Transthoracic echocardiography outcomes in critical COVID-19 and association with symptom burden - a longitudinal cohort study

Objective: To look for any relationship between severe/critical coronavirus disease 2019 (COVID-19) illness and post-discharge cardiac function, and also assess any correlation between this and post-COVID symptom burden. Design: Observational cohort study with both retrospective and prospective components. Setting: Intensive Care Unit (ICU) and subsequent outpatient clinic at a tertiary hospital in Western Sydney, New South Wales (NSW), Australia. Patients: All patients admitted to the ICU with COVID-19 infection between 01 July 2021 and 31 December 2021 were included (n=89). Interventions: The cohort was divided into survivors (n=61) and non-survivors (n=28). Those who underwent transthoracic echocardiography (TTE) (survivors, n=22;and non-survivors, n=23). The survivors who had an inpatient TTE were invited back for a repeat TTE and standardised symptom assessment questionnaire (COVID-19 Yorkshire Rehabilitation Scale [C19-YRS]). For all patients, demographic, clinical, biochemical, and pharmacologic data was collected. Measurements and results: Eighty-nine patients were included in the initial dataset, of which 45 had a TTE whilst acutely unwell, and 22/45 survived to hospital discharge. There were no significant differences in the measured TTE parameters between survivors and non-survivors. Of the survivors with a follow-up TTE, the majority of the changes seen in the initial study had resolved. Despite this, there was still an appreciable symptom burden in the domains of fatigue, breathlessness, ability to independently do activities of daily living, and overall reduced perception of health. Conclusions: In a cohort of critically unwell COVID-19 patients, there were no significant echocardiographic differences between survivors and non-survivors. For the survivors, whilst the majority of acute cardiac changes associated with COVID-19 infection resolved over time, however, there remained a significant symptom burden, including breathlessness and fatigability, suggesting a non-cardiac aetiology of these symptoms.

Emergency department presentations during the COVID-19 pandemic in Queensland (to June 2021): interrupted time series analysis.

OBJECTIVES: To assess emergency department (ED) presentation numbers in Queensland during the coronavirus disease 2019 (COVID-19) pandemic to mid-2021, a period of relatively low COVID-19 case numbers. DESIGN: Interrupted time series analysis. SETTING: All 105 Queensland public hospital EDs. MAIN OUTCOME MEASURES: Numbers of ED presentations during the COVID-19 lockdown period (11 March 2020 - 30 June 2020) and the period of easing restrictions (1 July 2020 - 30 June 2021), compared with pre-pandemic period (1 January 2018 - 10 March 2020), overall (daily numbers) and by Australasian Triage Scale (ATS; daily numbers) and selected diagnostic categories (cardiac, respiratory, mental health, injury-related conditions) and conditions (stroke, sepsis) (weekly numbers). RESULTS: During the lockdown period, the mean number of ED presentations was 19.4% lower (95% confidence interval, -20.9% to -17.9%) than during the pre-pandemic period (predicted mean number: 5935; actual number: 4786 presentations). The magnitudes of the decline and the time to return to predicted levels varied by ATS category and diagnostic group; changes in presentation numbers were least marked for ATS 1 and 2 (most urgent) presentations, and for presentations with cardiac conditions or stroke. Numbers remained below predicted levels during the 12-month post-lockdown period for ATS 5 (least urgent) presentations and presentations with mental health problems, respiratory conditions, or sepsis. CONCLUSIONS: The COVID-19 pandemic and related public restrictions were associated with profound changes in health care use. Pandemic plans should include advice about continuing to seek care for serious health conditions and health emergencies, and support alternative sources of care for less urgent health care needs.

The first Australian experience with ward-based continuous positive airway pressure for COVID-19 respiratory failure: a retrospective cohort study.

We present the first Australian cohort of patients with COVID-19 respiratory failure managed with escalating respiratory support including continuous positive airway pressure (CPAP) on a standard medical ward at a tertiary Sydney hospital during the 2021 COVID-19 Delta variant outbreak. We demonstrate an equivalent mortality to CPAP delivered in intensive care unit and outline our ward structure and management during the pandemic.