ABSTRACT
In this single-center observational study with 1,206 participants, we prospectively evaluated SARS-CoV-2-antibodies (anti-S RBD) and vaccine-related adverse drug reactions (ADR) after basic and booster immunization with BNT162b2- and ChAdOx1-S-vaccines in four vaccination protocols: Homologous BNT162b2-schedule with second vaccination at either three or six weeks, homologous ChAdOx1-S-vaccination or heterologous ChAdOx1-S/BNT162b2-schedule, each at 12 weeks. All participants received a BNT162b2 booster. Blood samples for anti-S RBD analysis were obtained multiple times over a period of four weeks to six months after basic vaccination, immediately before, and up to three months after booster vaccination. After basic vaccination, the homologous ChAdOx1-S-group showed the lowest anti-S RBD levels over six months, while the heterologous BNT162b2-ChAdOx1-S-group demonstrated the highest anti-S levels, but failed to reach level of significance compared with the homologous BNT162b2-groups. Antibody levels were higher after an extended vaccination interval with BNT162b2. A BNT162b2 booster increased anti-S-levels 11- to 91-fold in all groups, with the homologous ChAdOx1-S-cohort demonstrated the highest increase in antibody levels. No severe or serious ADR were observed. The findings suggest that a heterologous vaccination schedule or prolonged vaccination interval induces robust humoral immunogenicity with good tolerability. Extending the time to boost-immunization is key to both improving antibody induction and reducing ADR rate.
Subject(s)
COVID-19 , Drug-Related Side Effects and Adverse Reactions , Humans , Adult , BNT162 Vaccine , COVID-19/prevention & control , SARS-CoV-2 , Vaccination/adverse effects , Antibodies, Viral , ChAdOx1 nCoV-19ABSTRACT
Background: Guidelines of cardiopulmonary resuscitation (CPR) recommend the use of personal protective equipment (PPE) during the resuscitation of COVID-19 patients. Data on the effects of PPE on rescuers' stress level and quality of CPR are sparse and conflicting. This trial investigated the effects of PPE on team performance in simulated cardiac arrests. Methods: During the pandemic period, 198 teams (689 participants) performed CPR with PPE in simulated cardiac arrests (PPE group) and were compared with 423 (1451 participants) performing in identical scenarios in the pre-pandemic period (control group). Video recordings were used for data analysis. The primary endpoint was hands-on time. Secondary endpoints included a further performance of CPR and the perceived task load assessed by the NASA task-load index. Results: Hands-on times were lower in PPE teams than in the control group (86% (83-89) vs. 90% (87-93); difference 3, 95% CI for difference 3-4, p < 0.0001). Moreover, PPE teams made fewer change-overs and delayed defibrillation and administration of drugs. PPE teams perceived higher task loads (57 (44-67) vs. 63 (53-71); difference 6, 95% CI for difference 5-8, p < 0.0001) and scored higher in the domains physical and temporal demand, performance, and effort. Leadership allocation had no effect on primary and secondary endpoints. Conclusions: Having to wear PPE during CPR is an additional burden in an already demanding task. PPE is associated with an increase in perceived task load, lower hands-on times, fewer change-overs, and delays in defibrillation and the administration of drugs. (German study register number DRKS00023184).
ABSTRACT
If noninvasive ventilation (NIV or high-flow CPAP) fails in severe cases of COVID-19, escalation of treatment with orotracheal intubation and intermitted prone positioning is provided as standard care. The present case reports show two COVID-19 patients with severe refractory hypoxemia despite NIV treatment during the first wave (first half year 2020) and the resulting influence on the treatment regimen during the second wave (since October 2020) of the pandemic. Both patients (aged 63 years and 77 years) voluntarily positioned themselves on the side or in a prone position without prior sedation and oral intubation. Positional treatment promptly improved the arterial oxygenation level. The oxygenation index improved in the following days with continued NIV and intermittent prone and side position. The recovered patients were transferred from the intensive care unit at days 5 and 14, respectively after admission. The case reports, along with other reports, show that prone or lateral positioning may be important in the treatment of SARS-CoV2 pneumonia in awake and not yet intubated patients.