Pre-hospital Management of COVID-19: Looking for a Future Perspective

Acute severe symptoms and long-term sequelae caused by the novel coronavirus disease (COVID-19) are still major concerns for public health. In particular, it is an emerging need to prevent the overburn of health workers as well as the collapse of health care systems. To reach this purpose, it should be necessary to evaluate a standardized pre-hospital management for COVID-19 patients, but data about it are lacking. Thus, the aim of the present chapter is to analyze the in-hospital gesture hypothesizing its reproducibility at bedside.Meta-analyses and randomized clinical trials assessed were focused on the following topics: (1) early diagnosis through viral demonstration and serological testing;(2) home setting evaluation;(3) standardized multidimensional assessment of COVID-19 patients, including an early identification of specific clinical symptoms as well as a prognostic stratification through laboratory biomarkers and portable imaging techniques;(4) safe and easily administrable drugs, considering both new medications and repurposed molecules;(5) protocols regarding bedside oxygen therapy, prone positioning, and pulmonary rehabilitation.To date, several procedures for the in-hospital management of COVID-19 patients could be easily and safely applied in the outpatients' care. The institution of dedicated international open-access data banks could be useful to realize standardized pre-hospital protocols, and the implementation of remote approaches could provide the possibility to guarantee a continuous follow-up for these patients. Global efforts focused on this goal could represent the only way to decrease the pressure on health care systems and to restore their essential function, still allowing an effective management of mild-to-moderate COVID-19 stages. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Venous blood point-of-care testing (POCT) for paramedics in urgent and emergency care: protocol for a single-site feasibility study (POCTPara).

The COVID-19 pandemic placed the UK healthcare system under unprecedented pressure, and recovery will require whole-system investment in innovative, flexible and pragmatic solutions. Positioned at the heart of the healthcare system, ambulance services have been tasked with addressing avoidable hospital conveyance and reducing unnecessary emergency department and hospital attendances through the delivery of care closer to home. Having begun to implement models of care intended to increase 'see and treat' opportunities through greater numbers of senior clinical decision makers, emphasis has now been placed upon the use of remote clinical diagnostic tools and near-patient or point-of-care testing (POCT) to aid clinical decision making. In terms of POCT of blood samples obtained from patients in the pre-hospital setting, there is a paucity of evidence beyond its utility for measuring lactate and troponin in acute presentations such as sepsis, trauma and myocardial infarction, although potential exists for the analysis of a much wider panel of analytes beyond these isolated biomarkers. In addition, there is a relative dearth of evidence in respect of the practicalities of using POCT analysers in the pre-hospital setting. This single-site feasibility study aims to understand whether it is practical to use POCT for the analysis of patients' blood samples in the urgent and emergency care pre-hospital setting, through descriptive data of POCT application and through qualitative focus group interviews of advanced practitioners (specialist paramedics) to inform the feasibility and design of a larger study. The primary outcome measure is focus group data measuring the experiences and perceived self-reported impact by specialist paramedics. Secondary outcome measures are number and type of cartridges used, number of successful and unsuccessful attempts in using the POCT analyser, length of time on scene, specialist paramedic recruitment and retention, number of patients who receive POCT, descriptive data of safe conveyance, patient demographics and presentations where POCT is applied and data quality. The study results will inform the design of a main trial if indicated.

Moral Distress, Burnout, and Job Satisfaction in Emergency Medical Technicians during the COVID-19 Pandemic

Background: Emergency medical technicians (EMTs) or paramedics may not be able to do according to their moral standards during the COVID-19 pandemic, which can cause burnout and job dissatisfaction. Objectives: This study aimed to evaluate moral distress (MD), job satisfaction, and burnout among EMTs during the COVID-19 pandemic. Methods: This cross-sectional study was conducted in Bam, Iran in 2020. In total, 134 EMTs completed the online survey that included demographic information, a MD scale, the Maslach Burnout Inventory, and an item for assessing job satisfaction. Descriptive statistics along with independent samples t-test, one-way analysis of variance, Mann-Whitney U, and Kruskal-Wallis tests, as well as multiple linear regression analysis were used to analyze data. Results: The mean scores of MD and job satisfaction were 25.44 +/- 12.78 and 3.63 +/- 1.07, respectively. Concerning severity, the mean scores of emotional exhaustion, depersonalization, and personal accomplishment (PA) were 35.45 +/- 5.04, 20.61 +/- 3.40, and 33.04 +/- 4.07, respectively. All three burnout subscales were significantly correlated with job satisfaction (P < 0.05) and MD (P < 0.05). Access to personal protective equipment and education level significantly predicted MD (P < 0.05). Conclusion: Despite high burnout and moderate MD, EMTs reported high job satisfaction, possibly because of increased social respect and salary. EMTs can avoid MD and burnout by learning how to handle ethical challenges during the COVID-19 pandemic.

Pre-hospital Emergency Service Challenges in the Face of the COVID-19 Pandemic in Iran.

OBJECTIVE: With the outbreak of coronavirus disease 2019 (COVID-19), the workload of the Iran's health-care system along with the Pre-hospital Emergency Service (PHES) increased significantly so that Iranian fledgling emergency system had never experienced such a crisis. With regard to the importance of the function of PHES as the front-line staff of Iran's health system and its role in controlling the recent epidemic crisis, this study was conducted to identify the challenges of PHES function in the face of COVID-19 pandemic. METHODS: The study was conducted with qualitative approach through content analysis in 2021. Semi-structured interviews were used to collect data. Sampling was purposive and continued until data saturation. After 24 interviews, the data were saturated. The extracted codes were thoroughly prepared as a data pool. After encoding all available data, the related codes were categorized into a single theme. After extracting the themes, a network of themes, related to the research topic, was drawn, and then, the relationship between the themes was analyzed. RESULTS: Data analysis undertaken for the qualitative study resulted in the identification of 4 main themes included: challenges related to facilities and equipment, living with uncertainty, professional and organizational capabilities, and burnout. CONCLUSIONS: PHES personnel have an important and key role in providing care to patients during COVID-19 epidemic period. Individual and systemic challenges were among the most important issues in the experiences of these personnel. These challenges require organizational planning and special attention of health policy-makers to maintain the staff's physical and mental health during the pandemic and the possible crises ahead.

Required Personal Protective Equipment for Prehospital Healthcare Provider in COVID-19 Pandemic: A Systematic Review

Aims. Coronavirus Disease 2019 (COVID-19) is a highly contagious disease, and a variety of personal protective equipment (PPE) has been recommended as preventive measures for prehospital emergency personnel, which has led to considerable challenges and a great confusion for the personnel. This review aims to identify different types of PPE required in the care of COVID-19 patients in prehospital emergency system.Material and methods. This study was carried out by searching through databases including: Pubmed, Proqust, Google Scholar, and Cinahl. All articles that recommended different types of PPE against COVID-19 and infectious diseases for prehospital emergency personnel were collected in a table.Results. After carrying out the initial search in the databases, 1,009 studies were obtained and then 16 articles were selected. The findings seem to suggest using equipment including: gloves, face shields (shield/goggles), protective clothes (medical jumpsuit/scrubs), surgical masks, N-95 masks, powered air purifying respirators (PAPR), hair covers, shoe covers and washing up the hands by the emergency medical service (EMS) personnel.Discussion. The scrutiny of the relevant studies showed that each of them advised the EMS personnel to use a number of PPE. The present study highlighted the fact that there are other components of the PPE which can be useful to them.Conclusion. This study identified the most appropriate PPE needed for prehospital emergency personnel against COVID-19, and it is believed that planning for adequate access to this equipment and training on how to use them can significantly help to reduce the infection among the personnel.

Investigation of Fear of Covid-19 , Work Stress and Affecting Factors in Prehospital Emergency Healthcare Workers

Purpose: Since healthcare workers work in the same environment with infected patients, they have a higher risk in terms of COVID-19 transmission compared to other parts of society, and accordingly, they experience more stress. The aim of this study to investigate the fear of COVID-19, work stress, and affecting factors in prehospital healthcare workers. Material and Methods: The research has a descriptive and cross-sectional design. The research was completed with a total of 399 individuals. Data were collected online using an introductory information form, the Fear of COVID-19 Scale, and the General Work Stress Scale. Results: The level of fear of COVID-19 was higher in women compared to men (B=-1.451, p=0.012), in married individuals compared to singles (B=-1.667, p=0.011), in those with low income compared to those with moderate or high income (B=-2.259, p<0.001), and in those who were vaccinated compared to those who were not vaccinated (B=-1.722, p=0.005). Conclusion: In prehospital emergency healthcare workers, the fear of COVID-19 was higher among women, married individuals, those with low income, those who were COVID-19-vaccinated, and those with high levels of anxiety and depression. Those with low income, high education level, and high anxiety level had a higher level of work stress

Research Paper: Mental Health Status of Medical Staff Working in Ardabil Prehospital Emergency During COVID-19 Pandemic

Background: Prehospital emergency staff usually encounter patients in situations that can affect the mental health of the medical staff and cause symptoms of depression, anxiety, and stress. This study aimed to determine depression, anxiety, and stress in prehospital emergency personnel during the COVID-19 epidemic in Ardabil City, Iran, 2020. Materials and Methods: A descriptive cross-sectional study was conducted from March 2020 to April 2020 with the participation of 138 working staff in the prehospital emergency department of Ardabil City. The samples were selected by the census method. Necessary information was collected with a two-part questionnaire: a demographic questionnaire and the DASS-21 standard questionnaire. DASS-21 is a 21-item questionnaire that consists of three subscales of 7 questions: depression, anxiety, and stress. The obtained data were analyzed using descriptive statistics, including mean and standard deviation, and inferential analysis, including analysis of variance, independent t test, and multiple regression using SPSS software v. 22 statistical software. Results: The results showed that 45.7% of the staff had moderate depression, 44.9% moderate anxiety, and 77.5% normal stress. There was a significant relationship between work experience and stress level (P=0.03). There were significant associations between age with depression (P=0.04), anxiety (P=0.00) and stress (P=0.01). There was also a significant relationship between gender and variables of stress (P=0.00) and anxiety (P=0.01). Multiple regression results showed that gender and education variables are predictors of anxiety and stress, and age and education variables are predictors of depression (P<0.05). Conclusion: More than half of the staff had moderate to severe depression and anxiety. Considering that prehospital emergency personnel has a vital role in improving and promoting people's health in the community, eliminating the underlying factors that cause emotional reactions in them is considered a health priority. © 2022, Negah Institute for Scientific Communication. All rights reserved.

Changes in the prehospital emergency technician's resilience during the COVID-19 pandemic: A web-based cross-sectional study.

Background and Aims: Resilience is a process that enables people to control the stressors of their lives. During the COVID-19 crisis, work stress increased among prehospital emergency technicians. So, it was possible to reduce their resilience. This study aimed to investigate the changes in the prehospital emergency technicians' resilience during the pandemic of COVID-19. Methods: A cross-sectional study was conducted at the prehospital emergency department in Qazvin province. For 6 months, 234 emergency technicians participated in this study. Data collection tools included a demographic questionnaire and the emergency medical services resilience scale (EMSRS). Results: The Friedman test indicated no significant difference between the mean scores of EMS employees' resilience during 6 months (p > 0.05). However, the correlation matrix between the scores of EMSRS during 6 months indicated that the resilience scores of EMS employees were positively correlated during the study (p < 0.01). Conclusions: The EMS technicians' resilience was almost constant and moderate during the 6 months of care for patients with COVID-19 and their transfer to the hospital, indicating that the COVID-19 crisis could suppress the emergency medical technicians ability to increase resilience.

A fall in isolation: reflection on a complex case

This case review focuses on a male patient who had fallen and was found to be profoundly hypothermic, with an altered level of consciousness and evidence of seizure activity. With multiple time-critical features, this clinical presentation was made particularly challenging by the presence of several human factors. A reflective model that considered these human factors in the context of the COVID-19 pandemic, when this incident occurred, was employed. Reflecting on this incident revealed how some subconscious (intuitive) thinking led to a degree of unconscious bias compounded by availability heuristics and human factors present. This meant that the author encountered difficulty when trying to obtain peripheral vascular access and, although several alternative interventions were identified, the majority of these were unavailable at the time and some would require a change to standard clinical practice for many paramedics. The only intervention that could have been used earlier in the management of this patient was rectal diazepam, but the need for this was removed by the patient's seizure activity self-terminating. Given the increasing prevalence of falls, social isolation, mental health problems, alcohol and substance misuse, especially in the pandemic, this type of case was unlikely to be an isolated event, strengthening the argument that the range of clinical interventions available to paramedics should be increased.

The effect of lifestyle on the course of COVID-19 infection

Aim: Our study's goal was to see how pre-illness lifestyle affected the course of COVID-19 infection in patients hospitalized with COVID-19. Material(s) and Method(s): From January to May 2021, 66 patients aged 50 years and older whose PCR tests were positive for COVID-19 were studied in the pandemic service. The Pittsburgh Sleep Quality Index (PSQI), Mini Nutritional Assessment (MNA) scale, and International Short Physical Activity Questionnaire (IPAQ) were utilized to examine the impact of COVID-19 infected individuals lifestyles such as sleep, nutrition and physical activities on the illness before the infection. Result(s): According to the PSQI scale;the increases in discharged lymphocyte measurements were significant compared to the first hospitalization in the good and bad sleep group cases. A higher increase in NLR for the first hospitalization was seen in the bad sleep group compared to good sleep group. According to the MNA scale, all three groups had increased lymphocyte counts in discharge disposition in comparison to the first hospitalization. Patients at risk of malnutrition had higher increases in lymphocytes at discharge than malnourished individuals (p=0.049). Normal nutritional status had greater platelet measures than patients at risk of malnutrition (p=0.028). According to the IPAQ survey, very active cases had higher platelet measurements than minimally active cases. Discussion(s): In our study on the effect of lifestyle on the course of COVID-19 infection, patients with proper nutrition, good sleep quality, and sufficient physical activity did not require treatment in the ICU. This finding revealed the importance of adopting and maintaining a healthy lifestyle.Copyright © 2022, Derman Medical Publishing. All rights reserved.

Impact of the COVID-19 pandemic on prehospital characteristics and outcomes of out-of-hospital cardiac arrest among the elderly in Japan: A nationwide study.

Aim: To assess the impact of the 2020 coronavirus disease (COVID-19) pandemic on the prehospital characteristics and outcomes of out-of-hospital cardiac arrest (OHCA) in the elderly. Methods: In this population-based nationwide observational study in Japan, 563,100 emergency medical service-unwitnessed OHCAs in elderly (≥65 years) patients involving any prehospital resuscitation efforts were analysed (144,756, 140,741, 140,610, and 136,993 cases in 2020, 2019, 2018, and 2017, respectively). The epidemiology, characteristics, and outcomes associated with OHCAs in elderly patients were compared between 3 years pre-pandemic (2017-2019) and the pandemic year (2020). The primary outcome was neurologically favourable one-month survival. The secondary outcomes were the rate of bystander cardiopulmonary resuscitation (CPR), defibrillation by a bystander, dispatcher-assisted (DA)-CPR attempts, and one-month survival. Results: During the pandemic year, the rates of neurologically favourable 1-month survival (crude odds ratio, 95% confidence interval: 1.19, 1.14-1.25), bystander CPR (1.04, 1.03-1.06), and DA-CPR attempts (1.10, 1.08-1.11) increased, whereas the incidence of public access defibrillation (0.88, 0.83-0.93) decreased. Subgroup analyses based on interaction tests showed that the increased rate of neurologically favourable survival during the pandemic year was enhanced in OHCA at care facilities (1.51, 1.36-1.68) and diminished or abolished on state-of-emergency days (0.90, 0.74-1.09), in the mainly affected prefectures (1.08, 1.01-1.15), and in cases with shockable initial rhythms (1.03, 0.96-1.12). Conclusions: The COVID-19 pandemic increased the bystander CPR rate in association with enhanced DA-CPR attempts and improved the outcomes of elderly patients with OHCAs.

Influence of coronavirus disease 2019 case surges on prehospital emergency medical service for patients with trauma in Kobe, Japan.

Aim: In the current era of the coronavirus disease 2019 (COVID-19) pandemic, the responsiveness of emergency medical service (EMS) transport for patients with internal illness is often delayed. However, the influence of the COVID-19 pandemic on prehospital transport for patients with trauma has not yet been fully elucidated. This study aims to examine the effect of COVID-19 case surges on EMS transport for patients with trauma during the COVID-19 states of emergency in Kobe, Japan. Methods: EMS data during the states of emergency were compared with those in the 2019 prepandemic period. The incidence of difficulty securing hospital acceptance (four or more calls to medical institutions and ambulance staying at the scene for 30 min or more) was evaluated as a primary outcome. Secondary outcomes were the time spent at the trauma scene and the number of calls requesting hospital acceptance. The time spent at the trauma scene was stratified by trauma severity. Results: The incidence of difficulty securing hospital acceptance increased (1.2% versus 3.2%, P < 0.01). Logistic regression analysis revealed that the duration of the states of emergency was associated with difficulty securing hospital acceptance (odds ratio [OR] 2.08, 95% confidence interval 1.77-2.45; P < 0.01). Although the mean time spent at the trauma scene among the less severe, moderately severe, and severe trauma groups was prolonged, the time for the life-threatening group did not change. The number of request calls increased during the states of emergency. Conclusion: Difficulty securing hospital acceptance increased; however, the time spent at the trauma scene did not significantly change for the life-threatening group.

Structural Elements and Requirements in Forming Prehospital Health Response Teams in Response to Chemical, Biological, Radiation, and Nuclear Incidents (CBRN), a Comparative Review Study.

One of the important indicators of increasing the capacity of the health system and the chances of survival of patients and injured immediately after chemical, biological, radiation and nuclear (CBRN) accidents is rapid access to medical services. Establishing prehospital health response teams is one of the main strategies to improve the capacity and ability to respond to unusual events. The aim of this study was to investigate the factors influencing the formation of rapid response teams in the field of health in response to chemical, biological, radiation and nuclear accidents (CBRN EDMRT). In this study, the comparative review method was used. The study period was from November 1, 2021 to March 2022. Forming and deploying rapid health response teams based on an extensive multi-step search and keywords in multiple databases such as PubMed, CINHAL, Blackwell, Iranmedex, SID, Cochrane Database of Systematic Reviews, Google Scholar, Scopus Also, the websites of the Ministry of Health and the responsible organizations in different countries and the proposed structure were done by international institutions and sites. After accessing the resources and documents, the process of analysis and comparison of different team structures was performed. After the initial search, the structure and required elements of their teams were extracted. According to published articles and texts, 10 teams from the International Atomic Energy Agency (IAEA), the US Centers for Disease Control and Prevention (CDC), the US Department of Homeland Security, and the North Atlantic Treaty Organization (NATO), Australia, the British Public Health Organization, and the Japanese Red Cross were compared. Team requirements, population distribution, type of accident, level of team activity and training, equipment required by the team after the accident, according to which, each country/organization should consider the above factors to design and establish the structure of CBRN EDMRT to take. A study should be conducted to design a comprehensive and evidence-based structure.

[Prehospital ultrasound and cardiological emergencies]. / Échographie préhospitalière et urgences cardiologiques.

Technological advances over the past two decades have paved the way for the prehospital use of ultrasound. This practice was first developed in traumatology and then in a multitude of other indications, including cardiology. The development of pulmonary ultrasound is certainly the most visible illustration of this. Firstly, because it is an extra-cardiac examination that provides the answer to a cardiac question. Secondly because from a theoretical point of view this ultrasound indication was a bad indication for the use of ultrasound due to the air contained in the thorax. Thirdly, because this indication has become a 'standard of care' when caring for a patient with dyspnea - a practice that has become widespread during the COVID epidemic. In patients with heart failure, ultrasound has a high diagnostic power (including for alternative diagnoses) which is all the more precise since the technique is non-invasive, the response is obtained quickly, the examination can be repeated at desire to follow the evolution of the patient. The main other indications for prehospital ultrasound are cardiac arrest to search for a curable cause, identification of residual mechanical cardiac activity, monitoring of cerebral perfusion; chest pain, for both positive and negative diagnoses; shock for the search for an etiology and therapeutic follow-up or even pulmonary embolism or ultrasound for the search for dilation of the right ventricle which is now at the forefront of the recommendation algorithm.

Evaluating Nebraska EMS Providers' Ability and Willingness to Respond to Emergencies Resulting from Bioterrorist Attacks.

OBJECTIVE: Previous studies have found that public health systems within the United States are inadequately prepared for an act of biological terrorism. As the coronavirus disease (COVID-19) pandemic continues, few studies have evaluated bioterrorism preparedness of Emergency Medical Services (EMS), even in the accelerating environment of biothreats. METHODS: This study utilized an Internet-based survey to assess the level of preparedness and willingness to respond to a bioterrorism attack and identify factors that predict preparedness and willingness among Nebraska EMS providers. The survey was available for 1 month in 2021 during which 190 EMS providers responded to the survey. RESULTS: Only 56.8% of providers were able to recognize an illness or injury as potentially resulting from exposure to a biological agent. The provider Clinical Competency levels ranged from a low of 13.6% (ability to initiate patient care within his/her professional scope of practice and arrange for prompt referral appropriate to the identified condition(s)) to a high of 74% (the ability to respond to an emergency within the emergency management system of his/her practice, institution, and community). Only 10% of the respondents were both willing and able to effectively function in a bioterror environment. CONCLUSION: To effectively prepare for and respond to a bioterrorist attack, all levels of the health care system need to have the clinical skills, knowledge, and abilities necessary to treat patients exposed to biological agents. Policy changes and increased focus on training and drills are needed to ensure a prepared EMS system, which is crucial to a resilient state. EMS entities need to be aware of the extent of their available workforce so that the country can be prepared for the increasing threat of bioterrorism or other novel emerging infectious disease outbreaks. A resilient nation relies on a prepared set of EMS providers who are willing to respond to biological terrorism events.

A Qualitative Analysis of Emergency Medical Services (EMS) Personnel Experiences and Perceptions Responding to Drug Overdoses in the United States (US) During the COVID-19 Pandemic

Background: The purpose of this work was to describe the experiences of EMS personnel in responding to drug overdose-related calls and the impact the pandemic has had to help better inform current response and treatment efforts. Methods: Semi-structured interviews were conducted with 99 EMS personnel across 18 areas throughout the United States that were designated as Early Warning Network sentinel sites by the National Institute on Drug Abuse-funded National Drug Early Warning System. Participants were asked about topics including the potential burdens from the pandemic and the opioid crisis. We coded the interview responses and identified themes through qualitative analysis. Multiple cycles of descriptive coding, recoding, subcoding, pattern-coding, and thematic coding of responses were conducted. Results: Responses were categorized into the following themes: 1) being over-worked from increased call volume;2) increased risk for personal harm when responding to patients;3) compassion fatigue due to long hours and repeat calls for the same people;4) conflicting perceptions of the utility of naloxone;5) the need for better treatment options to respond to opioid crisis on top of COVID-19. Conclusions: The burden of the substance use disorder (SUD) crisis on EMS personnel has been compounded by the COVID-19 pandemic. These reports from EMS personnel throughout the US can help inform policy and procedures to better protect the mental health of EMS personnel and to ensure better care for patients with SUD. These experiences and recommendations may be of use for other countries as substance use and COVID-19 are global health issues. © 2023 The Authors. Published by College of Public Health Sciences, Chulalongkorn University. This is an open access article under the CC BY license.

COVID-19 as a risk factor for long-term mortality in patients managed by the emergency medical system: A prospective, multicenter, ambulance-based cohort study.

Introduction: COVID-19 has initially been studied in terms of an acute-phase disease, although recently more attention has been given to the long-term consequences. In this study, we examined COVID-19 as an independent risk factor for long-term mortality in patients with acute illness treated by EMS (emergency medical services) who have previously had the disease against those who have not had the disease. Methods: A prospective, multicenter, ambulance-based, ongoing study was performed with adult patients with acute disease managed by EMS and transferred with high priority to the emergency department (ED) as study subjects. The study involved six advanced life support units, 38 basic life support units, and five emergency departments from Spain. Sociodemographic inputs, baseline vital signs, pre-hospital blood tests, and comorbidities, including COVID-19, were collected. The main outcome was long-term mortality, which was classified into 1-year all-cause mortality and 1-year in- and out-of-hospital mortality. To compare both the patients with COVID-19 vs. patients without COVID-19 and to compare survival vs non-survival, two main statistical analyses were performed, namely, a longitudinal analysis (Cox regression) and a logistic regression analysis. Results: Between 12 March 2020 and 30 September 2021, a total of 3,107 patients were included in the study, with 2,594 patients without COVID-19 and 513 patients previously suffering from COVID-19. The mortality rate was higher in patients with COVID-19 than in patients without COVID-19 (31.8 vs. 17.9%). A logistic regression showed that patients previously diagnosed with COVID-19 presented higher rates of nursing home residency, a higher number of breaths per minute, and suffering from connective disease, dementia, and congestive heart failure. The longitudinal analysis showed that COVID-19 was a risk factor for mortality [hazard ratio 1.33 (1.10-1.61); p < 0.001]. Conclusion: The COVID-19 group presented an almost double mortality rate compared with the non-COVID-19 group. The final model adjusted for confusion factors suggested that COVID-19 was a risk factor for long-term mortality.

Ventilation rates measured by capnography during out-of-hospital cardiac arrest resuscitations and their association with return of spontaneous circulation.

BACKGROUND: Clinical guidelines for adult out-of-hospital cardiac arrest (OHCA) recommend a ventilation rate of 8-10 per minute yet acknowledge that few data exist to guide recommendations. The goal of this study was to evaluate the utility of continuous capnography to measure ventilation rates and the association with return of spontaneous circulation (ROSC). METHODS: This was a retrospective observational cohort study. We included all OHCA during a two-year period and excluded traumatic and pediatric patients. Ventilations were recorded using non-invasive continuous capnography. Blinded medically trained team members manually annotated all ventilations. Four techniques were used to analyze ventilation rate. The primary outcome was sustained prehospital ROSC. Secondary outcomes were vital status at the end of prehospital care and survival to hospital admission. Univariable and multivariable logistic regression models were constructed. RESULTS: A total of 790 OHCA were analyzed. Only 386 (49%) had useable capnography data. After applying inclusion and exclusion criteria, the final study cohort was 314 patients. The median ventilation rate per minute was 7 (IQR 5.4-8.5). Only 70 (22%) received a guideline-compliant ventilation rate of 8-10 per minute. Sixty-two (20%) achieved the primary outcome. No statistically significant associations were observed between any of the ventilation parameters and patient outcomes in both univariable and multivariable logistic regression models. CONCLUSIONS: We failed to detect an association between intra-arrest ventilation rates measured by continuous capnography and proximal patient outcomes after OHCA. Capnography has poor reliability as a measure of ventilation rate. Achieving guideline-compliant ventilation rates remains challenging.

Comparison of four different threshold values of shock index in predicting mortality of COVID-19 patients.

OBJECTIVE: The object of this study was to examine the accuracy in pre-hospital shock index (SI) for predicting intensive care unit (ICU) requirement and 30-day mortality among from COVID-19 patients transported to the hospital by ambulance. METHOD: All consecutive patients who were the age ≥18 years, transported to the emergency department (ED) by ambulance with a suspected or confirmed COVID-19 in the pre-hospital frame were included in the study. Four different cut-off points were compared (0.7, 0.8, 0.9, and 1.0) to examine the predictive performance of both the mortality and ICU requirement of the SI. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) was employed to evaluate each cut-off value discriminatory for predicting 30-day mortality and ICU admission. RESULTS: The total of 364 patients was included in this study. The median age in the study population was 69 (55-80), of which 196 were men and 168 were women. AUC values for 30-day mortality outcome were calculated as 0.672, 0.674, 0.755, and 0.626, respectively, for threshold values of 0.7, 0.8, 0.9 and 1.0. ICU admission was more likely for the patients with pre-hospital SI> 0.9. Similarly, the mortality rate was higher in patients with pre-hospital SI> 0.9. CONCLUSION: Early triage of COVID-19 patients will ensure efficient use of healthcare resources. The SI could be a helpful, fast and powerful tool for predicting mortality status and ICU requirements of adult COVID-19 patients. It was concluded that the most useful threshold value for the shock index in predicting the prognosis of COVID-19 patients is 0.9.