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International Journal of Stroke ; 17(3 Supplement):168, 2022.
Article in English | EMBASE | ID: covidwho-2139011


Background and Aims: The case fatality rate of acute spontaneous intracerebral hemorrhage (ICH) is high 54% at 1 year, and only 12% to 39% of survivors achieve long term functional independence. The INTEnsive care bundle with blood pressure Reduction in Acute Cerebral haemorrhage Trial (INTERACT3) was an international, multicentre, cluster-randomized clinical trial to assess a multifaceted goal-directed care bundle of physiological management in patients with acute ICH. We aimed to study the challenges encountered in recruitment during the pandemics in India. Method(s): Between August 2020 and October 2022, all adult patients presenting with spontaneous ICH within 6 hours from symptom onset were enrolled under the standard of usual care management until they are informed of crossing over to intervention and to be contacted at 6 months follow-up. Result(s): Six out of ten screened centres participated. The pandemic posed many challenges to the recruitment of patients in the trial: The ethics committee meetings were interrupted, preventing us enrolling more sites. Fewer patients presented to hospital due to fear of covid, economic crisis, transportation barriers, delayed presentation beyond 6 hours due to poor triaging, delay in RTPCR testing, slow referrals, unwillingness to followup in outpatient clinic. Solutions: frequent virtual meetings with ethics committees were held by site PIs, RTPCR switched to rapid testing, ER physicians trained to rapidly identify ICH cases and trial strategy was modified at each centre to boost recruitment. Conclusion(s): Alternative approaches for rapid triaging and modified strategies to recruitment are needed to overcome challenges of implementing a stroke trial during a pandemic.

Am J Respir Crit Care Med ; 204(1): 34-43, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1311194


Rationale: The role of and needs for extracorporeal membrane oxygenation (ECMO) at a population level during the coronavirus disease (COVID-19) pandemic have not been completely established. Objectives: To identify the cumulative incidence of ECMO use in the first pandemic wave and to describe the Nationwide Chilean cohort of ECMO-supported patients with COVID-19. Methods: We conducted a population-based study from March 3 to August 31, 2020, using linked data from national agencies. The cumulative incidence of ECMO use and mortality risk of ECMO-supported patients were calculated and age standardized. In addition, a retrospective cohort analysis was performed. Outcomes were 90-day mortality after ECMO initiation, ECMO-associated complications, and hospital length of stay. Cox regression models were used to explore risk factors for mortality in a time-to-event analysis. Measurements and Main Results: Ninety-four patients with COVID-19 were supported with ECMO (0.42 per population of 100,000, 14.89 per 100,000 positive cases, and 1.2% of intubated patients with COVID-19); 85 were included in the cohort analysis, and the median age was 48 (interquartile range [IQR], 41-55) years, 83.5% were men, and 42.4% had obesity. The median number of pre-ECMO intubation days was 4 (IQR, 2-7), the median PaO2/FiO2 ratio was 86.8 (IQR, 64-99) mm Hg, 91.8% of patients were prone positioned, and 14 patients had refractory respiratory acidosis. Main complications were infections (70.6%), bleeding (38.8%), and thromboembolism (22.4%); 52 patients were discharged home, and 33 died. The hospital length of stay was a median of 50 (IQR, 24-69) days. Lower respiratory system compliance and higher driving pressure before ECMO initiation were associated with increased mortality. A duration of pre-ECMO intubation ≥10 days was not associated with mortality. Conclusions: Documenting nationwide ECMO needs may help in planning ECMO provision for future COVID-19 pandemic waves. The 90-day mortality of the Chilean cohort of ECMO-supported patients with COVID-19 (38.8%) is comparable to that of previous reports.

COVID-19/therapy , Extracorporeal Membrane Oxygenation/statistics & numerical data , Respiratory Distress Syndrome/therapy , Adult , Aged , COVID-19/complications , COVID-19/diagnosis , COVID-19/epidemiology , Chile/epidemiology , Female , Humans , Incidence , Male , Middle Aged , Needs Assessment , Respiratory Distress Syndrome/diagnosis , Respiratory Distress Syndrome/epidemiology , Respiratory Distress Syndrome/virology , Retrospective Studies , Severity of Illness Index , Treatment Outcome