Fulminant myocarditis following SARS-CoV-2 mRNA vaccination rescued with venoarterial ECMO: A report of two cases

Objectives: Cases of fulminant myocarditis after mRNA COVID-19 vaccination have been reported. The most severe may need venoarterial extracorporeal membrane oxygenation (V-A ECMO) support. Here we report two cases successfully rescued with V-A ECMO. Method(s): We included all the cases supported with V-A ECMO for refractory cardiogenic shock due to myocarditis secondary to a mRNA SARS-COV2 vaccine in the high-volume adult ECMO Program in Vall Hebron University Hospital since January 2020. Result(s): We identified two cases (table). One of them was admitted for out-of-hospital cardiac arrest. In both, a peripheral V-A ECMO was implanted in the cath lab. An intra-aortic balloon pump was needed in one case for left ventricle unloading. Support could be successfully withdrawn in a mean of five days. No major bleeding or thrombosis complications occurred. Definite microscopic diagnosis could be reached in one case (Image, 3). Treatment was the same, using 1000mg of methylprednisolone/day for 3 days. A cardiac magnetic resonance 10 days after admission showed a significant improvement in systolic function and diffuse oedema and subepicardial contrast intake in different segments (Image, 1-2). Both patients were discharged fully recovered. Conclusion(s): V-A ECMO should be established in cases of COVID-19 vaccine-associated myocarditis with refractory cardiogenic shock during the acute phase. (Table Presented).

The impact of COVID-19 on extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest (OHCA): A single centre study

Objectives: The COVID-19 pandemic has been affecting everything including ECMO service. At the moment we have to equip PPE before ECPR and we thought it may influence on time to establish venoarterial ECMO and patient outcomes. Method(s): We compared OHCA-patients who underwent ECPR in our hospital before (January 2015 - March 2020) and after (April 2020 - December 2022) the Government of Japan declared a state of emergency in relation to COVID-19. Result(s): There were 32 and 9 patients in the pre- and post-COVID-19 pandemic sample. Of these, 9 (28.1%) vs. 5 (55.6%) survived extracorporeal life support (ECLS), p=0.23, and 4 (12.5%) vs. 2 (22.2%) had good neurologic outcomes (cerebral performance category 1- 2) after ECLS. Seven (21.9%) vs. 1 (12.5%) were discharged or transferred alive from the hospital (one patient of the post-COVID-19 cohort has been still hospitalised for rehabilitation), p>0.99. Mean values of low-flow time were respectively 67.3 minutes (SD 18.3) and 55.6 minutes (SD 17.1), p=0.091, and median values of time to establish ECMO from admission were respectively 32.5 minutes (IQR 15.8) and 26.0 minutes (IQR 4.0), p=0.23. Conclusion(s): There were no differences in time-toECMO or outcomes in patients who underwent ECPR for refractory OHCA before and after the COVID-19 pandemic.

Does intensive follow-up increase days alive and well out of hospital in heart failure?

151 Figure 1Day after discharge from hospitalDid you feel well today?Please write yes or no.Weight, kg123456789101112131415161718192021222324252627282930 151 Table 1Baseline characteristicsBaseline characteristicsStandard Follow-UpN=9Intensive Follow-UpN=17Age (years)78 [69,81]74 [65,82]Gender [number of females (%)] 2 (22%)7 (41%)Rockwood Frailty Score (2 weeks pre admission) 3 [3,5]5 [3,5]Left Ventricular Systolic Function (%)Preserved 34%Mildly impaired 11%Moderately impaired 33%Severely impaired 22%Preserved 35%Mildly impaired 12%Moderately impaired 18%Severely impaired 35%NTproBNP ng/L4772 [2883,4859]9 88 [4333,14876]eGFR on discharge, ml/min/1.73m246 [35,63]51 [30,82]Comorbidity Number (in addition to HF)3 [2,4]5 [3,6]SBP, mmHg108 [106,111]110 [103,120]Number of people known COVID positive (%)0%6%Descriptive statistics are expressed as Median [IQR] or N (%).Abbreviations: eGFR: Estimated Glomerular Filtration Rate, HF: Heart failure, IQR: Inter-Quartile Range, NTproBNP: N-terminal prohormone of brain natriuretic peptide, SBP: Systolic Blood Pressure. 151 Table 2Effectiveness of intensive follow-upStandard Follow-UpIntensive Follow-UpDays alive and well out of hospital12 [8,25]22 [15,28]Days with weight recorded27 [14,30]27 [7,30]ACEi, ARB, or entresto (%)6 (67%)14 (82%)Beta-Blocker (%)8 (89%)16 (94%)% max. dose of Beta-Blocker 44 [25,53]50 [34,100]MRA%5 (56%)9 (53%)Dose of MRA, mg25 [25,25]25 [25, 25]SGLT2 inhibitor (on Dapaglifozin or empaglifozin) (%)5 (56%)14 (82%)Total number of Disease Modifying Agents (max 4)3 [2,4]3 [3,4]Descriptive statistics are expressed as Median [IQR] or N (%).Abbreviations: ACEi: Angiotensin Converting Enzyme Inhibitor, ARB: Angiotensin Receptor Blocker, IQR: Inter-Quartile Range, MRA: Mineralocorticoid receptor antagonist, SGLT2 inhibitors: Sodium-glucose cotransporter-2 inhibitors.Conflict of InterestNone

Comparison of out-of-hospital cardiac arrests during the COVID-19 pandemic with those before the pandemic: an updated systematic review and meta-analysis.

The coronavirus disease of 2019 (COVID-19) pandemic, directly and indirectly, affected the emergency medical care system and resulted in worse out-of-hospital cardiac arrest (OHCA) outcomes and epidemiological features compared with those before the pandemic. This review compares the regional and temporal features of OHCA prognosis and epidemiological characteristics. Various databases were searched to compare the OHCA outcomes and epidemiological characteristics during the COVID-19 pandemic with before the pandemic. During the COVID-19 pandemic, survival and favorable neurological outcome rates were significantly lower than before. Survival to hospitalization, return of spontaneous circulation, endotracheal intubation, and use of an automated external defibrillator (AED) decreased significantly, whereas the use of a supraglottic airway device, the incidence of cardiac arrest at home, and response time of emergency medical service (EMS) increased significantly. Bystander CPR, unwitnessed cardiac arrest, EMS transfer time, use of mechanical CPR, and in-hospital target temperature management did not differ significantly. A subgroup analysis of the studies that included only the first wave with those that included the subsequent waves revealed the overall outcomes in which the epidemiological features of OHCA exhibited similar patterns. No significant regional differences between the OHCA survival rates in Asia before and during the pandemic were observed, although other variables varied by region. The COVID-19 pandemic altered the epidemiologic characteristics, survival rates, and neurological prognosis of OHCA patients. Review registration: PROSPERO (CRD42022339435).

[Impact of the COVID-19 pandemic on basic resuscitation and success rate after sudden cardiac arrest]. / A COVID­19-pandémia hatása a hirtelen szívmegállást követo alapszintu újraélesztésre és annak sikerességére.

Since the onset of the coronavirus disease, infection-related mortality has been tracked worldwide and the number of deaths caused by the virus is counted daily. The coronavirus pandemic has not only transformed our daily life, but reorganized the whole healthcare system. In response to the increased demand for hospital admissions, leaders in different countries have implemented a number of emergency actions. The restructuring has had both direct and indirect negative effects on the epidemiology of sudden cardiac death, the willingness of lay rescuer to give cardiopulmonary resuscitation and the use of automated external defibrillators, but these negative effects vary widely across continents and countries. In order to protect lay people and health workers as well as to prevent the spread of the pandemic, the previous recommendations of the European Resuscitation Council on basic and advanced life support have undergone a few modifications. Orv Hetil. 2023; 164(13): 483-487.

Rise in Out-of-Hospital Cardiac Arrest Cases in Chicago in 2020

Background: Italy, France and New York City have reported an increase in out-of-hospital cardiac arrest (OHCA) incidence during the COVID-19 pandemic. The purpose of our study was to assess the effect of COVID-19 on OHCA cases in Chicago. Method(s): Cardiac Arrest Registry to Enhance Survival (CARES) database was used. Bivariate analysis was conducted to assess changes in demographic and other characteristics. We excluded the cases that occurred in a healthcare facility or a nursing home. We compared the cases reported in 2020 to 2019 (and prior years). ArcGIS was used to geocode incident addresses and to show the temporal distribution by community areas. Bivariate analysis was done using chi-square tests. Result(s): A total of 3221 OHCA cases were reported in Chicago in 2020, which is 31.5% higher than those reported in 2019 (n=2450 cases). This increase was higher than what has been noticed historically (for instance, the increase from 2018 to 2019 was only 17%). There was an increase in Hispanic OHCA cases (17.3% in 2020 vs. 13.5% in 2019, p<0.01) but a decrease in White cases (20.5% vs. 23.1%). The cases in 2020 were less likely to be reported at public location (22% vs. 26%, p<0.001) or have shockable rhythm (10% vs. 13%, p=0.0002). There was a marked increase in those that were declared dead in the field in 2020 (37% vs. 27%, p<0.001). However, there were no statistically significant differences in age distribution, gender, witnessed arrest (49% vs. 51%, p=0.07) or bystander cardiopulmonary resuscitation (BCPR) (23% vs. 22%, p=0.3). Conclusion(s): A better understanding of the causes of the excess cardiac arrest numbers will be important to help plan and better prepare for future public health interventions. The effect of COVID19 on OHCA survival needs to be examined further in future studies.

Urine Output and Mortality in Patients Resuscitated from out of Hospital Cardiac Arrest.

BACKGROUND: Limited data exist regarding urine output (UO) as a prognostic marker in out-of-hospital-cardiac-arrest (OHCA) survivors undergoing targeted temperature management (TTM). METHODS: We included 247 comatose adult patients who underwent TTM after OHCA between 2007 and 2017, excluding patients with end-stage renal disease. Three groups were defined based on mean hourly UO during the first 24 h: Group 1 (<0.5 mL/kg/h, n = 73), Group 2 (0.5-1 mL/kg/h, n = 81) and Group 3 (>1 mL/kg/h, n = 93). Serum creatinine was used to classify acute kidney injury (AKI). The primary and secondary outcomes respectively were in-hospital mortality and favorable neurological outcome at hospital discharge (modified Rankin Scale [mRS]<3). RESULTS: In-hospital mortality decreased incrementally as UO increased (adjusted OR 0.9 per 0.1 mL/kg/h higher; p = 0.002). UO < 0.5 mL/kg/h was strongly associated with higher in-hospital mortality (adjusted OR 4.2 [1.6-10.8], p = 0.003) and less favorable neurological outcomes (adjusted OR 0.4 [0.2-0.8], p = 0.007). Even among patients without AKI, lower UO portended higher mortality (40% vs 15% vs 9% for UO groups 1, 2, and 3 respectively, p < 0.001). CONCLUSION: Higher UO is incrementally associated with lower in-hospital mortality and better neurological outcomes. Oliguria may be a more sensitive early prognostic marker than creatinine-based AKI after OHCA.

Out of hospital cardiac arrest during COVID-19 pandemic: A retrospective study from north east of Italy

The novel coronavirus disease 2019 (COVID-19) outbreak affected the epidemiology and the outcomes of Out- Of Hospital Cardiac Arrest (OHCA). We performed a retrospective observational study in the Western district of Vicenza (Veneto, Italy) to evaluate patients affected by non-traumatic OHCA and we analyzed epidemiological and clinical characteristics associated with sustained Return Of Spontaneous Circulation (ROSC). We collected 114 cases from January 2019 to May 2021 and we compared data of the pre-pandemic period (2019) with the pandemic one (2020-2021). During the pandemic we found an increase of bystander CPR, of OHCA with a cardiac cause and of shockable presenting rhythms. All these observations weren't associated with an increase of sustained ROSC, which could be determined by both the reorganization of the health care system with the reduction of medical screenings and by the interruption of training courses reducing the efficacy of cardiopulmonary resuscitation. On the other hand, the higher percentage of presenting shockable rhythm reinforces the importance of bystander rule and of short time to start CPR.

[Out-of-hospital adult basic life support: new guidelines and the involvement of bystanders]. / A kórházon kívüli felnott alapszintu újraélesztés új irányelvei és a laikusok bevonásának kérdései.

Survival rate for out-of-hospital cardiac arrest remains low across Europe. In the last decade, involving bystanders turned out to be one of the most important key factors in improving the outcome of out-of-hospital cardiac arrest. Beside recognizing cardiac arrest and initiate chest compressions, bystanders could be also involved in delivering early defibrillation. Although adult basic life support is a sequence of simple interventions that can be easily learnt even by schoolchildren, non-technical skills and emotional components can complicate real-life situations. This recognition combined with modern technology brings a new point of view in teaching and implementation. We review the latest practice guidelines and new advances in the education (including the importance of non-technical skills) of out-of-hospital adult basic life support, also considering the effects of COVID-19 pandemic. We briefly present the Szív City application developed to support the involvement of lay rescuers. Orv Hetil. 2023; 164(12): 443-448.

Changes in neurological outcomes of out-of-hospital cardiac arrest during the COVID-19 pandemic in Japan: a population-based nationwide observational study.

Background: There is growing interest in the indirect negative effects of coronavirus disease 2019 (COVID-19) on mortality. We aimed to assess its indirect effect on out-of-hospital cardiac arrest (OHCA) outcomes. Methods: We analysed a prospective nationwide registry of 506,935 patients with OHCA between 2017 and 2020. The primary outcome was favourable neurological outcome (Cerebral Performance Category 1 or 2) at 30 days. The secondary outcomes were public access defibrillation (PAD) and bystander-initiated chest compression. We performed an interrupted time series (ITS) analysis to assess changes in the trends of these outcomes around the declaration of a state of emergency (April 7 - May 25, 2020). We also performed a subgroup analysis stratified by infection spread status. Findings: We identified 21,868 patients with OHCA witnessed by a bystander who had an initial shockable heart rhythm. ITS analysis showed a drastic decline in PAD use (relative risk [RR], 0.60; 95% confidence interval [CI], 0.49-0.72; p < 0.0001) and a reduction in favourable neurological outcomes (RR, 0.79; 95% CI, 0.68-0.91; p = 0.0032) all over Japan after the state of emergency was declared when compared with the equivalent time period in previous years. The decline in favourable neurological outcomes was more pronounced in areas with COVID-19 spread than in areas without spread (RR, 0.70; 95% CI, 0.58-0.86 vs. RR, 0.87; 95% CI, 0.72-1.03; p for effect modification = 0.019). Interpretation: COVID-19 is associated with worse neurological outcomes and less PAD use in patients with OHCA. Funding: None.

Initial five and ten-minute regional cerebral oxygen saturation as a predictor of the futility of resuscitation for out-of-hospital cardiac arrest

This study aimed to investigate the usefulness of cerebral regional oxygen saturation (rSO2) during the initial 5 and 10 minutes of cardiopulmonary resuscitation (CPR) compared with an initial rSO2 and mean rSO2 during entire CPR to predict the futility of resuscitation for patients without of-hospital-cardiac arrest (OHCA). This was a prospective study involving 52 adult patients presenting in OHCA and whose cerebral rSO2 values were measured until either CPR was terminated or sustained return of spontaneous circulation (ROSC) was achieved. Receiver operating characteristics analyses were used to evaluate which time and type of measurement is better to predict non-ROSC. The area under the curve (AUC) of each rSO2 value according to measurement time (overall, initial 5 minutes and 10 minutes) were the highest value of 0.743, 0.724, and 0.739, mean values of 0.724, 0.677 and 0.701 and rSO2 (Changes in values of regional cerebral oxygen) value of 0.722, 0.734 and 0.724, respectively, while all of the initial values had a poor AUC (<0.7) and also were not statistically significant. The optimal cut-off value of each rSO2 values during overall, initial 5 minutes and 10 minutes were the highest value of 26% (sensitivity, 53.9% specificity, 92.3%), 24% (sensitivity, 56.4% specificity, 92.3%), and 30% (sensitivity, 61.5% specificity, 84.6%), mean value of 15.2%, 15.3% and 16%, respectively. None of the patients with a persistent rSO2 <=18% during the overall period achieved ROSC. Initial 5 minutes and 10 minutes cerebral rSO2 values an out-of-hospital-cardiac arrest (OHCA) are a better predictor in deciding the futility of CPR, compared to initial and overall measurements.Copyright © 2023 The Author(s). Published by MRE Press.

"Pushing Geographic Boundaries: Interfacility transport and remote extracorporeal membrane oxygenation cannulation of patients during COVID-19 pandemic".

Amidst the pandemic, geographical boundaries presented challenges to those in need of higher levels of care from referral centers. Authors sought to evaluate potential predictors of treatment success; assess our transport and remote cannulation process; and identify transport associated complications.Retrospective series of critically ill adults with COVID-19 transferred by our Extracorporeal Membrane Oxygenation (ECMO) team 24 March 2020 through 8 June 2021. Descriptive statistics and associated interquartile ranges (IQR) were used to summarize the data.Sixty-three patients with COVID associated acute respiratory distress syndrome (ARDS) requiring ECMO support were admitted to our ECMO center. Mean age was 44 years old (SD 12; IQR 36-56). 59% (n = 37) of patients were male. Average body mass index was 39.7 (SD 11.3; IQR 31-48.5). Majority of patients (77.8%; n = 35) had severe ARDS. Predictors of treatment success were not observed.Transport distances ranged from 2.2 to 236 miles (median 22.5 miles; IQR 8.3-79); round trip times from 18 to 476 min (median 83 min; IQR 44-194). No transport associated complications occurred. Median duration of ECMO support was 17 days (IQR 9.5-34.5). Length of stay in the Intensive Care Unit (median 36 days; IQR 17-49) and hospital (median 39 days; IQR 25-57) varied. Amongst those discharged, 60% survived.

Acute Coronary Syndrome during the Era of Covid-19: Perspective and Implications Using Google Trends

Background Acute coronary syndrome (ACS) hospital admissions decreased during the start of the COVID-19 outbreak. There is limited information on how Google searches related to patients behavior during this time. Methods We examined de-identified data from 2019 through 2020 regarding monthly: 1) admissions for ACS from the Veterans Affairs Healthcare System;2) out of hospital cardiac arrest (OHCA) from NEMSIS public dataset;and 3) Google searches for "chest pain", "coronavirus", "chest pressure", and "hospital safe" from Google Trends. We analyzed the trends for ACS admissions, OHCA, and Google searches. Results During the early months of the first COVID-19 outbreak: 1)Veterans Affairs data showed a significant reduction in ACS admissions at a national and regional (Florida) level (Figure 1);2) NEMSIS database showed a marked increase in OHCA at a national level;and 3) Google Trends showed a significant increase in the before mentioned Google searches at a national and regional level. Conclusion ACS hospital admissions decreased during the beginning of the pandemic likely due to delayed healthcare utilization secondary to patients fear of acquiring COVID-19 infection. Concordantly, Google searches for hospital safety and ACS symptoms increased along with OHCA events during this time. Our results suggest that Google Trends may be a useful tool to predict patients behavior and increase preparedness for future events, however, statistical strategies to establish association are needed. [Formula presented]Copyright © 2023 American College of Cardiology Foundation

Impact de la Covid-19 sur les arrêts cardiaques extrahospitaliers en phase de suractivité épidémique : données du registre RéAC

Introduction : Notre objectif était d'analyser la survie des patients victimes d'un arrêt cardiaque extrahospitalier (ACEH) durant la pandémie Covid-19 et de comparer les données en fonction du centre de traitement de l'appel choisi, le 15 ou le 18. Méthode : Nous avons extrait les données exhaustives du Registre des arrêts cardiaques (RéAC), entre le 1er mars et le 30 avril 2020. Nous avons effectué trois comparaisons de la survie à 30 jours (J30) de cohortes de patients : 1) Covid vs non-Covid ;2) appels arrivés au service d'aide médicale urgente (Samu) (15) vs aux sapeurs-pompiers (SP) (18) et 3) appels arrivés au 15 vs 18 pour les patients Covid. Résultats : Sur un total de 870 ACEH, 184 étaient atteints de la Covid. Nous avons observé 487 (56 %) appels arrivés au 15 et 383 (44 %) au 18. La survie à J30 était de 3 %. Les ACEH Covid avaient une survie à J30 plus faible que les non-Covid (0 vs 4 %, p < 0,001). Le délai d'arrivée de SP était plus long lors d'un appel au 15. En revanche, aucune différence de survie n'est observée entre les appels arrivés au 15 ou au 18. Conclusion : La survie consécutive à un ACEH durant la pandémie est extrêmement faible. Cependant, quel que soit le numéro composé (15 ou 18), la survie n'est pas différente, même si le délai d'arrivée des prompts secours est plus court lors d'un appel au 18.Alternate abstract: Introduction: Our aim was to analyze the outof-hospital cardiac arrest (OHCA) care and patients' survival during COVID-19 pandemic by comparing the emergency phone number called to initiate the alert [EMS(#15) or firefighters(#18)]. Procedures: We used data from the French OHCA Registry (RéAC), between March 1, 2020 and April 30, 2020. We performed three comparisons of patient cohorts: 1) COVID vs non-COVID;2) 15 vs 18 calls and 3) in COVID patients, 15 vs 18 calls. Results: We included 870 OHCA, among them, 184 were affected by COVID-19. There were 487 (56%) calls to 15 and 383 (44%) to 18. Patient survival at D+30 during the study was 3%. COVID+ patients had a lower survival rate at D+30 than non-COVID patients (0% vs. 4%, P < 0.001). Firefighters had a long time to arrive on the scene for calls to 15. No difference in survival was observed between 15 or 18 calls. Conclusion: The poor survival of patients during the pandemic is multi-causal but does not appear to be related to the emergency phone number called to initiate the alert [EMS (#15) or firefighters (#18)] even if the arrival time for prompt assistance is shorter on the call to 18.

Vaccination status and knowledge of CPR do not affect medical students' decision to perform BLS during the COVID-19 pandemic

Introduction: To address the risks of transmission by COVID-19, various recommendations been released by medical societies, which include strongly advocating for the use of personal protective equipment. In addition, hands-only cardiopulmonary resuscitation (CPR) has also been promoted among cardiac arrest victims. Some studies which evaluated healthcare practitioners' attitudes towards CPR during the pandemic showed negative attitudes in responding to those who have unknown COVID-19 status citing safety as the primary reason. At present, there is no study which evaluates the attitudes of medical students towards Basic Life Support (BLS) during the pandemic. Purpose(s): The study aimed to determine the factors associated with willingness of medical students to perform basic life support in out-of-hospital cardiac arrest during the COVID-19 pandemic. Method(s): This is a cross-sectional study using online surveys. We performed face validation and pilot study on 39 medical students. The main survey was disseminated in Metro Manila schools wherein 349 medical students participated. Questions included demographic data, prior BLS training, and vaccination status, evaluated knowledge of CPR, and determined their attitudes on CPR during the pandemic. Result(s): Results showed that 338 (97%) were willing to do CPR during the pandemic. Majority are fully vaccinated (99%) and are BLS-trained (75%). The median total knowledge score was 7 out of 10. Of all participants, 37 (11%) had a perfect score. Most (79%) had a passing mark. Majority (61%) claimed that a victim's vaccination status does not play a role in deciding to perform CPR. Among the unwilling, 55% factored in a victim's vaccination status. Most who agreed to perform CPR will do so if they are provided with adequate protection (55%). Simple and multiple logistic regression analyses showed that students who will do CPR on a patient who is not fully vaccinated or has unknown vaccination status have about 5 times higher odds of having the will to perform BLS during the pandemic. It also found that there is no correlation between knowledge, vaccination status, and prior training with choosing to perform BLS during the pandemic. This means that if a student is willing to do CPR on a victim wherein chances of contracting COVID-19 infection are higher, then their likelihood of performing BLS regardless of victim status, during the pandemic is five times more likely. Conclusion(s): Most Filipino medical students are willing to perform BLS during the pandemic and in spite of risks of COVID-19 transmission. Their adequate knowledge, full vaccination status, or prior training did not influence their decision. In a pandemic situation, the students' willingness to perform CPR among those with unknown COVID-19 status influences their decision to perform BLS in general.

Out-of-hospital management strategies for gastric cancer patients during the COVID-19 outbreak.

Since the outbreak of Corona Virus Disease 2019 occurred in December 2019, the reduction of population mobility has curbed the spread of the epidemic to some extent but also prolonged the waiting time for the treatment of patients with gastric cancer. Based on fully understanding the different staging characteristics of gastric cancer, clinical departments should develop reasonable out-of-hospital management strategies. On one hand, reasonable communication channels should be established to allow patients to receive adequate guidance out of the hospital. On the other hand, shared decisions with patients should be made to adjust treatment strategies, and education on viral prevention should be implemented to minimize the impact of the epidemic on tumor treatment.Copyright © 2020 by the Chinese Medical Association.

Analysis of the impact of various risk factors on short-term and long-term outcomes in patients with COVID-19 on maintenance hemodialysis.

Patients receiving renal replacement therapy (RRT) in the form of maintenance hemodialysis (MHD) belong to a group of particularly high risk of infection and the course of COVID-19. The new coronavirus infection also has a great impact on long-term outcomes. Material(s) and Method(s): A retrospective observational study included 510 patients on MHD, hospitalized from April 1, 2020 to April 01, 2021. The outcome of hospitalization was chosen as the primary endpoint of the study: discharge or 28-day mortality. Death within 6 months after discharge and the development of complications related to COVID-19 during this period were considered as secondary endpoints. Data collection was carried out by analyzing electronic and archival medical records. Quantitative variables: age, duration of hospitalization, days in the intensive care unit, laboratory blood parameters: the level of D-Dimer, Glucose, Interleukin-6, Procalcitonin, Lymphocytes and Platelets, CRP, CPK, CPK-MB, LDH, Fibrinogen, Ferritin. Qualitative indicators: gender, ventilator, ARDS, the presence of diabetes, the presence of obesity, the presence of complications: cardiovascular, gastrointestinal, septic, macrothrombotic, stage of pneumonia. To identify statistically significant predictors of the risk of an event, the odds ratio (OR) method was used. Result(s): average age 57.8+/-14 years, men - 59.5%, average bed day 17.6+/-10.6 days. In concomitant diseases, diabetes mellitus was indicated in 24% of patients, obesity was registered in 4.3% of patients. Hospital mortality (28-day) in the total cohort of follow-up was 16.05%, in total with out-of-hospital mortality of 22%. Mortality in intensive care reached 62.7%, on ventilator more than 86%, with ARDS 94.3%. No statistical significance was revealed by gender and the presence of diabetes mellitus (DM) in concomitant diseases. When comparing short-term outcomes, the age groups over 65 differed statistically. The following laboratory blood parameters showed a significant difference (P<0.001): D-Dimer, Glucose, IL-6 lymphocytes, Leukocytes, Neutrophils, Platelets, LDH, Ferritin. The following odds ratios (OR) were obtained: ARDS (OR 143.78;95% CI 33.4-616.2;p=0.0001), on ventilator (OR 57.96;95% CI 23.1-144.5;p=0.0001), the presence of septic complications (OR 26.4;95% CI 13.8-50;p=0.0001), the course of the disease is defined as severe (OR 25;95% CI 12.9-48.2;p=0.0001), the course of the disease is defined as complicated (OR 11.6;95% CI 6.8-19.7;p=0.0001), the presence of gastrointestinal complications (OR 6.5;95% CI 2.28-18.4;p=0.0007), the presence of obesity (OR 2.57;95% CI 1.0-6.5;p=0.039). Mortality of patients receiving two main treatment regimens T-1 and T-2 did not differ (15.8% vs 15.7%). Significant differences (p=0.0001) appeared when compared with the T-0 and T-4 schemes, in which mortality was recorded at 8.8% and 85.7%, respectively. When comparing long-term outcomes, the analysis did not reveal statistical significance by gender. The statistical difference was noted by age. Among laboratory indicators, the PCT level was higher in survivors with complications. A significant difference among all survivors and deceased (P<0.001) was shown by: D-Dimer, blood glucose level, IL-6, CRP. The highest OR was calculated for the following indicators: the presence of gastrointestinal complications (OR 7.7;95% CI 1.0-57.7;p=0.03), the initial LDH blood level of 622 units /l (OR 4.7;95% CI 1.63-13.63;p=0.0086), the course of the disease defined as complicated (OR 4.05;95% 1.97-8.33;p=0.003), the course of the disease is defined as severe (OR 2.4;95% CI 1.17-5.0;p=0.03). Conclusion(s): gastrointestinal complications had the greatest impact on unfavorable short-term and long-term outcomes in patients on programmed hemodialysis. In relation to such laboratory markers as Ferritin, CRH, LDH, threshold values of a significant increase in the chances characteristic of dialysis patients were obtained. During the first year of the epidemic, therapy remained largely supportive and aimed at prevent ng complications, the main isolated treatment regimens showed no significant differences in the impact on the outcomes of COVID-19.Copyright © 2022 Interregional public organization Association of infectious disease specialists of Saint-Petersburg and Leningrad region (IPO AIDSSPbR). All rights reserved.

Characteristics of patients with acute coronary syndrome in the COVID-19 pandemic: Acute coronary syndrome characteristics in patients with COVID-19

Aim: Coronavirus disease 2019 (COVID-19) has caused thrombotic disease. In this study, we aimed to determine the demographic and clinical characteristics of acute coronary syndrome (ACS) patients infected with COVID-19 and to investigate whether they differ from patients with ACS without COVID-19 in terms of these characteristics. Material(s) and Method(s): The study was designed as a single-center retrospective study. Thirty-three COVID-19 infected ACS patients (Group 1) and 100 ACS patients without COVID-19 infection (Group 2) were included in the study. Result(s): The groups were compared in terms of coronary angiographic data. Twenty-eight (84.8%) patients in Group 1 and 74 (74%) patients in Group 2 were presented as non-ST elevation myocardial infarctus. Patients were compared in terms of baseline Thrombolysis in Myocardial Infarctus (TIMI) flow, thrombus stage, myocardial blush (end), using of thrombus aspiration catheter, stent thrombosis, and TIMI flow after percutaneous coronary intervention, and it was observed that there was no statistical difference between the groups (p> 0.05). Discussion(s): COVID-19 infection can cause plaque rupture, myocardial damage, coronary spasm and cytokine storm by triggering the coagulation and inflammation process. The fact is that we did not encounter an increased thrombus load in this study.Copyright © 2022, Derman Medical Publishing. All rights reserved.

Evaluate the Features of Ohca Patients Living in Pakistan Both before and after the Covid-19 Epidemic in Order to Determine Their Outcomes

Aim: Bystander cardiopulmonary resuscitation (CPR) combined with public-access defibrillation has been shown to enhance overall survival for out-of-hospital cardiac arrest. This is one of top reasons of mortality across the globe. The COVID-19 global epidemic has modeled numerous problems for emergency medical services, along with reference of compression-only resuscitation also guidelines for comprehensive protective equipment. These suggestions and advice have created shortcomings and protracted fast response. On the other hand, the risk variables that determine the results of OHCA while the pandemic is ongoing are not well established. The main aim of our research remained to exploremedical features in addition results of OHCA individuals in Pakistan both before and after the COVID-19 epidemic. Method(s): The electronic medical records and paper records kept by EMS were utilized to compile the data for this single-center, retrospective observational analysis. The number of emergency hospital returns based on varying qualities in Sir Ganga Ram Hospitalized patients during and prior to the COVID-19 pandemic in Pakistan were collected. Patients with OHCA who went to the emergency department at Sir Ganga Ram Hospital in Lahore before the COVID-19 pandemic (April 2019 to March 2020) were identified. Result(s): Here were a total of 145 patients who participated in this study (80 males, or 58.2% of the total;mean [SD] age, 64.7 years);64 among those individuals contributed in our currentresearch during the COVID-19 era, and 75 among those individuals contributed in our currentresearch before COVID-19 period. Bystander witnessing and method of chest compression was always the two general baseline features that were found to be substantially different between the two groups (p-values of less than 0.002 and less than 0.002, accordingly). Duringthe COVID-19 era, the ED ROSC was substantially lower than it had been before the COVID-19 period (25.68 percent vs 45.04 percent;adjusted odds ratio of 0.22;p-value less than 0.002) Survival to admission remainedsuggestivelyinferiorthroughout COVID-19 phase compared to the previous time period (26.01 percent vs 41.78 percent, accustomed odds ratio of 0.27, p-value of 0.006). On the other hand, there was no important statistically substantial difference in the 28-day survival rates (4.5% throughout COVID-19 era also 11.54% earlier COVID-19 period). Conclusion(s): Patients who had cardiac arrest outside of a hospital in Pakistan had a much lower chance of surviving long enough to be admitted during the COVID-19 epidemic that occurred there. In addition, the two groups' witness reactions and methods of cardiopulmonary resuscitation couldn't have been more different from one another.Copyright © 2023, Anka Publishers. All rights reserved.

The comparison of emergency medical service responses to and outcomes of out-of-hospital cardiac arrest before and during the COVID-19 pandemic in Thailand: a cross-sectional study.

BACKGROUND: During the coronavirus disease 2019 (COVID-19) pandemic, the format of patients with out-of-hospital cardiac arrest (OHCA) management was modified. Therefore, this study compared the response time and survival at the scene of patients with OHCA managed by emergency medical services (EMS) before and during the COVID-19 pandemic in Thailand. METHODS: This retrospective, observational study used EMS patient care reports to collect data on adult patients with OHCA coded with cardiac arrest. Before and during the COVID-19 pandemic was defined as the periods of January 1, 2018-December 31, 2019, and January 1, 2020-December 31, 2021, respectively. RESULTS: A total of 513 and 482 patients were treated for OHCA before and during the COVID-19 pandemic, respectively, showing a decrease of 6% (% change difference =- 6.0, 95% confidence interval [CI] - 4.1, - 8.5). However, the average number of patients treated per week did not differ (4.83 ± 2.49 vs. 4.65 ± 2.06; p value = 0.700). While the mean response times did not significantly differ (11.87 ± 6.31 vs. 12.21 ± 6.50 min; p value = 0.400), the mean on-scene and hospital arrival times were significantly higher during the COVID-19 pandemic compared with before by 6.32 min (95% CI 4.36-8.27; p value < 0.001), and 6.88 min (95% CI 4.55-9.22; p value < 0.001), respectively. Multivariable analysis revealed that patients with OHCA had a 2.27 times higher rate of return of spontaneous circulation (ROSC) (adjusted odds ratio = 2.27, 95% CI 1.50-3.42, p value < 0.001), and a 0.84 times lower mortality rate (adjusted odds ratio = 0.84, 95% CI: 0.58-1.22, p value = 0.362) during the COVID-19 pandemic period compared with that before the pandemic. CONCLUSIONS: In the present study, there was no significant difference between the response time of patients with OHCA managed by EMS before and during COVID-19 pandemic period; however, markedly longer on-scene and hospital arrival times and higher ROSC rates were observed during the COVID-19 pandemic than those in the period before the pandemic.