ABSTRACT
Background and aims: Relative Bradycardia (RB) is a poorly understood condition that refers to inappropriately low heart rate response to a given increase in body temperature. Dysfunctional crosstalk between the immune system and the autonomous nervous system has been advocated. It is most often observed in intracellular gram negative and parasitic infections, with a prevalence ranging between 15% and 20%. The aim of this study was to identify the prevalence, clinical determinants and significance of RB in patients hospitalized for SARS-CoV-2 infection and to evaluate its prognostic value for long-covid syndrome during follow-up. Method(s): We enrolled consecutive patients hospitalized for SARS-CoV-2 infection from March 2020 to April 2021. We collected clinical parameters including clinostatic and orthostatic blood pressure (BP) and heart rate (HR) at 1,3 and 5 minutes, oxygen saturation, body temperature (BT), routine blood tests, 12-lead ECG, and 48-h Holter ECG. At follow up, clinical symptoms were investigated by novel Malmo POTS Symptoms (MAPS) questionnaire. Result(s): Total population included 269 inpatients (mean age 67+/-17 years, 59% male).Of these, 30 (11%) presented with sinus bradycardia and 37 (14%) RB. RB was more frequently observed in younger male patients with higher BT and heightened CRP levels. There were no significant correlations between BP and HR orthostatic changes and BR during hospital admission or during follow-up. No clinically relevant arrhythmias were revealed during 48-hour ECG monitoring. After mean16-month follow-up, MAPS score was higher in patients with RB (30+/-19) compared to those without RB (18+/-21, p=0.001) during index hospital admission. Dizziness, palpitations and fatigue were more frequently reported in patients with RB(p<0.001). Conclusion(s): RB is not an uncommon condition during acute COVID-19. SARS-CoV-2 inpatients who presented RB during index hospitalization showed a higher symptom burden during follow-up, as recorded by MAPS score. Further studies are needed to clarify the clinical significance of RB and its value to predict post-acute sequelae of COVID-19. (Figure Presented).
ABSTRACT
Background: Extracorporeal Membrane Oxygenation (ECMO) is being increasingly used among critically ill patients some of whom have multiple organ failure and need concurrent use of continuous renal replacement therapy (CRRT). Limited data are available regarding outcomes among such patients. Method(s): We report retrospective data on patients who were treated with ECMO with or without CRRT over a period of 36 months (Jan 2019 - Mar 2022) at hospitals within a single integrated healthcare system in Pennsylvania. Patients with end stage renal disease were not eligible to receive ECMO within this system. Result(s): 166 patients were treated with ECMO of whom 50 (30.1%) received CRRT during the course of their treatment. Mean age of patients on ECMO was 52.1 years (interquartile range 43-64), 68.1% were male;and 23.5% had Covid-19. Reasons for ECMO included cardiac arrest (43%), post cardiac surgery (18%), acute respiratory distress syndrome (38%) and transcatheter aortic valve placement (2%). Patients received either Venoarterial (VA) ECMO (45.8% patients;mean age 60.0) and its variant extracorporeal cardiopulmonary resuscitation (eCPR) (9.6%;mean age 50.9) or Venovenous (VV) ECMO (44.6%;mean age 44.4). A comparison among patients who needed CRRT versus those who did not is provided in figure 1. 38% patients who received CRRT survived to discharge compared to 62.9% who did not receive CRRT (p=0.003) Conclusion(s): Nearly 1 in 3 patients treated with ECMO needed CRRT at some point during their care. Patients who needed CRRT on ECMO were significantly less likely to survive to discharge. Nephrology service was involved in the care of ECMO patients from the beginning in some cases. However, there remains a need for early multi-disciplinary care for critically ill patients requiring ECMO therapy. (Table Presented).