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Chest ; 162(4):A1821, 2022.
Article in English | EMBASE | ID: covidwho-2060870


SESSION TITLE: Outcomes Across COVID-19 SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Coronavirus disease 2019 (COVID-19) and influenza infections are associated with systemic inflammatory reactions that predispose to Takotsubo cardiomyopathy (TTS). Studies have investigated the epidemiology and clinical features of TTS in COVID-19 and influenza infection, however, there are limited data comparing TTS between patients with COVID-19 and influenza. METHODS: We searched PubMed/Medline, Web of Science, SCOPUS, EMBASE, and Google Scholar until November 1st, 2021, for case reports, case series, and observational cohort studies using these keywords: takotsubo syndrome/takotsubo cardiomyopathy, stress-induced cardiomyopathy, and broken heart syndrome combined with the terms COVID-19 and/or SARS-CoV-2, flu and/or influenza. All the published case reports included in the final analysis were in English and were categorized into patients with ‘COVID-19 + TTS’ and ‘Flu + TTS’. RESULTS: We identified 37 studies describing 64 patients with COVID-19+TTS and 10 case reports describing 10 patients with Flu + TTS. The mean age of patients in the COVID-19 + TTS was similar to the influenza group (69 years). Although women were more disproportionately affected by TTS in both groups, COVID-19 + TTS patients had a higher proportion of men than the Flu + TTS group (44% vs 30%) and previously reported incidence of TTS in men in the general population. Compared to patients with Flu + TTS, COVID-19 + TTS had a longer mean time from testing positive to developing TTS (7.3 days vs. 3.1 days), higher incidence rates of acute respiratory distress syndrome (77% vs. 40%), hypoxemic respiratory failure (86% vs. 60%), more likely to require invasive mechanical ventilation (63% vs. 40%) and higher in-hospital mortality rates (36%, n=23 vs 10%, n=1) CONCLUSIONS: Our systematic review highlights some important differences in the presentation and outcomes of TTS in patients with COVID-19 compared to seasonal influenza. Patients with COVID-19 + TTS had higher rates of respiratory complications and excess all-cause mortality compared to Flu + TTS. In contrast to the general population and patients infected with influenza, TTS tends to affect more men with COVID-19 infection. CLINICAL IMPLICATIONS: Hospitalized patients with COVID-19 who develop TTS appear to have a more severe disease course and poorer outcome compared to hospitalized patients with Flu+TTS. The study findings provide additional knowledge comparing complications between COVID-19 and influenza infections and may contribute to the continued efforts to manage the COVID-19 pandemic. DISCLOSURES: no disclosure on file for Temidayo Abe;No relevant relationships by Thomas Allingham No relevant relationships by Omovefe Edika No relevant relationships by Hammad Khalid No relevant relationships by Ifeoma Ogbuka No relevant relationships by Titilope Olanipekun No relevant relationships by Richard Snyder No relevant relationships by Abhinav Vedire No relevant relationships by Nicholas Wilson

Chest ; 162(4):A720, 2022.
Article in English | EMBASE | ID: covidwho-2060675


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