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Objective: Multiple major health organisations recommend the use of extracorporeal membrane oxygenation (ECMO) support for COVID-19-related acute hypoxaemic respiratory failure. Method(s): From march 2020 to november 2021 we done 108 veno-venous ECMO therapies. 35 patients required implantation immediately in intensive care unit in place of call by mobile ECMO team. Depend from distance of call it was used medical ambulance, rescue helicopter or medical plane. Result(s): In the first analyzed period (March-December 2020), 90-day mortality was 41%. 8 (7.6%) patients were discharged from the Intensive Care Unit. The remaining 3 (4.2%) were discharged home. 7 patients (6.6%) had both lung transplants. 7 patients (6.6%) required conversion to VV-A ECMO therapy due to the development of acute heart failure. Conclusion(s): In the analyzed period of March-December 2020, the mortality was 41%. As a result, the lower effect of regression of consolidation and inflammatory lesions of lung tissue indicates that ECMO therapy remains the treatment method in high-risk patients as a bridge therapy to lung transplantation.
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Remdesivir (RDV) is an antiviral medication used most recently for the treatment of COVID-19. Although no adverse effects were observed on perinatal parameters in reproductive and development toxicology studies at doses up to four-fold clinical area under the curve (AUC) exposures, some researchers have reported that therapeutic levels of RDV may impair early embryogenesis, as observed by in vitro studies. In addition, the influence of prenatal RDV exposure on maternal IgG transfer in the placenta is still unknown. Administration of RDV in pregnant humanized mouse model (Tg32), which expresses the human Fc gamma receptor and transporter (FCGRT) gene, was used to further evaluate potential effects on IgG transfer and concurrent perinatal endpoints. Animals were dosed daily from gestational days (GDs) 10- 14 with 25 mg/kg RDV (GS-5734) via intravenous injection (n=3-5 per group). Concurrent vehicle control animals were dosed intravenously with 12% sulfobutyl ether- beta-cyclodextrin in water (pH3.5;NaOH/HCl). All animals were administered 2 mg/kg human IgG via intravenous injection on GD 14. Placentae and fetuses were collected from dams on GD 14, 15, 16, and 18 and evaluated using histopathology and qPCR for inflammation markers. No abnormal morphologies (necrosis/apoptosis) of placentae were observed between the concurrent control and RDVdosed groups. Additionally, no differences in maternal body weights were observed. There were no statistically significant differences in placenta weights. There were no statistically significant changes in pregnancy parameters (implantation sites and dead fetuses/litter) and fetal weights between the RDV-dosed group and concurrent controls at GD 14, 15, 16, and 18. No changes were observed in transcript levels of inflammation markers in the RDV-dosed group when compared to the concurrent control group. There was a slightly lower ratio of fetal IgG level to maternal IgG levels in the RDV-dosed group;however, no statistically significant differences were observed between the RDV-dosed group and concurrent controls on GD 14, 15, 16, and 18. Our results suggest that a daily dose of 25 mg/kg RDV on GDs 10-14 in humanized mice did not cause adverse effects on placenta and fetal development. (Funded by the Perinatal Health Center of Excellence: E0300201.).
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Introduction: Spinal cord and dorsal root ganglion stimulation (SCS and DRG) are standard of care in chronic neuropathic pain. During the COVID-19 pandemic, it was critical to arrange postoperative care. Furthermore, the disparity between travel times and transportation options could influence the decision on seeking healthcare. Lacking financial resources could enhance this issue. Telehealth is usually restricted to video conferences, without interfering with implanted medical devices. Now, there exists a platform for remote programming of those devices. It is accessible via smartphones and allows direct contact between a patient and their doctor. Method(s): We initiated a pilot study for evaluating the performance of remote care in patients with SCS or DRG stimulation. We plan the enrollment of 20 patients, 10 each in the retrospective and the prospective group. Retrospective data has been collected from on-site programmed patients in our outpatient clinic in a large registry study. Prospective data is being collected under the new standard of care in the remotely programmed patients. We assess ten scores and categories to evaluate the status preoperatively, at implantation, and the postoperative course. The postoperative data are assessed in the context of video conferences for remote programming. 12 months after implantation, a final video conference is scheduled. In both groups, the same stimulation systems are used. Result(s): The study is ongoing. In the retrospective group (n=8), the mean duration of the programming appointment including waiting time was 43 minutes and the mean travel time 71 minutes (mean travel distance 106km with corresponding costs). So far, 5 patients have been enrolled for remote programming. Measured with the Telehealth Usability Questionnaire, their overall satisfaction with the system is high. In the Patient Global Impression of Change Scale 6 months after implantation, the retrospective group has a mean of 5 and the prospective group of 6 points. Considering the Visual Analog Scale, there was an improvement in both groups between the baseline and follow-up (in the retrospective group from mean 8 to 5 and in the prospective group from mean 8 to 2). Conclusion(s): The general convenience with the remote programming is high. Compared to the retrospective group, the patients do not experience a lack of efficacy of their stimulation. The use of remote programming offers various advantages, e.g., no travel times nor costs that allow simplified and more frequent programming. Especially in a pandemic or in case of travel limitations it is a very helpful tool. Disclosure: Mareike Mueller, MD: None, Andrea Dreyer: None, Phyllis McPhillips, RN: None, Guilherme Santos Piedade, MD: None, Sebastian Gillner, MD: ABBOTT: Consulting Fee:, Boston Scientific: Consulting Fee:, Philipp Slotty, MD: None, Jan Vesper, MD,PhD: Abbott: Consulting Fee:, Abbott: Fees for Non-CME/CE Services (e.g. advisor):, Medtronic: Fees for Non-CME/CE Services (e.g. advisor):, Boston Scientific: Consulting Fee:, Medtronic: Consulting Fee:, UniQure: Fees for Non-CME/CE Services (e.g. advisor):, ABBOTT: Consulting Fee:, Abbott: Speakers Bureau:, ABBOTT: Consulting Fee: Self, ABBOTT: Speakers Bureau: Self, ABBOTT: Contracted Research: Self, Boston Scientific: Consulting Fee: Self, Boston Scientific: Contracted Research: SelfCopyright © 2023
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Background: Only recently studies have been able to demonstrate the safety and efficacy of purification therapies in inflammatory diseases. Here we present the management of a young (21y) male patient in severe cardiogenic shock due to COVID-19 perymyocarditis admitted to the ICU at Bolzano Central Hospital. November 30th 2020 the patient developed high fever (>40 C) and diarrhea. After unsuccessfully being treated orally with a macrolide he was admitted to a peripheral hospital the 4th of December. The day after he deteriorated, required transfer to the ICU, endotracheal intubation and pharmacological cardiovascular support (Norepinephrine, Levosimendan). Antimicrobial treatment was started with piperacillin/tazobactam, linezolid and metronidazole. Despite multiple radiological and microbiological diagnostic attempts the origin of this severe septic shock remained unclear. December 6th the patient was transferred to Bolzano Central Hospital for VA-ECMO evaluation. Method(s): The transesophageal echocardiography revealed 15-20% of EF, lactate (5,2 mmol/l), cardiac enzymes (TropT 1400 mcg/l) and inflammatory parameters (PCT 35 ng/ml, IL-6 685 pg/ml) were elevated. We performed cardiac monitoring via Swan-Ganz catheter. The cardiac index was 1,6 l/min/m2. The peak dosage for Norepinephrine reached 7,5mg/h (1,47 mcg/kg/min). At Bolzano ICU we facilitate the pharmacological therapy with milrinone, vasopressin and low dose epinephrine. Furthermore, we impost continuous hemodiafiltration with CytoSorb filter. Result(s): Only hours after the start of filtration therapy the patient improved and we were able to gradually reduce catecholamine therapy, lactate values decreased. A VA-ECMO implantation was no more necessary. December 10th, we saw a stable patient without ventilatory or cardiovascular support, at echocardiography we revealed a normal EF. Conclusion(s): Clinically we saw a young patient in severe septic/cardiogenic shock due to perimyocarditis. Yet diagnostic attempts (CT-scan, multiple blood/urinary/liquor cultures) remained negative. Despite multiple negative PCR tests for SARS-CoV2 infection we performed specific immunoglobulin analysis and received a positive result for IgM. We therefore conclude on a COVID-19 associated perymyocarditis. Furthermore, this case illustrates the potential benefit of cytokine filtration and elimination in COVID-19 patients with altered IL6 levels.
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Objectives: Extracorporeal membrane oxygenation has been widely used in patients with severe respiratory failure due to Covid-19 infection. ECMO was initiated at ECMO center or implantation performed in regional hospitals and patients transferred to ECMO center for further treatment. The aim of the study was to evaluate characteristics and outcomes of patients retrieved with ECMO versus thoseimplanted in our institution. Method(s): Retrospective, single center study. Data of all Covid-19 patients, supported with ECMO from 2020.04.01 to 2022.06.01 in our institution were evaluated. Data of patients retrieved on ECMO to our hospital were compared with data of patients when ECMO support was initiated at our institution. Result(s): During Covid-19 pandemic 54 patients with severe respiratory failure were supported with ECMO. Out of them 24(44.4%) patients were retrieved on ECMO. In all patient VV configuration was used. There were no significant differences of preoperative characteristics between retrieved vs institutionally cannulated patients (mean age 44 +/- 16 vs 45 +/- 12 years, pre-ECMO arterial pO2 62 +/- 16 vs 66 +/- 14 mmHg, pre-ECMO mechanical ventilation 2.1 vs 2.2 days). The overall survival to hospital discharge was 32%, 33% in patients retrieved with ECMO vs 30% in the group of patients with ECMO implantation on site. Conclusion(s): Patient characteristics and hospital survival of patients who were retrieved with implanted ECMO to our ECMO center were comparable to those patients with ECMO implantation on site.
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Objectives: The effectiveness of prone positioning (PP) under VV-ECMO for severe COVID-19 still be unclear. Until now, PP under VV-ECMO was often performed as the trump card for refractory hypoxemia and weaning off ECMO. On the other hand, PP has the effect of promoting homogenization of Lung aeration and leading to prevention of VILI. Combine use of early prone positioning together VV-ECMO may have synergy effects of ultra-lung protective strategy. In this study, we analyzed early PP cases under VV-ECMO for severe COVID-19 in our hospital and examined their efficacy and feasibility. Method(s): We performed a retrospective study of patients with SARS-CoV-2-induced ARDS submitted to early PP during VV-ECMO. During VVECMO, PP was considered in case of "Type-H transition in imaging findings (CT / LUS) " and cases that the physician deemed necessary. The lung aeration is evaluated by LUS before and after each PP. If there is a finding that the dorsal collapsed lung is improved through PP, it is implemented as effective, and it continued. Result(s): From April 2021 to August 2021, there were a total of 10 early PP cases under ECMO, and the age was (average) 56 years. ECMO was implanted with P/F 98 and Murray score 3.3 points, and PP was started 14 hours after the ECMO implantation. The average PP duration is 17.4 hours and PP performed 5.8 times per patient. Comparing blood gas and respiratory mechanics before and after PP showed a significant difference in PaCO2 (before: 46 +/- 8 vs after: 42 +/- 9, p = 0.02). Finally, there were 10 ECMO successful weaning (100%) and 8 surviving discharges (80%). No major complications were observed. Conclusion(s): Early PP under VV-ECMO for severe COVID-19 can be safely performed, and it is suggested that the synergy effect of ultra-lung protective strategy may be associated with a reduction of hospital mortality.
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Background: The COVID-19 pandemic has had an unprecedented impact on the United States health system and its ability to deliver care. In particular, surgical and interventional procedures suffered a significant decline in the early stages of the pandemic for a multitude of reasons including, PPE and personnel shortages, the deference of elective procedures, and governmental bans on elective procedures. The impact of these factors on electrophysiology (EP) procedural rates in the United States is unknown. Objective(s): To study the impact of the COVID-19 pandemic on EP procedural volume in the United States (2019-2020). Method(s): We analyzed the National inpatient sample (2019-2020) to identify hospitalizations involving EP procedures using ICD-10-PCS codes. Weighted analysis was performed to determine the number of procedures performed on a monthly basis. The US census data was employed to ascertain procedure rates per million population, the trends of which are displayed in Figure 1. Result(s): A total of 236,991 EP procedures were performed in 2020 - a 9% decrease from 2019 (n= 260,615). This included an annualized 11.25% decrease in device implantations (ICD and PPM), a 7.7% drop in AF ablations, and a 5.4% decrease in VT ablations as compared to 2019. Interestingly rates of left atrial appendage occlusion (LAAO) procedures saw an annualized 3.7% increase in 2020. The maximal per-month decline in procedural volume was noted in April 2020. An overall decline of 48% in EP procedures was noted, with the most precipitous drop with LAAO (90%), followed by AF Ablation (65%), PPM (4.3%), ICD (3.8%), and least with VT ablation (2.5%). Conclusion(s): The COVID-19 pandemic has had a significant and heterogonous impact on EP procedural volume. Despite a precipitous 48% decline in April 2020, overall, 2020 procedure rates have recovered to a 9% drop from 2019. [Formula presented]Copyright © 2023
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More than one-third of the cases of infective endocarditis (IE) occur in older patients. The disease is often characterized by atypical symptoms. The incidence of neurological complications is high and represents a strong independent predictor of severe outcomes and mortality. IE is a rare but serious complication of transcatheter aortic valve implantation (TAVI). A persistent delirium as a unique manifestation of post-TAVI IE in an older patient is presented in this clinical case.
Subject(s)
Aortic Valve Stenosis , Delirium , Endocarditis, Bacterial , Endocarditis , Prosthesis-Related Infections , Transcatheter Aortic Valve Replacement , Humans , Aged , Transcatheter Aortic Valve Replacement/adverse effects , Prosthesis-Related Infections/epidemiology , Prosthesis-Related Infections/etiology , Endocarditis/etiology , Endocarditis/complications , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/etiology , Delirium/etiology , Delirium/complications , Aortic Valve Stenosis/surgery , Aortic Valve , Treatment Outcome , Risk FactorsABSTRACT
Background: According to the Italian National Statistical Institute, the 12- month probability of survival in the general population between 90 and 94 years-old is 26%. Pacemaker (PM) implantation is often an urgent and necessary intervention, but in these patients the benefit in terms of quality and duration of life is unclear. Purpose(s): To analyze characteristics, outcome and factors associated with survival in patients who had turned 90 at the time of PM implant. Method(s): All the PM implants performed in patients >=90 from 1/1/2019 to 12/31/2020 were analyzed. Clinical parameters, device characteristics and follow-up data were extrapolated from the SuitEstensa Ebit reporting system;the exitus was verified by analyzing data from the Regional Health System. Result(s): During the study interval, among the 554 patients undergoing PM implantation in our Center, 69 (12%) were >=90 years-old (mean age 92+/-2 years, 46% male;complete/advanced AV block in 76%). Twenty-six (38%) patients had history of atrial fibrillation and 19 (28%) ischemic heart disease. A cardiological co-morbidity (excluding AF) was present in 23 patients (33%). Oncological, pneumological and neurological comorbidities were present in 12 (18%), 19 (28%) and 32 (46%) respectively. Renal impairment was present in 25 patients (36%). In 47 patients (68%) there were at least 2 co-morbidities. After implantation (single-chamber in 36, dualchamber in 25 and VDD single-lead dual-chamber in 8 patients) complications occurred in 3 patients (2 pneumothorax and 1 lead dislodgment). Remote monitoring was activated in 57 patients (83%). Within August 31st 2021 (mean follow-up 288+/-193 days) 24 patients died (35%, 219+/-241 days after implant). Five patients (19% of patients implanted in 2019) died within 12 months. No patients died for device malfunction. Three patients died because of COVID-19 pneumonia. Renal dysfunction (Hazard Ratio-HR 8.05, p=0.002) and the presence of 2 or more co-morbidities (HR 6.03;p=0.015) were associated with a higher risk of death at univariate analysis;other significant variables were diabetes (HR 2.34;p=0.038), left ventricular ejection fraction (LVEF) (HR 0.70 for 5% variation;p=0.005), walking impairment (HR 2.99, p=0.006), the presence of oncological (HR 2.21;p=0.003), pneumological (HR 2.55;p=0.024) and neurological (HR 1.90, p=0.007) comorbidities. At multivariable analysis the only significant parameter associated with survival was LVEF (0.76 for 5% difference;p=0.043) Conclusion(s): At our Center, patients >=90 years-old undergo PM implantation mainly for advanced AVB. The good survival in the medium term, even better than expected in the general population, does not justify a too conservative attitude especially, but exclusively, in patients with less comorbidities.
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We offer an elegant new and straightforward paradigm to implant false autobiographical memories. Participants received 20 autobiographical events including a critical false event (i.e., swimsuit falling off) and had to indicate whether they ever experienced these events. After 1 week, participants who did not experience the false event received a second survey suggesting that they actually did experience the false event. Participants had to provide belief and recollection ratings and event-related details. Also, one group of participants was told that the false event happened once (Single group) while the other group was told that the event happened repeatedly (Repeated group). Depending on the memory type (e.g., false belief or false memory), false memory implantation ranged between 9% and 30%. Furthermore, false beliefs were most likely to be elicited in the Single group. This novel paradigm can offer new insights on how false autobiographical memories can be implanted. (PsycInfo Database Record (c) 2023 APA, all rights reserved) Impact Statement A bitter controversy exists surrounding the topic of therapy-induced false memories. Because of this controversy, memory scholars have devised several ways to create false memories. The "lost-in-the-mall" paradigm has become the popular procedure to implant false autobiographical memories. Although the paradigm is highly influential, the paradigm is time consuming and requires extensive training to interview participants and score participants' reports. Therefore, we offer an elegant new and straightforward paradigm to implant false autobiographical memories. Inspired by the memory blindness literature and because of the COVID-19 pandemic, we created a new paradigm that can be fully implemented online. In this paradigm, subjects receive a list of twenty autobiographical events including a critical false event (i.e., swimming trunks falling off), and have to indicate whether they ever experienced these events. Following a 1-week interval, participants stating that they did not experience the false event receive a second survey suggesting that they actually did experience the false event and stating that they experienced several true events. Participants have to provide, before and after receiving imagination instructions, belief and recollection ratings, and event-related details. In the present study, we also told one group that the false event happened once (Single group) while the other group was suggested that the event happened repeatedly (Repeated group). Depending on the memory type (e.g., false belief or false memory), false memory implantation ranged between 9% and 30%. Furthermore, false beliefs were most likely to be elicited in the Single group while false memory rates did not statistically differ between groups. This novel paradigm can offer new insights on how false autobiographical memories can be implanted. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
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Background Over the past 20 years, transcatheter aortic valve replacement (TAVR) has been safely and rapidly adopted in the U.S., representing a paradigm shift in the management of aortic stenosis. Despite the growing demand for TAVR, little is known about the process from referral to TAVR (time to TAVR). This survey-based study aims to identify factors that impact this process. Methods In 2022, an online survey was emailed to structural heart program coordinators at a large health system (27 programs, n=27) to assess structure-, process-, and patient-related factors that impact the time to TAVR. Descriptive statistics of key care pathway checkpoints, and barriers encountered in the process are reported. Results The response rate was 81% (n=22). Most programs reported taking 3 days or less from the valve clinic referral to 1st contact with pt (n=15, 68%), 2 weeks or less from 1st contact to 1st clinic visit (n=17, 77%), and 2 weeks or less from 1st clinic visit to scheduled TAVR (n=16, 73%). Staffing, scheduling computed tomography, COVID restrictions, authorizations, comorbidities were common barriers impacting the time to TAVR. Conclusion Understanding factors impacting the time to TAVR as well as key metrics of efficiency along this process is critical for responding to its growing demand. [Formula presented]Copyright © 2023 American College of Cardiology Foundation
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Background Prolonged wait times for Transcatheter Aortic Valve Replacement (TAVR) are associated with increased mortality. Rural health care systems may have challenges in efficiency due to travel related delays. We determined temporal trends and predictors of Short TAVR Wait Time (STWT: TAVR <=30 days from first referral). Methods We identified 918 consecutive patients with Aortic Stenosis (AS) undergoing TAVR from 1/1/19-6/30/22 at a rural tertiary care center. Patients with wait times?>90 days (N=87) were excluded due to patient preferences or treatment of comorbidities. We assessed TAVR wait times (means and STWT%) over time and determined the impact of COVID 19 onset (3/1/20) and driving distance on TAVR efficiency. Results Half of the cohort achieved STWT (51%). TAVR volumes, patient age, sex, and comorbidities were generally stable over time. Mean wait times decreased despite the onset of COVID 19: pre-COVID 36+/- 19 vs post-COVID 31+/- 19 days (p=0.003) (Figure). There was no interaction of travel distance and mean wait time: 33+/- 19 days <= 60 miles vs 32+/- 19 days?> 60 miles (P=NS). Conclusion TAVR efficiency improved over the past 4 years with one half of patients experiencing a STWT. Neither COVID 19 nor long travel distance negatively impacted TAVR efficiency in a rural health care network. [Formula presented]Copyright © 2023 American College of Cardiology Foundation
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Background: Patients with COVID-19 are generally primarily treated in regional medical centers. Besides oxygen therapy, treatment usually involves mechanical ventilation and prone positioning should the patient develop acute respiratory distress syndrome (ARDS). In patients with refractory respiratory failure, initiation of veno-venous extracorporeal membrane oxygenation (vv-ECMO) may be the last therapeutic resort. Treatment with vv-ECMO requires highly experienced medical equipment and personnel. ECMO centers may be able to aid the regional medical centers, as this is not available for most hospitals. Implantation of the vv-ECMO system at the bedside and subsequently transporting the patient to a specialized center for further therapy could relieve both regional and specialized hospitals. Method(s): All patients in the participating centers of the DIVI between January 2020 and March 2021 with severe COVID-19induced ARDS were evaluated. Patients treated with vv-ECMO were included. Two groups were determined. The first group (group A) consisted of patients primarily treated in a regional medical center. These patients were cannulated at the bedside and transferred to the ECMO center. Group B consisted of patients directly referred to a specialized ECMO center. A comparison between mortality and ECMO-associated complications was made. Result(s): In total, 650 patients were treated with vv-ECMO in the timeframe. Group A consisted of 195 patients and group B of 455 patients. Patient characteristics such as sex, body mass index and pre-existing comorbidities were comparable. The time to admission to the intensive care unit was for both groups comparable. The delay from intubation to ECMO implantation was significantly shorter in group A 4.3 +/- 0.4 days versus 6.5 +/- 0.3 days (p < 0.001). Total time on mechanical ventilation, days spent in the intensive care unit and ECMO runtime were comparable in both groups. Furthermore, there was no significant difference in ECMO-associated complications and mortality. Conclusion(s): Respiratory failure due to severe COVID-19 pneumonia may primarily be treated in a regional medical center. There is no significant increase in ECMO-associated complications and mortality due to ECMO implantation and patient transfer to a specialized center, should therapy escalation be needed.
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Objective: To evaluate the need for cardiac monitoring of unselected patients recovered from COVID-19 and to estimate the risk of development of arrhythmias after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Result(s): Presence of significant pathology detected was rare (one paroxysmal atrial fibrillation in 73-year-old woman with dilated left atrium;71-year-old man with atrioventricular blockade with indication for implantation of the pacemaker, when cardiac MRI didn't find any signs of myocardial inflammation. After evaluation both were not related to previous SARS-CoV-2 infection. During one-year follow-up after COVID-19 infection there was no change in heart rate variability evaluated by SDNN (V1 vs V3 156.6+/-40.6 vs 156,0+/-38.0;p = 0.855), rMSSD (V1: 33+/-13.95 to 30.6+/-12.89;p = 0.175) and triangle (V1: 28.5+/-7.8 to 29.5+/-8.8;p = 0.488). Dividing heart rate oscillations into low-frequency (LF), and high-frequency (HF) bands, we have found statistically significant changes between V1 a V3 for LF (718+/-433.7 to 646+/-361;p = 0.024) and HF (341.5+/-335 to 268.0+/-266;p = 0.032). These parameters are mostly affected by breathing rate and are representing possible autonomic dys-regulation (HF/LF ratio). Conclusion(s): Despite many information regarding cardiac impairment of SARS-CoV2 our study does not suggest an increased risk of development of arrhythmias after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) even in a population with high proportion of ongoing symptomatology. Some findings may suggest autonomic dysfunction after COVID-19. Based on our results the routine ECG monitoring is currently not recommended after COVID-19 recovery.
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Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic placed an enormous strain on the healthcare system. Data on the impact of COVID-19 on the utilization and outcomes of structural heart disease (SHD) interventions in the United States are scarce. Method(s): The National Inpatient Sample from 2016 to 2020 was queried to identify adult admissions for transcatheter aortic valve replacement (TAVR), left atrial appendage occlusion (LAAO), and transcatheter end-to-end repair (TEER). The primary outcome was temporal trends of procedure utilization rate per 100,000 admissions over quarters from 2016 to 2020. The secondary outcomes were adjusted rates of in-hospital mortality, major complications, and length of stay (LOS). Result(s): Among 434,630 weighted admissions (TAVR: 305,550;LAAO: 89,300;TEER: 40,160), 95,010 admissions (22%) were during the COVID-19 era. There was a decline during the second quarter of 2020 followed by an increase to the pre pandemic levels (TAVR: 220 to 253, LAAO: 57 to 109, and TEER:31 to 36 per 100,000 admissions, Ptrend<0.001) (Figure). There were no differences in the mortality or major complication rates. Median LOS has decreased in TAVR (4 days to 1 day) and in TEER (3 days to 1 day) but remained stable in LAAO (1 day). Conclusion(s): This nationwide analysis showed that SHD interventions decreased during the early waves of COVID-19 pandemic. There was a significant reduction in hospital LOS without differences in in-hospital mortality or complication rates during the pandemic. These data suggest that hospitals adapted to the unprecedent challenges during the pandemic to provide advanced cardiac care to patients. [Formula presented]Copyright © 2023
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Introduction: The COVID-19 pandemic forced the Hospital Pharmacy Service (HPS) to adapt the outpatient pharmaceutical care services to ensure continuity and prevent exposure of onco-haematology outpatients to the virus. This situation was used to optimize clinical outcomes, accessibility and security through the establishment of a telepharmacy program (TP). Two years later, we describe the experience and analyse the impact. Material(s) and Method(s): The HPS coordinated with the Oncology and Haematology Services a TP that included: - Adaptation of schedules to make appointments. - Database in Excel. - Organization with delivery company. - Acquisition of resources. - Implantation and extension to all candidate patients. - Analysis of results and quality control. TP was implemented on March 23, 2020 and continues today. The patients have an appointment for: first telematic consultation (start of treatment), successive consultation (continuation or switch) or successive home delivery. Results and discussion: 533 deliveries were performed to a total of 142 patients in 2 years, since the implementation of the TP: 408 deliveries to 136 patients during the first year and 125 to 51 during the second year. The maximum activity was in April 2020, which represented 43%. 120 visits to the HPS were avoided. Virtual pharmaceutical care was carried out for initiations or changes to 112 patients and 53 calls were answered by telephone consulting interactions, adverse effects, dosage or requesting deliveries. On the first 3 months, home deliveries did not suppose cost since Civil Protection carried them out voluntarily. After that, the rate was 14 euros/shipment, whichmeant a total of 3.400 euros in the studied period. Satisfaction surveys were conducted on 64 random patients: 97% rated the service received as excellent;the remaining 3% as good. The medication arrived in optimal conditions in 98% of shipments. In those cases that needed to contact the HPS, 91% always did;9% usually. Conclusion(s): 100% of patients would like to maintain this service in the future. However, in the last year, shipments have decreased by 70% compared to the previous year. TP has changed the practice of outpatient pharmacy and allows to adapt the pharmaceutical care during the COVID-19 pandemic.
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Objectives: To study the clinico-electrophysiological profile of patients with Infrahisian Wenckebach (IHW) conduction. Material(s) and Method(s): Patients with a clinical diagnosis of atrioventricular (AV) block who underwent permanent pacemaker implantation (PPI) based on standard indications from July 2021-June 2022 at The Madras Medical Mission were subjected to pre-implant Electrophysiology study to document conduction pathology. Result(s): A total of 94 patients underwent PPI for AV block during the study period. EPS was performed in all but one patient (COVID pneumonia). The incidence of IHW was 9/93 (9.6%) of patients with AV block. There is no gender predisposition (M-4, F-5) and their mean age was 71.4 +/- 11.7 years. As many as half of the patients (5/9) had an underlying narrow QRS. The mean QRS duration was 130 +/- 19.3. Ischemic heart disease affected half of the patients and cardiomyopathy in 4/9 patients (mean EF 45.1 +/- 13.7%). Presentation was syncope in all, mean NYHA class was 2.1. Presentation ranged from isolated 1st-degree AV block (1/9) to tri-fascicular block (3/9). In EP study, the mean basal HV interval was 94.7 +/- 27.1 ms. IHW was noted spontaneously in 4 patients and on atrial pacing in the remaining. In the literature, a total of 11 documented cases have been reported (8 case reports). Unlike typical Wenckebach, the increment in PRI is minimal in the 2nd beat of the train. Conclusion(s): Wenckebach periodicity is classically considered an AV nodal phenomenon. IHW is scarcely reported in the literature. Distinction becomes critical as IHW is harbinger of a complete AV block. This is the largest series and the first clinic-etiological profile of IHW patients published to date.
ABSTRACT
Background Fulminant myocarditis can cause biventricular dysfunction with a mortality rate over 40%. We report a case with severe biventricular failure due to fulminant myocarditis that was successfully supported by left and right ventricular assist devices. Case A 65-year-old woman presented with chest pain, abdominal pain and diarrhea. She was hypotensive and labs revealed elevated troponin-T of 13.5 ng/mL and lactate of 4.3 mmol/L. She was positive for COVID by antigen testing. She was started on multiple vasopressor infusions and admitted to the intensive care unit. Echocardiogram revealed a severely reduced left ventricular ejection fraction of 15% and severe global hypokinesis. The following day, she developed a wide complex tachycardia that was refractory to amiodarone, lidocaine and multiple defibrillation attempts. She was transferred emergently to the cardiac cath lab where coronary angiography revealed an isolated 70% stenosis of the distal left circumflex artery. A Swan-Ganz catheter was placed that yielded a cardiac index by Fick of 1.2 L/min/m2, systemic vascular resistance of 1270 dynesseccm-5 and mixed venous oxygen saturation of 35%. Decision was made to emergently insert an Impella CP device. That evening, she developed complete heart block and transvenous pacing wire was inserted. Due to frequent suction alarms, decision was made to insert ProtekDuo device, which resulted in hemodynamic stabilization. A temporary coronary sinus pacing lead for atrial capture was inserted to improve atrioventricular synchrony. After several days of monitoring, repeat echocardiogram showed complete recovery of biventricular function and Impella CP and ProtekDuo devices were removed. Decision-making The decision of early implantation of ProtekDuo device was made to provide adequate blood flow to the left ventricular assist device for hemodynamic support. In addition, increased atrioventricular synchrony via insertion of temporary coronary sinus pacing wire improved cardiac output. Conclusion Fulminant myocarditis involving biventricular dysfunction can be supported by the use of simultaneous left and right ventricular assist devices.Copyright © 2023 American College of Cardiology Foundation