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1.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-318207

ABSTRACT

Background: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection could result in different laboratory abnormalities. The prediction of the outcome based on simple demographics and laboratory parameters could be useful for clinical purposes. The objective of the study is to develop and validate a score (Covid19-score) based on demographics and laboratory findings, performed at hospital admission in patients with a SARS-CoV-2 infection confirmed on a reverse transcriptase-polymerase chain reaction of the nasopharyngeal swab, to predict in-hospital mortality. Methods: Three cohorts of patients from three different hospitals were studied consecutively. The studied data came from patients’ electronic records. On the basis of the retrospective analysis of the mortality in the developing cohort from the first hospital the cut-off points predicting in-hospital mortality for gender, age, hemoglobin, mean corpuscular volume, platelet count, leukocyte count, sodium, potassium, creatinine level, C-reactive protein level were found and Covid19-score as a sum of points was calculated for each patient. The area under the receiver operating characteristic curve (AUC) of the Covid19-score for predicting survival to hospital discharge was counted. The Covid19-score was validated using data of patients from a second hospital. The significance of Covid19-score was confirmed on the prospective cohort of patients collected from a third hospital,Results: AUC of the Covid19-score for predicting survival to hospital discharge was 0.89 (0.84-0.95) p<0.001 in developing cohort, 0.850 (0.75-0.88) p<0.001 in validation cohort and 0.773 (0.731-0.816) p<0.001 in the prospective cohort. Conclusion: The Covid19-score is useful in predicting the clinical outcome for hospitalized patients with SARS-CoV-2 infection

2.
Am J Emerg Med ; 53: 122-126, 2022 03.
Article in English | MEDLINE | ID: covidwho-1638161

ABSTRACT

BACKGROUND: Endotracheal intubation (ETI) is still the gold standard of airway management, but in cases of sudden cardiac arrest in patients with suspected SARS-CoV-2 infection, ETI is associated with risks for both the patient and the medical personnel. We hypothesized that the Vie Scope® is more useful for endotracheal intubation of suspected or confirmed COVID-19 cardiac arrest patients than the conventional laryngoscope with Macintosh blade when operators are wearing personal protective equipment (PPE). METHODS: Study was designed as a prospective, multicenter, randomized clinical trial performed by Emergency Medical Services in Poland. Patients with suspected or confirmed COVID-19 diagnosis who needed cardiopulmonary resuscitation in prehospital setting were included. Patients under 18 years old or with criteria predictive of impossible intubation under direct laryngoscopy, were excluded. Patients were randomly allocated 1:1 to Vie Scope® versus direct laryngoscopy with a Macintosh blade. Study groups were compared on success of intubation attempts, time to intubation, glottis visualization and number of optimization maneuvers. RESULTS: We enrolled 90 out-of-hospital cardiac arrest (OHCA) patients, aged 43-92 years. Compared to the VieScope® laryngoscope, use of the Macintosh laryngoscope required longer times for tracheal intubation with an estimated mean difference of -48 s (95%CI confidence interval [CI], -60.23, -35.77; p < 0.001). Moreover VieScope® improved first attempt success rate, 93.3% vs. 51.1% respectively (odds ratio [OR] = 13.39; 95%CI: 3.62, 49.58; p < 0.001). CONCLUSIONS: The use of the Vie Scope® laryngoscope in OHCA patients improved the first attempt success rate, and reduced intubation time compared to Macintosh laryngoscope in paramedics wearing PPE for against aerosol generating procedures. TRIAL REGISTRATION: ClinicalTrials registration number NCT04365608.


Subject(s)
Allied Health Personnel/statistics & numerical data , Intubation, Intratracheal/instrumentation , Laryngoscopes/standards , Adult , Aged , Aged, 80 and over , Airway Management/instrumentation , Airway Management/methods , Airway Management/statistics & numerical data , Allied Health Personnel/standards , Female , Humans , Intubation, Intratracheal/methods , Intubation, Intratracheal/statistics & numerical data , Laryngoscopes/statistics & numerical data , Male , Middle Aged , Personal Protective Equipment/adverse effects , Personal Protective Equipment/standards , Personal Protective Equipment/statistics & numerical data , Prospective Studies , Resuscitation/instrumentation , Resuscitation/methods , Resuscitation/statistics & numerical data
3.
BMC Infect Dis ; 21(1): 945, 2021 Sep 14.
Article in English | MEDLINE | ID: covidwho-1413302

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) constitutes a major health burden worldwide due to high mortality rates and hospital bed shortages. SARS-CoV-2 infection is associated with several laboratory abnormalities. We aimed to develop and validate a risk score based on simple demographic and laboratory data that could be used on admission in patients with SARS-CoV-2 infection to predict in-hospital mortality. METHODS: Three cohorts of patients from different hospitals were studied consecutively (developing, validation, and prospective cohorts). The following demographic and laboratory data were obtained from medical records: sex, age, hemoglobin, mean corpuscular volume (MCV), platelets, leukocytes, sodium, potassium, creatinine, and C-reactive protein (CRP). For each variable, classification and regression tree analysis were used to establish the cut-off point(s) associated with in-hospital mortality outcome based on data from developing cohort and before they were used for analysis in the validation and prospective cohort. The covid-19 score was calculated as a sum of cut-off points associated with mortality outcome. RESULTS: The developing, validation, and prospective cohorts included 129, 239, and 497 patients, respectively (median age, 71, 67, and 70 years, respectively). The following cut of points associated with in-hospital mortality: age > 56 years, male sex, hemoglobin < 10.55 g/dL, MCV > 92.9 fL, leukocyte count > 9.635 or < 2.64 103/µL, platelet count, < 81.49 or > 315.5 103/µL, CRP > 51.14 mg/dL, creatinine > 1.115 mg/dL, sodium < 134.7 or > 145.4 mEq/L, and potassium < 3.65 or > 6.255 mEq/L. The AUC of the covid-19 score for predicting in-hospital mortality was 0.89 (0.84-0.95), 0.850 (0.75-0.88), and 0.773 (0.731-0.816) in the developing, validation, and prospective cohorts, respectively (P < 0.001The mortality of the prospective cohort stratified on the basis of the covid-19 score was as follows: 0-2 points,4.2%; 3 points, 15%; 4 points, 29%; 5 points, 38.2%; 6 and more points, 60%. CONCLUSION: The covid-19 score based on simple demographic and laboratory parameters may become an easy-to-use, widely accessible, and objective tool for predicting mortality in hospitalized patients with SARS-CoV-2 infection.


Subject(s)
COVID-19 , SARS-CoV-2 , Hospital Mortality , Hospitalization , Humans , Infant, Newborn , Laboratories , Male , Prospective Studies
4.
BMC Infect Dis ; 21(1): 945, 2021 Sep 14.
Article in English | MEDLINE | ID: covidwho-1406710

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) constitutes a major health burden worldwide due to high mortality rates and hospital bed shortages. SARS-CoV-2 infection is associated with several laboratory abnormalities. We aimed to develop and validate a risk score based on simple demographic and laboratory data that could be used on admission in patients with SARS-CoV-2 infection to predict in-hospital mortality. METHODS: Three cohorts of patients from different hospitals were studied consecutively (developing, validation, and prospective cohorts). The following demographic and laboratory data were obtained from medical records: sex, age, hemoglobin, mean corpuscular volume (MCV), platelets, leukocytes, sodium, potassium, creatinine, and C-reactive protein (CRP). For each variable, classification and regression tree analysis were used to establish the cut-off point(s) associated with in-hospital mortality outcome based on data from developing cohort and before they were used for analysis in the validation and prospective cohort. The covid-19 score was calculated as a sum of cut-off points associated with mortality outcome. RESULTS: The developing, validation, and prospective cohorts included 129, 239, and 497 patients, respectively (median age, 71, 67, and 70 years, respectively). The following cut of points associated with in-hospital mortality: age > 56 years, male sex, hemoglobin < 10.55 g/dL, MCV > 92.9 fL, leukocyte count > 9.635 or < 2.64 103/µL, platelet count, < 81.49 or > 315.5 103/µL, CRP > 51.14 mg/dL, creatinine > 1.115 mg/dL, sodium < 134.7 or > 145.4 mEq/L, and potassium < 3.65 or > 6.255 mEq/L. The AUC of the covid-19 score for predicting in-hospital mortality was 0.89 (0.84-0.95), 0.850 (0.75-0.88), and 0.773 (0.731-0.816) in the developing, validation, and prospective cohorts, respectively (P < 0.001The mortality of the prospective cohort stratified on the basis of the covid-19 score was as follows: 0-2 points,4.2%; 3 points, 15%; 4 points, 29%; 5 points, 38.2%; 6 and more points, 60%. CONCLUSION: The covid-19 score based on simple demographic and laboratory parameters may become an easy-to-use, widely accessible, and objective tool for predicting mortality in hospitalized patients with SARS-CoV-2 infection.


Subject(s)
COVID-19 , SARS-CoV-2 , Hospital Mortality , Hospitalization , Humans , Infant, Newborn , Laboratories , Male , Prospective Studies
5.
Kardiol Pol ; 79(3): 277-286, 2021 03 25.
Article in English | MEDLINE | ID: covidwho-1204474

ABSTRACT

BACKGROUND: Obtaining vascular access is one of the key procedures performed in patients in emergency settings. AIMS: The study was conducted as a meta­analysis and a systematic review and aimed to address the following question: which intravascular access method should be used in patients with COVID­19 when wearing full personal protective equipment (PPE)? METHODS: We performed a systematic search of PubMed, EMBASE, and CENTRAL databases for randomized controlled trials that compared intravascular access methods used by operators wearing full level C PPE. We evaluated procedure duration and the success rate of intraosseous and peripheral intravenous accesses. RESULTS: Eight randomized controlled trials were included in quantitative synthesis. The use of PPE during intravascular access procedures had an impact on procedure duration in the case of intraosseous access (mean difference [MD], 11.69; 95% CI, 6.47-16.92; P <0.001), as well as reduced the success rate of intraosseous access by 0.8% and intravenous access by 10.1%. Under PPE conditions, intraosseous access, compared with peripheral intravenous access, offered a shorter procedure time (MD, -41.43; 95% CI, -62.36 to -24.47; P <0.001). CONCLUSION: This comprehensive meta­analysis suggested that the use of PPE significantly extends the duration of intravascular procedures. However, under PPE conditions, operators were able to obtain intraosseous access in a shorter time and with a higher success rate than in the case of intravenous access.


Subject(s)
Infusions, Intraosseous , Infusions, Intravenous , Personal Protective Equipment , COVID-19 , Humans , Randomized Controlled Trials as Topic
7.
Kardiol Pol ; 79(3): 277-286, 2021 03 25.
Article in English | MEDLINE | ID: covidwho-1016583

ABSTRACT

BACKGROUND: Obtaining vascular access is one of the key procedures performed in patients in emergency settings. AIMS: The study was conducted as a meta­analysis and a systematic review and aimed to address the following question: which intravascular access method should be used in patients with COVID­19 when wearing full personal protective equipment (PPE)? METHODS: We performed a systematic search of PubMed, EMBASE, and CENTRAL databases for randomized controlled trials that compared intravascular access methods used by operators wearing full level C PPE. We evaluated procedure duration and the success rate of intraosseous and peripheral intravenous accesses. RESULTS: Eight randomized controlled trials were included in quantitative synthesis. The use of PPE during intravascular access procedures had an impact on procedure duration in the case of intraosseous access (mean difference [MD], 11.69; 95% CI, 6.47-16.92; P <0.001), as well as reduced the success rate of intraosseous access by 0.8% and intravenous access by 10.1%. Under PPE conditions, intraosseous access, compared with peripheral intravenous access, offered a shorter procedure time (MD, -41.43; 95% CI, -62.36 to -24.47; P <0.001). CONCLUSION: This comprehensive meta­analysis suggested that the use of PPE significantly extends the duration of intravascular procedures. However, under PPE conditions, operators were able to obtain intraosseous access in a shorter time and with a higher success rate than in the case of intravenous access.


Subject(s)
Infusions, Intraosseous , Infusions, Intravenous , Personal Protective Equipment , COVID-19 , Humans , Randomized Controlled Trials as Topic
8.
Kardiol Pol ; 78(12): 1254-1261, 2020 12 23.
Article in English | MEDLINE | ID: covidwho-1000925

ABSTRACT

BACKGROUND: Cardiopulmonary resuscitation with the use of personal protective equipment (PPE) for aerosol generating procedures (AGP) in patients with suspected or confirmed coronavirus disease 2019 (COVID­19) remains challenging. AIMS: The aim of this study was to compare 3 chest compression (CC) methods used by paramedics wearing PPE. METHODS: The single­blinded, multicenter, randomized, crossover simulation study involved 67 paramedics wearing PPE AGP. They performed 2­minute continuous CCs in an adult with suspected or confirmed COVID­19 in 3 scenarios: 1) manual CCs; 2) CCs with the TrueCPR feedback device; 3) CCs with the LUCAS 3 mechanical CC device. RESULTS: The depth of CC was more frequently correct when using LUCAS 3 compared with TrueCPR and manual CC (median [IQR] 51 [50-55] mm vs 47 [43-52] mm vs 43 [38-46] mm; P = 0.005). This was also true for the CC rate (median [IQR]102 [100-102] compressions per minute [CPM] vs 105 [98-1114] CPM vs 116 [112-129] CPM; P = 0.027) and chest recoil (median [IQR]100% [98%-100%] vs 83% [60%-92%] vs 39% [25%-50%]; P = 0.001). A detailed analysis of 2­minute resuscitation with manual CCs showed a decrease in compression depth and full chest recoil after 1 minute of CCs. CONCLUSION: We demonstrated that during simulated resuscitation with the use of PPE AGP in patients with suspected or confirmed COVID­19, CC with LUCAS 3 compared with manual CCs as well as the TrueCPR essentially increased the CC quality. In the case of manual CCs by paramedics dressed in PPE AGP, it is advisable to change the person performing resuscitation every minute.


Subject(s)
COVID-19/epidemiology , Cardiopulmonary Resuscitation/methods , Heart Arrest/therapy , Heart Massage/instrumentation , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Personal Protective Equipment , Adult , Aged , Cross-Over Studies , Female , Humans , Male , Middle Aged , Poland , Single-Blind Method
9.
Cardiol J ; 28(1): 15-22, 2021.
Article in English | MEDLINE | ID: covidwho-902849

ABSTRACT

BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is a challenge for medical personnel, especially in the current COVID-19 pandemic, where medical personnel should perform resuscitation wearing full personal protective equipment. This study aims were to assess the characteristics and outcomes of adults who suffered an OHCA in the COVID-19 pandemic treated by emergency medical service (EMS) teams. METHODS: All EMS-attended OHCA adults over than 18 years in the Polish EMS registry were analyzed. The retrospective EMS database was conducted. EMS interventions performed between March 1, and April 30, 2020 were retrospectively screened. RESULTS: In the study period EMS operated 527 times for OHCA cases. The average age of patients with OHCA was 67.8 years. Statistically significantly more frequently men were involved (64.3%). 298 (56.6%) of all OHCA patients had resuscitation attempted by EMS providers. Among resuscitated patients, 73.8% were cardiac etiology. 9.4% of patients had return of spontaneous circulation, 27.2% of patients were admitted to hospital with ongoing chest compression. In the case of 63.4% cardiopulmonary resuscitation was ineffective and death was determined. CONCLUSIONS: The present study found that OHCA incidence rate in the Masovian population (central region of Poland) in March-April 2020 period was 12.2/100,000 adult inhabitants. Return of spontaneous circulation in EMS was observed only in 9.4% of resuscitated patients. The presence of shockable rhythms was associated with better prognosis. The prehospital mortality, even though it was high, did not differ from those reported by other studies.


Subject(s)
COVID-19/epidemiology , Cardiopulmonary Resuscitation/methods , Emergency Medical Services/statistics & numerical data , Out-of-Hospital Cardiac Arrest/therapy , Pandemics , Registries , Aged , Aged, 80 and over , Cause of Death/trends , Female , Follow-Up Studies , Humans , Incidence , Italy/epidemiology , Male , Out-of-Hospital Cardiac Arrest/epidemiology , Prognosis , Retrospective Studies , SARS-CoV-2
10.
Wiad Lek ; 73(8): 1659-1662, 2020.
Article in English | MEDLINE | ID: covidwho-875338

ABSTRACT

OBJECTIVE: Introduction: The SARS-CoV-2 virus was recognized in December 2019 in China. From that moment it has quickly spread around the whole world. It causes COVID-19 disease manifested by breathlessness, coughing and high temperature. The COVID-19 pandemic has become a great challenge for humanity. The aim: To analyze interventions of emergency medical teams during the SAR-CoV-2 pandemic, and to compare obtained data with the same periods in 2018-2019. PATIENTS AND METHODS: Material and methods: The study retrospectively analyzed interventions of emergency medical teams in the period from 15.03 to 15.05 in 2018 - 2020. 1,479,530 interventions of emergency medical teams were included in the study. The number of interventions, reasons for calls, and diagnoses made by heads of the emergency medical teams during the SARS-CoV-2 pandemic were compared to the same period in 2018-2019. RESULTS: Results: Authors observed the decline in the number of interventions performed by emergency medical teams during the pandemic in relation to earlier years by approximately 25%. The big decline concerned interventions that were the reason for calls to public places, such as "traffic accident" and "collapse". In the case of diagnoses made by the head of the emergency medical team, the diagnoses regarding stroke or sudden cardiac arrest remained at the similar level. Others showed a marked decline. CONCLUSION: Conclusions: Reduced social activity contributed to a reduced number of interventions by emergency medical teams in public places. The societal fear of the unknown also contributed to the decrease in the number of interventions performed by emergency medical teams. People began to avoid contact with other people.


Subject(s)
Coronavirus Infections , Emergency Medical Services , Pandemics , Pneumonia, Viral , Betacoronavirus , COVID-19 , China/epidemiology , Humans , Poland/epidemiology , Retrospective Studies , SARS-CoV-2
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