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SESSION TITLE: Acute COVID-19 and Beyond: from Hospital to Homebound SESSION TYPE: Original Investigations PRESENTED ON: 10/18/2022 02:45 pm - 03:45 pm PURPOSE: In-hospital cardiac arrest (IHCA) has been reported to be as high as 75%, with pooled worldwide case fatality rates (CFR) of COVID-19 patients in the ICU estimated as 37%. To our knowledge, there has not been any systematic reviews specifically investigating world-wide survival outcomes of intubated COVID-19 adult patients who undergo IHCA and receive cardiopulmonary resuscitation (CPR). The aim of our study was to evaluate the outcomes of such patients up until hospital discharge. METHODS: A systematic literature search using relevant keywords was performed for original articles published in Embase, Medline and Pubmed Central databases from 2019 to February 6 2022. Patients aged 18 and older who had COVID-19 and were intubated prior to undergoing cardiac arrest were included. Extracted data were summarized in a table showing publication details and country, study designs, total sample size, comorbidities, age, gender, initial cardiac rhythm during cardiac arrest, initial survival after CPR and survival outcomes up until discharge. STATISTICAL ANALYSIS We performed descriptive statistics using Microsoft Excel. Where applicable, measures such as mean, frequency, proportion and range were used. Case fatality rate was also calculated. Methological quality was assessed using Joanna Briggs Institute (JBI) critical appraisal tools. Interrater accuracy and reliability were assessed using Cohen’s kappa. RESULTS: We screened 912 deduplicated articles, of which 38 studies met our criteria for final inclusion. There were 230 total patients, of which 174 patients (75.7%) were intubated. Out of those, 161 patients (70%) underwent CPR and only 4 survived. CFR defined as total number of intubated COVID-19 patients who underwent CPR and died (n= 157) divided by total number of intubated COVID-19 patients who underwent CPR (n=161) was calculated to be 97.5% (95% Cl: 95.1 – 99.92%). Mean age of intubated COVID-19 patients who underwent CPR was 54 years, with 27.5% being females and 72.5% males. The most reported comorbidities of intubated COVID-19 patients who underwent CPR were hypertension (37.5%), diabetes (30%), prior lung pathology (17.5%), obesity(7.5%), hyperlipidemia (5%), stroke (5%), Coronary Artery Disease (CAD) (2.5%). CONCLUSIONS: Our CFR were higher than has been previously recorded for ICU patients with COVID-19. This suggests that COVID-19 patients on mechanical ventilation who deteriorate to the point of going into cardiac arrest are a particularly vulnerable population, and CPR in this subset of COVID-19 patients may be nearly futile. More studies are needed to investigate preventive and management strategies to mitigate such poor outcomes. CLINICAL IMPLICATIONS: Knowledge of survival outcomes in intubated COVID-19 adult patients can help facilitate early plan of care discussions given the limited resources many hospitals experienced during the pandemic. DISCLOSURES: No relevant relationships by Stephen Avera No relevant relationships by Marshaleen Henriques King No relevant relationships by Sorochi Iloanusi No relevant relationships by Chinedu Ivonye No relevant relationships by Ifeoma Ogbuka No relevant relationships by Titilope Olanipekun
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BACKGROUND: The ACGME requires internal medicine residents to engage in research during residency and present their findings in a scientific setting as one of the requirements for training completion. The ongoing COVID-19 pandemic has significantly impacted medical residency education globally, and there is limited data on the effect of the pandemic on scholarly productivity among internal medicine residents METHODS: We collected socio-demographic data of participants and responses on research activities during residency training before and during the pandemic. We assessed the perceived impact of the COVID-19 pandemic on scholarly productivity by asking the respondents to report if there has been an 'increase', 'decrease', or 'no change' in scholarly output comparing prepandemic and during the COVID-19 pandemic period. Respondents who reported decreased scholarly output were asked to provide reasons for the decline and suggest ways to improve scholarly productivity during pandemics. RESULTS: A total of 68 residents completed the survey which corresponds to a response rate of 85%. The mean age group was 30-34 years and 51% of the participant were females. Of the total number of respondents, 43% reported a decline in the number of publications during the COVID-19 pandemic compared to the pre-pandemic period. About 26% responded that the pandemic has had a negative impact on their level of participation in scientific conferences due to the cancellation of most in-person scientific conferences in compliance with social distancing and pandemic restrictions. More females reported a decline in scholarly productivity due to a combination of burnout from the pandemic and competing family commitments. CONCLUSIONS: In this survey, a significant proportion of residents of an academic internal medicine residency program reported a decline in research and scholarly productivity due to the COVID-19 pandemic. Burnout, loss of morale, and insufficient time due to competing domestic duties were the major contributory factors. Female residents were more affected due to burnout and challenges from having to strike a balance between their training and family duties. More research electives during training, more time to focus on mental health, dedicated faculty to mentor residents on research, and providing support for female residents to cope with domestic responsibilities may improve scholarly productivity during pandemics.
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SETTING AND PARTICIPANTS: Residents of an Academic Medicine Resident Program (81 residents) - Morehouse School of Medicine, Atlanta, GA. DESCRIPTION: Journal clubs are an integral part of internal medicine residency education. Residents are mandated to participate in journal clubs to critically assess medical literature, epidemiology, and biostatistics as part of the accreditation requirements. However, studies show that the journal club activities have not been sufficient in improving scholarly productivity among residents often due to lack of specific goals and inability to sustain residents' interest and participation. At our institution, a resident-led research initiative called journal café (JC) was set up in the 2013/2014 academic year to increase the participation of residents in research and foster a culture of evidence-based clinical practice. Membership and participation in the journal café are voluntary. The JC runs independently of the mandatory residency journal club. JC members form different working groups based on shared research interests and meet on the last Friday of each month for 1 hour to discuss proposed research projects, critique scientific peer-reviewed publications, learn about research designs, epidemiology, and statistical analysis. EVALUATION: We evaluated the impact of the JC by conducting a survey of the internal medicine residents at our institution to compare research productivity between journal café members (29) and non-members (39). Research activities were categorized into two groups: 1. Published s and body of manuscripts in peer-reviewed scientific journals;2. Presentation of research work (oral or poster) at scientific meetings. The research publications and presentations were verified using research search engines. The majority of JC members were in post-graduate year 2. JC members were more likely to be interested in pursuing subspecialty fellowship training after residency (79% vs. 23%). The mean (SD) number of research publications among members of journal café was 7.3 (3.1) compared to 3.5 (2.6) among non-members. Likewise, JC members had a higher average number of research presentations at scientific conferences (6.6, SD 3.7 vs. 2.7, SD 2.1). On COVID19 related research, half of the respondents (n=35/68) reported conducting COVID-19 related research out of which 22 (63%) were JC members and 13 (37%) non-JC members. JC members were also more likely to publish COVID19 related research in peer-reviewed journals (68% vs 32%, n=19). DISCUSSION / REFLECTION / LESSONS LEARNED: A resident-led research initiative (Journal cafe) at an academic internal medicine residency program improves scholarly activity and boosts COVID-19 pandemic-related research productivity. The JC gives residents the opportunity to work together based on shared research interests which likely improved commitment and research productivity. Resident-led research clubs supported by the residency program may complement the traditional journal clubs and enhance residents' participation in research.