Impact of VieScope® on first-attempt success during simulated COVID-19 patients intubation: A randomized cross-over simulation trial.

BACKGROUND: The purpose of our study was to determine the efficacy of intubation with VieScope® and Macintosh laryngoscope in different scenarios of simulated COVID-19 patients by paramedics wearing personal protective equipment (PPE) for aerosol gener-ating procedures (AGPs). METHODS: Study was designed as a prospective, observational, randomized, crossover simulation trial. 37 paramedics took part in the study. They performed endotracheal intubation (ETI) of a person suspected of COVID-19. Intubation was performed using VieS-cope® and Macintosh laryngoscopes in two research scenarios: Scenario A - normal airway and Scenario B - difficult airway. Both the order of participants and the methods of intubation were random. RESULTS: In Scenario A, time to intubation using VieScope® and Macintosh laryngoscope amounted to 35.3 (IQR; 32-40) seconds and 35.8 (IQR: 30-40)s, respectively. Nearly all participants performed ETI successfully both with VieScope® and Macintosh laryngo-scope (100% vs. 94.6%). In scenario B, intubation with the VieScope®, compared to the Macintosh laryngoscope, was associated with a shorter intubation time (p<0.001), a higher success rate of the first intubation attempt (p<0.001), a better visualization degree glottis (p=0.012) and ease of intubation (p<0.001). CONCLUSION: Our analysis suggests that the use of a VieScope® compared to Macintosh laryngoscope in difficult airway intuba-tion performed by paramedics wearing PPE-AGP is associated with shorter intubation times, greater intubation efficiency as well as better visualization of the glottis. Additional clinical trials are necessary to confirm the obtained results.

The effect of zinc supplementation on the course of COVID-19 - A systematic review and meta-analysis.

INTRODUCTION AND OBJECTIVE: Zinc is a trace element that plays a role in stimulating innate and acquired immunity. The aim of the study was to determine the antiviral effect of the administration of zinc in COVID-19 patients. MATERIAL AND METHODS: A literature search was performed in P Web of Science, PubMed, Scopus and Cochrane databases from 1 January 2020 - 22 August 2022. In addition, reference lists of the included articles and their related citations in PubMed were also reviewed for additional pertinent studies. RESULTS: A total of 9 eligible studies were identified. In-hospital mortality in zinc supplementation patients, and patients treated without zinc, varied and amounted to 21.6% vs. 23.04% difference (OR=0.71; 95%CI: 0.62-0.81; p<0.001). 28-day to 30-day mortality in patients treated with zinc was 7.7%, compared to 11.9% for patients treated without zinc (OR=0.61; 95%CI: 0.35-1.06; p=0.08). In-hospital adverse events among patients treated with and without COVID-19 did not show any statistically significant differences in relation to acute kidney injury occurrence (12.8% vs. 12.4%, respectively; OR=0.63; 95%CI: 0.19-2.12; p=0.45, as well as need for mechanical ventilation (13.2% vs. 14.1%; OR=0.83; 95%CI: 0.52-1.32; p=0.43). CONCLUSIONS: Zinc supplementation is associated with lower COVID-19 in-hospital mortality. Additionally, it is risk-free in COVID-19 patients since there have been no negative side effects, such as acute renal damage or the requirement for mechanical ventilation compared to patients without COVID-19. Due to scientific evidence and the role it represents in the human body, zinc supplementation should be taken into consideration for COVID-19 patients as an adjunct therapy.

The Impact of COVID-19 on Pediatric Cardiac Arrest Outcomes: A Systematic Review and Meta-Analysis.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused a global pandemic, required the donning of personal protective equipment during clinical contact, and continues to be a significant worldwide public health concern. Pediatric cardiac arrest is a rare but critical condition with a high mortality rate, the outcomes of which may be negatively affected by donning personal protective equipment. The aim of this study is to perform a systematic review and meta-analysis of the impact of the COVID-19 pandemic on pediatric cardiac arrest outcomes. We conducted a systematic review with meta-analysis in the following databases: PubMed, EMBASE, Scopus, Web of Science, and Cochrane Library from their inception to 1 October 2022. We included studies published in English on pediatric patients with cardiac arrest, dichotomized by the pre- and during-COVID-19 periods and then stratified by COVID-19 positive or negative status, to evaluate clinical outcomes associated with cardiac arrest. Six studies were included in the meta-analysis. In witnessed out-of-hospital cardiac arrest patients, there were no differences between the pandemic and pre-pandemic periods for witnessed cardiac arrest (28.5% vs. 28.7%; odds ratio (OR) = 0.99; 95% confidence interval (CI): 0.87 to 1.14; p = 0.93), administration of bystander cardiopulmonary resuscitation (61.5 vs. 63.6%; OR = 1.11; 95%CI: 0.98 to 1.26; p = 0.11), bystander automated external defibrillator use (both 2.8%; OR = 1.00; 95%CI: 0.69 to 1.45; p = 0.99), return of spontaneous circulation(8.4 vs. 8.9%; OR = 0.93; 95%CI: 0.47 to 1.88; p = 0.85), survival to hospital admission (9.0 vs. 10.2%, OR = 0.81; 95%CI: 0.45 to 1.44; p = 0.47), or survival to hospital discharge (13.4 vs. 12.4%; OR = 0.62; 95%CI: 0.22 to 1.72; p = 0.35). COVID-19 did not change pediatric cardiac arrest bystander interventions or outcomes.

Systematic review with meta-analysis of mid-regional pro-adrenomedullin (MR-proadm) as a prognostic marker in Covid-19-hospitalized patients.

BACKGROUND: Mid-regional pro-adrenomedullin (MR-proADM) is useful for risk stratification in patients with sepsis and respiratory infections. The study's purpose was to assess the available data and determine the association between MR-proADM levels and mortality in COVID-19 participants. METHODS: A comprehensive literature search of medical electronic databases was performed including PubMed, Web of Science, Scopus, Cochrane, and grey literature for relevant data published from 1 January 2020, to 20 November 2022. Mean differences (MD) with 95% confidence intervals (CI) were calculated. RESULTS: Fourteen studies reported MR-proADM levels in survivors vs. non-survivors of COVID-19 patients. Pooled analysis showed that MR-proADM level in the survivor group was 0.841 ± 0.295 nmol/L for patients who survive COVID-19, compared to 1.692 ± 0.761 nmol/L for non-survivors (MD = -0.78; 95%CI: -0.92 to -0.64; p < 0.001). CONCLUSIONS: The main finding of this study is that mortality of COVID-19 is linked to MR-proADM levels, according to this meta-analysis. The use of MR-proADM might be extremely beneficial in triaging, assessing probable therapy escalation, predicting potential complications during therapy or significant clinical deterioration of patients, and avoiding admission which may not be necessary. Nevertheless, in order to confirm the obtained data, it is necessary to conduct large prospective studies that will address the potential diagnostic role of MR-proADM as a marker of COVID-19 severity.KEY MESSAGESSeverity of COVID-19 seems to be linked to MR-proADM levels and can be used as a potential marker for predicting a patient's clinical course.The use of MR-proADM might be beneficial in triaging, assessing probable therapy escalation, predicting potential complications during therapy or significant clinical deterioration of patients, and avoiding admission which may not be necessary.For patients with COVID-19, MR-proADM may be an excellent prognostic indicator because it is a marker of endothelial function that may predict the precise impact on the equilibrium between vascular relaxation and contraction and lowers platelet aggregation inhibitors, coagulation inhibitors, and fibrinolysis activators in favor of clotting factors.

Prediction Value of KREBS Von Den Lungen-6 (KL-6) Biomarker in COVID-19 Patients: A Systematic Review and Meta-Analysis.

The SARS-CoV-2 (COVID-19) pandemic is a major issue that necessitates the use of cutting-edge disease prediction models. The aim of the study was to assess the existing evidence regarding association between Krebs von den Lungen-6 levels and COVID-19 severity. A literature search was performed on Web of Science, PubMed, Scopus and Cochrane Central Register of Controlled Trials databases from 1 January 2020 up to 2 August 2022. The electronic database search was supplemented by searching Google Scholar. In addition, reference lists of relative articles were also reviewed. KL-6 levels among COVID-19 positive vs. negative patients varied and amounted to 443.37 ± 249.33 vs. 205.73 ± 86.8 U/mL (MD = 275.33; 95%CI: 144.57 to 406.09; p < 0.001). The KL-6 level was 402.82 ± 261.16 U/mL in the severe group and was statistically significantly higher than in the non-severe group (297.38 ± 90.46 U/mL; MD = 192.45; 95%CI: 118.19 to 266.72; p < 0.001). The KL-6 level in the mild group was 272.28 ± 95.42 U/mL, compared to 268.04 ± 55.04 U/mL in the moderate COVID-19 group (MD = -12.58; 95%CI: -21.59 to -3.57; p = 0.006). Our meta-analysis indicates a significant association between increased KL-6 levels and SARS-CoV-2 infection. Moreover, KL-6 levels are significantly higher in patients with a more severe course of COVID-19, indicating that KL-6 may be a useful predictor to identify patients at risk for severe COVID-19.

Prognostic Performance of Cystatin C in COVID-19: A Systematic Review and Meta-Analysis.

Cystatin C is a specific biomarker of kidney function. We perform this meta-analysis to determine the association of Cystatin C with the COVID-19 severity. In this systematic review and meta-analysis, we searched PubMed, EMBASE, Cochrane library, and Web of Science for studies published until 2nd September 2022 that reported associations between Cystatin C levels and COVID-19 severity. The analysis was performed using a random-effects model to calculate pooled standard mean difference (SMD). Twenty-five studies were included in the meta-analysis. Pooled analysis showed statistically significant differences of Cystatin C levels among survive vs. decreased patients (0.998 ± 0.225 vs. 1.328 ± 0.475 mg/dL, respectively; SMD = -2.14; 95%CI: -3.28 to -1.01; p < 0.001). Cystatin C levels in COVID-19 severe vs. non-severe groups varied and amounted to 1.485 ± 1.191 vs. 1.014 ± 0.601 mg/dL, respectively (SMD = 1.81; 95%CI: 1.29 to 2.32; p < 0.001). Additionally, pooled analysis showed that Cystatin C levels in patients with acute kidney injury (AKI) was 1.562 ± 0.885 mg/dL, compared to 0.811 ± 0.108 mg/dL for patients without AKI (SMD = 4.56; 95%CI: 0.27 to 8.85; p = 0.04). Summing up, Cystatin C is a potentially very good marker to be used in the context of COVID-19 disease due to the prognosis of patients' serious condition, risk of AKI and mortality. In addition, Cystatin C could be used as a marker of renal complications in COVID-19 other than AKI due to the need to monitor patients even longer after leaving the hospital.