients of two affiliated Hospitals, undergone a CTA examination for PE suspicion, were retrospectively enrolled. Comorbidities, laboratory tests and clinical outcomes (hospitalization, discharge, death) were assessed. A parenchymal stage (early, progressive, peak, absorption) for lung involvement was assigned. RESULTS: A cohort of 114 patients (mean age 61 years; 26.3 % females) with severe COVID-19 pneumonia were evaluated. At last follow-up 25 (21.9 %) were hospitalized, 72 (63.2 %) discharged, 17 (14.9 %) dead. Eighty-eight patients (77.2 %) had at least one comorbidity, being cardiovascular ones the most frequent (44.7 %). CTA revealed PE in 65 patients (57 %), with concomitant pulmonary trunk and/or main arteries involvement in 16.9 %. PE defects were ubiquitous in 18.5 % of cases. The predominant parenchymal stages were the progressive (24.6 %) and peak (67.7 %). DD levels showed a significant correlation with PE occurrence and extent in pulmonary branches, despite anticoagulant therapies; trend of correlation with pulmonary stages was also noted. CONCLUSIONS: PE is a frequent complication in severe COVID-19 patients, particularly during central parenchymal stages and despite ongoing anticoagulant therapy. CTA and DD levels play a crucial role in the assessment of suspected PE, despite anticoagulant therapies, along with proper information about lung involvement extent.