ABSTRACT
Introduction: SARS-CoV-2 is responsible for the current global pandemic. SARS-CoV-2 infection underlies the novel viral condition coronavirus disease 2019 (COVID-19). COVID-19 causes significant pulmonary sequelae contributing to serious morbidities. The pathogenesis of COVID-19 is complex with a multitude of factors leading to varying levels of injury numerous extrapulmonary organs. This review of 124 published articles documenting COVID- 19 autopsies included 1,142 patients. Method(s): A PubMed search was conducted for COVID-19 autopsy reports published before March 2021 utilizing the query COVID-19 Autopsy. There was no restriction regarding age, sex, or ethnicity of the patients. Duplicate cases were excluded. Findings were listed by organ system from articles that met selection criteria. Result(s): Pulmonary pathology (72% of articles;866/1142 patients): diffuse alveolar damage (563/866), alveolar edema (251/866), hyaline membrane formation (234/866), type II pneumocyte hyperplasia (165/866), alveolar hemorrhage (164/866), and lymphocytic infiltrate (87/866). Vascular pathology (41% of articles;771/1142 patients): vascular thrombi (439/771)-microvascular predominance (294/439)-and inflammatory cell infiltrates (116/771). Cardiac pathology (41% of articles;502/1142 patients): cardiac inflammation (186/502), fibrosis (131/502), cardiomegaly (100/502), hypertrophy (100/502), and dilation (35/502). Hepatic pathology (33% of articles;407/1142 patients): steatosis (106/402) and congestion (102/402). Renal pathology (30% of articles;427/1142 patients): renal arteries arteriosclerosis (111/427), sepsis-associated acute kidney injury (81/427) and acute tubular necrosis (77/427). Conclusion(s): This review revealed anticipated pulmonary pathology, along with significant extrapulmonary involvement secondary to COVID-19, indicating widespread viral tropism throughout the human body. These diverse effects require additional comprehensive longitudinal studies to characterize short-term and long-term COVID-19 sequelae and inform COVID-19 treatment.
ABSTRACT
Introduction: Critical care outreach teams (CCOT) provide an outward facing service for critical care, supporting acutely unwell patients on the wards. During the last two surges of the coronavirus (Covid-19) pandemic, CCOTs played a pivotal role in providing support to ward teams. This was particularly in respect to the management of acute non-invasive respiratory support, which was being delivered outside of Critical Care areas at a scale not previously seen in the United Kingdom. Objectives: We describe the structure, role and effect of a newly created South London Network (SLCCON) in supporting CCOT teams from different hospitals with these challenges. Methods: SLCCON The SLCCON was established in June 2019, and it comprises of 25 individuals, both nurses and doctors. The SLCCON represents seven hospitals within South London, including both district generals and larger tertiary referral hospitals. The aim of the network was to explore the opportunities for collaborative working and standardisation of CCOT service delivery. Survey: A cross-sectional, anonymous online survey (SurveyPlanet), containing 13 mixed questions, was emailed to all members of the SLCCON (n=25). The aim of the survey was to understand the impact of the network on individual and team experience. Questions were generated by two senior team members in consultation with CCOT leads from one other hospital. The survey was emailed in August 2021 with one reminder emailed at two weeks. Results: Out of 14 (56%) respondents who completed the survey, 8 (57%) were service leads and 6 (43%) were team members. Eleven (79%) respondents had attended network meetings, and of these, 11 (100%) thought the network meetings had been useful in providing peer support. The main perceived benefits of the network were opportunities to collaborate with colleagues and the sharing of practice (Figure 1). In addition, respondents perceived access to guidelines from other hospitals and advice on maintaining patient safety during the pandemic to be the most important support received from the network (Figure 2). All participants expressed a wish for the network to continue. Respondents suggested further potential going forwards to share and standardise data collection and practice, and to collaborate on publications and the delivery of education. Discussion: Despite the relatively low number of responses, the results indicate a positive impact of the SLCCON. The opportunity to share practice and the provision of important wellbeing and peer support during a period of extreme pressure and stress, demonstrates the importance of the network. The future of SLCCON was associated with educational, research and data sharing opportunities.
ABSTRACT
Background. Rescue ECMO has been used worldwide in patients (pts) with ARDS caused by COVID-19. Bacterial super-infections affect 3.5-14.3% of hospitalized pts with COVID-19. Pts requiring ECMO may be at an increased risk of infection due to their severity of illness, gut translocation and ECMO impact on host immunity. Methods. This was a retrospective review of pts requiring ECMO for COVID-19 from April 2020-2021 at a single center. Strict definitions of infections (including ventilator-associated PNA, VAP) were in accordance with CDC criteria. Results. 43 ECMO pts with 1065 ECMO days were evaluated. Median age was 53 yrs (range: 21-62) and median BMI was 36.2 (range: 19.4-75.8). 70% were men and 65% were white. 37 patients (86%) experienced a total of 40 infectious episodes with a median onset from ECMO cannulation to first infection of 10.5d (range: 4-50). Median SOFA and SAPSII scores at time of infection were 12 (6-20) and 63 (30-90), respectively. PNA was the most common infection (78%, with 19% of cases complicated by bacteremia and 3% by empyema) (Fig. 1). The most common organisms isolated were Enterobacterales (37%), S. aureus (25%) and P. aeruginosa (16%) (Fig. 2). Only 2% of all organisms were multi-drug resistant. 3 pts had fungal infections (1 candidemia, 2 aspergillus PNA). Duration of ECMO was significantly longer for infected pts (26d, range: 5-92d) vs (11d, range: 3-24d), p=.01. 95% of infected pts had received steroids vs. 67% of uninfected pts, p=0.09. Treatment success at 1 week was 50%, and 24% and 40% of pts had recurrent infections and persistent/recurrent organisms in clinical cultures, respectively. S. aureus (54%) and Enterobacterales (26%) were associated with persistent or recurrent clinical cultures, requiring prolonged antimicrobial therapy. Mortality rate at 30 days was 65% and was significantly higher for pts with infection than those without (67% vs 33%, p=.02). Conclusion. Super-infection (most commonly PNA) occurred in almost all COVID-19 pts requiring ECMO for >4 days, and was a significant risk factor for death. Recurrent infections among survivors were common, especially when caused by Enterbacterales or S. aureus. Super-infection and mortality rates of ARDS pts on ECMO for COVID-19 were worse than for ARDS pts on ECMO for influenza at our center.