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1.
SSRN; 2022.
Preprint in English | SSRN | ID: ppcovidwho-343337

ABSTRACT

Background: The outcomes of out-of-hospital cardiac arrests (OHCAs) are typically poor. Although an outcome trend has been periodically reported for decades, none—specifically one stratified by hospital levels—have been reported from 2017–2021. The coronavirus disease-2019 (COVID-19) pandemic has significantly altered hospitals’ resuscitation capabilities. This study presented trends in OHCA outcomes during the pandemic by comparing three different hospital levels. Methods: Eligible adults with nontraumatic OHCAs from January 2017 to December 2021 in three hospitals (teaching medical center, urban second-level hospital, and rural second-level hospital) were retrospectively enrolled. The demographics, Utstein style variables, and covariates were reviewed and recorded. The primary outcome was survival to admission after a sustained return of spontaneous circulation. The secondary outcomes were survival to hospital discharge, and good neurological outcomes (cerebral performance category score 1 or 2). Findings: In total, 2,819 OHCA patients were analyzed (mean age, 71 years old;60% male). Overall, 31% of patients sustained survival to admission, 11% sustained survival to hospital discharge, and 7% had a good neurological outcome. The oldest patients had the poorest outcomes. Outcomes in the teaching medical center during the COVID-19 pandemic period were significantly poorer than those during the pre-pandemic period. Interpretation: The COVID-19 pandemic did not change the incidence of documented OHCAs;however, there was a change in the outcome trend patterns in OHCA patients. Additionally, the COVID-19 pandemic made OHCA outcomes more consistent across different hospital levels. Funding: This work was supported by the National Taiwan University Hospital Hsin-Chu Branch and the National Health Research Institutes (grant number: NHRI-111-H01).

2.
Anaesthesia, Pain & Intensive Care ; 26(4):496-502, 2022.
Article in English | Academic Search Complete | ID: covidwho-2026667

ABSTRACT

Background & Objective: The use of Personal Protective Equipment (PPE) is highly recommended during chest compression in COVID-19 patients, as it can generate aerosols. It was thought that quality of chest compression might be affected by the use of PPE. We compared the quality of chest compression with or without PPE using a mannequin to formulate practical recommendations. Methodology: This observational analytical study used randomised crossover design, and was carried out in Cipto Mangunkusumo National General Hospital from December 2020 to July 2021. After a thorough assessment, a total of 92 samples fulfilled the inclusion and exclusion criteria. The chosen participants were postgraduate residents, and they were asked to do chest compression on a mannequin with (Group-I) and without PPE (Group-II) and with breaks in between. The quality of CPR was measured using feedback tool CPR R Series® Monitor (Zoll Inc., USA). After a break the groups were crossed over and re-evaluated. Results: Sixty-five (35.3%) non-PPE participants did quality compression, but only 16 (8.7%) did quality compression when using PPE (P < 0.001). Effective compression was done by 80 (43.5%) of the non-PPE participants, compared to 61 (33.2%) participants doing the compression effectively when using PPE (P = 0.002). Eighty-two (44.6%) non- PPE participants did adequate compressions compared to 61 (33.2%) participants when using PPE (P < 0.001). Meanwhile, the post-compression fatigue level was 7 (6.00-9.00) when using PPE compared to 5 (3.00-7.00) when not using PPE (P < 0.001). Conclusion: The use of PPE during chest compressions can reduce the quality of compression and increase the level of post-compression fatigue compared to performing chest compressions without PPE. PPE use was also associated with low levels of effectiveness, and adequacy of the chest compression. Abbreviations: PPE - Personal Protective Equipment;CPR – Cardiopulmonary resuscitation;AHA - American Heart Association;ERC - European Resuscitation Council [ FROM AUTHOR] Copyright of Anaesthesia, Pain & Intensive Care is the property of Department of Anaesthesia, Pain & Intensive Care and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

3.
Int J Emerg Med ; 15(1):46, 2022.
Article in English | PubMed | ID: covidwho-2021235

ABSTRACT

BACKGROUND: Out-of-hospital cardiac arrest (OHCA) remains one of the leading causes of death worldwide, and bystander CPR with public-access defibrillation improves OHCA survival outcomes. The COVID-19 pandemic has posed many challenges for emergency medical services (EMS), including the suggestion of compression-only resuscitation and recommendations for complete personal protective equipment, which have created operational difficulties and prolonged response time. However, the risk factors affecting OHCA outcomes during the pandemic are poorly defined. This study aimed to assess the characteristics and outcomes of OHCA patients before and during the COVID-19 pandemic in Thailand. METHODS: This single-center, retrospective cohort study used data from electronic medical records and EMS paper records. All OHCA patients who visited Ramathibodi Hospital's emergency department before COVID-19 (March 2018 to December 2019) and during COVID-19 (March 2020-December 2021) were identified, and the number of emergency department returns of spontaneous circulation (ED-ROSC) and characteristics in OHCA patients before and during the COVID-19 pandemic in Thailand were collected. RESULTS: A total of 136 patients were included (78 men [59.1%];mean [SD] age, 67.9 [18] years);60 of these were during the COVID-19 period (beginning March 2020), and 76 were before the COVID-19 period. The overall baseline characteristics that differed significantly between the two groups were bystander witness and mode of chest compression (p-values < 0.001 and < 0.001, respectively). The ED ROSC during the COVID-19 period was significantly lower than before the COVID-19 period (26.67% vs. 46.05%, adjusted OR 0.21, p-value < 0.001). There were significant differences in survival to admission between the COVID-19 period and before (25.00% and 40.79%, adjusted OR 0.26, p-value 0.005). However, 30-day survivals were not significantly different (3.3% during the COVID-19 period and 10.53% before the COVID-19 period). CONCLUSIONS: During the COVID-19 pandemic in Thailand, ED ROSC and survival to admission in out-of-hospital cardiac arrest patients were significantly reduced. Additionally, the witness responses and mode of chest compression were very different between the two groups. TRIAL REGISTRATION: This trial was retrospectively registered on 7 December 2021 in the Thai Clinical Trial Registry, identification number TCTR20211207006.

4.
Journal of the American College of Emergency Physicians Open ; 3(5), 2022.
Article in English | Web of Science | ID: covidwho-2013483

ABSTRACT

Background The impact of the COVID-19 pandemic on out-of-hospital cardiac arrest (OHCA) burden of disease in the United States is unknown. We sought to estimate and compare disability-adjusted life years (DALYs) lost because of OHCA during the COVID-19 pandemic to prepandemic values. Methods DALY were calculated as the sum of years of life lost (YLL) and years lived with disability (YLD). Adult non-traumatic emergency medical services-treated OHCA from the Cardiac Arrest Registry to Enhance Survival database for 2016 to 2020 were used to estimate YLL. Cerebral performance category score disability weights were used to estimate YLD. The calculated DALY for the study population was extrapolated to a national level to estimate total US DALY. Data were reported as DALY total and rate. Data for 2020 (pandemic) were compared prepandemic years (2016-2019) via the chi-square test or t-test, as appropriate. Results A total of 440,438 OHCA met study inclusion criteria. Total OHCA DALY in the United States increased from 4,468,155 (YLL = 4,463,988;YLD = 4167) in 2019 to 5,379,660 (YLL = 5,375,464;YLD = 4197) in 2020. The DALY rate increased from 1357 per 100,000 individuals in 2019 to 1630 per 100,000 individuals in 2020. Bystander cardiopulmonary resuscitation (CPR) rates did not significantly change (47.96% in 2016-2019 vs. 47.89% in 2020;p = 0.157). Conclusion The overall burden of disease because of adult OHCA increased significantly during the COVID-19 pandemic. We observed no change in the willingness of layperson bystanders to perform CPR on a national level in the United States.

5.
Acute Medicine & Surgery ; 9(1), 2022.
Article in English | Web of Science | ID: covidwho-2013338

ABSTRACT

Aim: The coronavirus disease (COVID-19) pandemic has led to an increase in out-of-hospital cardiac arrests (OHCAs) and mortality. However, there has been no reports in Japan using nationwide registry data. We compared survival among patients with OHCAs and detailed information on the cause during the COVID-19 pandemic (2020), and during the pre-pandemic period (2019). Methods: Using a Japanese population-based retrospective cohort study design, we analyzed registry data on 39,324 and 39,170 patients with OHCAs in 2019 and 2020, respectively. We compared patient outcomes in 2019 and 2020 using univariable and multivariable logistic regression analyses. Results: The proportion of OHCAs of cardiac origin increased significantly from 61.6% in 2019 to 62.7% in 2020 (P = 0.001). The use of bystander CPR (6.9% versus 5.7%, P < 0.001) and publicaccess automated external defibrillator pads (3.7% versus 3.0%, P < 0.001) decreased significantly from 2019 to 2020. The 1-month survival for OHCA of cardiac origin (12.1% versus 10.7%;adjusted odds ratio [OR] 0.93, 95% confidence interval [Cl] 0.87-1.00), asphyxia (10.9% versus 8.8%;adjusted OR 0.80, 95% CI 0.70-0.92), and external causes (adjusted OR 0.66;95% CI 0.46-0.96), also decreased significantly from 2019 to 2020. Conclusions: In Japan, the 1-month survival after OHCA of cardiac origin, or due to asphyxia or external causes, decreased significantly during the COVID-19 pandemic period.

6.
Scientific reports ; 12(1):14575, 2022.
Article in English | MEDLINE | ID: covidwho-2008311

ABSTRACT

Public access automated external defibrillators (AEDs) represent emergency medical devices that may be used by untrained lay-persons in a life-critical event. As such their usability must be confirmed through simulation testing. In 2020 the novel coronavirus caused a global pandemic. In order to reduce the spread of the virus, many restrictions such as social distancing and travel bans were enforced. Usability testing of AEDs is typically conducted in-person, but due to these restrictions, other usability solutions must be investigated. Two studies were conducted, each with 18 participants: (1) an in-person usability study of an AED conducted in an office space, and (2) a synchronous remote usability study of the same AED conducted using video conferencing software. Key metrics associated with AED use, such as time to turn on, time to place pads and time to deliver a shock, were assessed in both studies. There was no difference in time taken to turn the AED on in the in-person study compared to the remote study, but the time to place electrode pads and to deliver a shock were significantly lower in the in-person study than in the remote study. Overall, the results of this study indicate that remote user testing of public access defibrillators may be appropriate in formative usability studies for determining understanding of the user interface.

7.
Resuscitation Plus ; 12:100299, 2022.
Article in English | ScienceDirect | ID: covidwho-2008090

ABSTRACT

Aim The coronavirus disease (COVID-19) pandemic has negatively affected access to healthcare and treatment. This study aimed to explore the impact of the COVID-19 pandemic on older adults with out-of-hospital cardiac arrest (OHCA) in Japan, a country with a super-aging society. Methods This secondary analysis of the All-Japan Utstein Registry included patients aged 65 years and older with bystander-witnessed OHCA between January 1, 2005, and December 31, 2020. Survival outcomes were compared by time period using multivariable logistic regression analyses. The primary outcome measured was the one-month survival rate with neurologically favorable outcomes. Results Before the COVID-19 pandemic, survival outcomes were steadily improving, and 32,024 patients in 2019 and 31,894 in 2020 were eligible for analysis. The proportions of conventional cardiopulmonary resuscitation and shock by public-access automated external defibrillators were lower in 2020 than in 2019 (6.7% versus 5.7%, p < 0.001 and 2.5% versus 2.1%, p < 0.001, respectively). Compared to 2019, the one-month survival after OHCA and prehospital return of spontaneous circulation decreased significantly in 2020 than in 2019 (7.7% versus 6.6%, adjusted odds ratio [AOR]: 0.88, 95% confidence interval [CI]: 0.83–0.94, and 16.8% versus 14.9%, AOR: 0.87, 95% CI: 0.83–0.91, respectively). The proportion of neurologically favorable outcomes also decreased, but the decrease was not statistically significant (3.4% versus 2.8%, AOR: 0.92, 95% CI: 0.83–1.01). Conclusion In this population-focused, bystander-witnessed study regarding OHCA, the analysis of nationwide registry data revealed that the COVID-19 pandemic was associated with reduced survival among older adults with OHCA in Japan.

8.
Resuscitation ; 175:S25-S27, 2022.
Article in English | EMBASE | ID: covidwho-1996684

ABSTRACT

Background: The COVID-19 pandemic has overwhelmed healthcare systems, strained ambulance services and, directly or indirectly, affected community responses to patients who experience cardiac arrests outside hospitals. Previous observational studies have shown a notable rise in Out-of-Hospital Cardiac Arrest (OHCA) cases during the pandemic in different parts of the world compared to the same period in 2019, including the United Kingdom and the United States 1, 2. This systematic review’s intention is to shed light on the incidence and survival outcomes of adult OHCA patients. Methods: A comprehensive review of MEDLINE, EMBASE, the Cochrane Library, Web of Science, WHO’s Global Index Medicus, WHO’s Global Research Literature on Coronavirus 2019 and medRxiv up to 8 September 2021 was conducted to identify articles and preprints that reported OHCA figures before and during the COVID-19 pandemic. Primary outcomes were OHCA incidence, Return of Spontaneous Circulation (ROSC) and survival to hospital discharge. Results: Twenty-one studieswere included in the final analysis, out of 2877 potentially eligible records. There were 12,619 OHCA cases during the COVID-19 pandemic, compared with 8353 OHCA cases in the same period of 2019, representing a 51.1% increase in OHCA incidence during the pandemic. In terms of survival outcomes, ROSC and survival to hospital discharge rates were substantially reduced during the pandemic compared to the pre-pandemic period. Conclusion: The pandemic has had an impact on the incidence and survival outcomes among adult OHCA patients compared to the prepandemic period. Moreover, the pandemic has delayed ambulance care processes and disrupted community responses to OHCA. 1. Fothergill RT et al. Out-of-hospital cardiac arrest in London during the COVID-19 pandemic. Resusc Plus. 2021;5:100066. 2. Lai PH et al. Characteristics associated with out-of-hospital cardiac arrests and resuscitations during the Novel Coronavirus Disease 2019 pandemic in New York City. JAMA Cardiol. 2020;5(10):1154– 63.(Table Presented)(Table Presented)

9.
Resuscitation ; 175:S23, 2022.
Article in English | EMBASE | ID: covidwho-1996683

ABSTRACT

Purpose: The Coronavirus 2019 (COVID-19) pandemic impacted adult out-of-hospital arrest (OHCA) outcomes in the United States. The impact of the pandemic on pediatric OHCA is unknown. Materials and methods: An analysis of the Cardiac Arrest Registry to Enhance Survival for non-traumatic pediatric OHCAs (≤18 years) was conducted. Outcomes during 3 pandemic surge periods in 2020 (March 16 to May 15, July 1 to August 15, and October 16 to December 31) were compared to the same time periods pre-pandemic in 2019. The primary outcomes were overall survival and neurologically favorable survival, defined as a cerebral performance score of 1 or 2 at the time of hospital discharge. Age groups included infants (<1 year), children (1 to 11 years), and adolescents (≥12 years). Results: A total of 1381 pandemic surge period arrests were compared to 1274 pre-pandemic arrests. There was an increase in OHCAs in adolescents (pandemic 26.6% [368/1381], pre-pandemic 22.4% [286/1274], p = 0.01). Therewere no differences in OHCAs by sex, race/ethnicity, witness status, location, initial rhythm, bystander CPR rates or bystander AED use. There were no differences in overall survival during the pandemic surge periods in 2020 (10.6% [147/ 1381]), as compared to the same months in 2019 (9.7% [123/1274], p = 0.40) or in neurologically favorable survival (2020: 8.9% [123/1381] vs. 2019: 7.3% [93/1274], p = 0.13). Conclusions: During the COVID-19 pandemic surge periods in 2020, pediatric OHCA survival rates in the United Stateswere similar to the rates of pediatric OHCA pre-pandemic. Further study is warranted to determine if pediatric survival for OHCA was affected during the delta and omicron COVID-19 surges in 2021.

10.
Resuscitation ; 178: 116-123, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-1991251

ABSTRACT

AIM: Extracorporeal cardiopulmonary resuscitation (ECPR) is performed in refractory out-of-hospital cardiac arrest (OHCA) patients, and the eligibility has been conventionally determined based on three criteria (initial cardiac rhythm, time to hospital arrival within 45 minutes, and age <75 years) in Japan. Owing to limited information, this study descriptively determined neurological outcomes after applying the three criteria among OHCA patients who underwent ECPR. METHODS: This study conducted a post-hoc analysis of data from the Comprehensive Registry of Intensive Care for OHCA Survival (CRITICAL) study. This was a multi-institutional prospective observational study of OHCA patients in Osaka Prefecture, Japan. All adult (aged ≥18 years) OHCA patients with internal medical causes treated with ECPR between 1 July 2012 and 31 December 2019 were evaluated. We described one-month neurological favourable outcomes based on the three criteria (initial shockable, time to hospital arrival within 45 minutes, and age <75 years), and we compared them using the chi-square test. RESULTS: Among 18,379 patients screened from the CRITICAL study database, we included 517 OHCA patients treated by ECPR; 311 (60.2%) patients met all three criteria. Favourable neurological outcomes were as follows: patients meeting no or one criterion: 2.3% (1/43), those meeting two criteria: 8% (13/163), and those meeting all criteria: 16.1% (50/311) (P-value = 0.004). CONCLUSIONS: In this study, approximately 60% of patients treated by ECPR met the three criteria (initial shockable, time to hospital arrival within 45 minutes, and age <75 years), and the greater the number of criteria met, the better were the neurological outcomes achieved.


Subject(s)
Cardiopulmonary Resuscitation , Extracorporeal Membrane Oxygenation , Out-of-Hospital Cardiac Arrest , Adolescent , Adult , Aged , Humans , Prospective Studies , Registries , Retrospective Studies
11.
World Journal of Emergency Medicine ; 13(5):144-147, 2022.
Article in English | EMBASE | ID: covidwho-1988369

ABSTRACT

Out-of-hospital cardiac arrest (OHCA) is one of the three leading causes of death in industrialized countries.[1,2] Some studies have described the impact of the first COVID-19 pandemic wave in terms of the number of cases and OHCA survival rates in various regions,[3,4] but few have addressed the relationship between the successive phases and how they affected OHCA.[5,6] The 14-day cumulative incidence peaked at more than 990 cases, with these rates remaining above 200 for an eight-month period between 15 March 2020 and 15 March 2021 in Madrid, Spain. The objectives of the current study were twofold. First, we sought to describe how the different waves in the first pandemic year aff ected the healthcare activity of the Spanish emergency medical services (EMS). Second, we compared effects of the pandemic year on OHCA care to those of the preceding non-pandemic year in terms of initiating cardiopulmonary resuscitation and survival in a community with a high incidence of COVID-19.

12.
Journal of Microbiology, Immunology and Infection ; 2022.
Article in English | ScienceDirect | ID: covidwho-1983502

ABSTRACT

Background/purpose Predictors for out-of-hospital cardiac arrest (OHCA) in COVID-19 patients remain unclear. We identified the predictors for OHCA and in-hospital mortality among such patients in community isolation centers. Methods From May 15 to June 20, 2021, this cohort study recruited 2,555 laboratory-confirmed COVID-19 patients admitted to isolation centers in Taiwan. All patients were followed up until death, discharge from the isolation center or hospital, or July 16, 2021. OHCA was defined as cardiac arrest confirmed by the absence of circulation signs and occurring outside the hospital. Multinomial logistic regressions were used to determine factors associated with OHCA and in-hospital mortality. Results Of the 37 deceased patients, 7 (18.9%) had OHCA and 30 (81.1%) showed in-hospital mortality. The mean (SD) time to OHCA was 6.6 (3.3) days from the symptom onset. After adjusting for demographics and comorbidities, independent predictors for OHCA included age ≥65 years (adjusted odds ratio [AOR]: 13.24, 95% confidence interval [CI]: 1.85–94.82), fever on admission to the isolation center (AOR: 12.53, 95%CI: 1.68–93.34), and hypoxemia (an oxygen saturation level below 95% on room air) (AOR: 26.54, 95%CI: 3.18–221.73). Predictors for in-hospital mortality included age ≥65 years (AOR: 10.28, 95% CI: 2.95–35.90), fever on admission to the isolation centers (AOR: 7.27, 95% CI: 1.90–27.83), and hypoxemia (AOR: 29.87, 95% CI: 10.17–87.76). Conclusions Time to OHCA occurrence is rapid in COVID-19 patients. Close monitoring of patients’ vital signs and disease severity during isolation is important, particularly for those with older age, fever, and hypoxemia.

13.
Hong Kong Journal of Emergency Medicine ; 29(1):23S-24S, 2022.
Article in English | EMBASE | ID: covidwho-1978657

ABSTRACT

Background: Regional variations in the impact of the coronavirus disease-2019 (COVID-19) pandemic on out-of-hospital cardiac arrest (OHCA) have been reported. We aimed to examine differences in the community response, emergency medical services (EMS) interventions, and outcomes of OHCA, in Singapore (population 5.7 million) and Atlanta (population 4.16 million), before and during the pandemic. Methods: Using prospectively collected Singapore Pan-Asian Resuscitation Outcomes Study (PAROS) and Atlanta Cardiac Arrest Registry to Enhance Survival (CARES) data, we compared EMS-treated adult OHCAs (≥18 years) during the pandemic period (17weeks from the date of first confirmed COVID-19 case) and pre-pandemic period (corresponding weeks in 2019). The primary outcome was pre-hospital return of spontaneous circulation (ROSC). We reported adjusted odds ratios (aOR) for OHCA characteristics, pre-hospital interventions, and outcomes using binary logistic regression. Results: Of the 3987 EMS-treated OHCAs (overall median age 69 years, 60.1% males) in Singapore and Atlanta, 2084 occurred during the pandemic and 1903 during the pre-pandemic period. Compared with Atlanta, OHCA cases in Singapore were older (median age 72 vs 66 years), received more bystander interventions (65.1% vs 41.4% received cardiopulmonary resuscitation (CPR) and 28.4% vs 10.1% had automated external defibrillator application), yet observed less pre-hospital ROSC (11.3% vs 27.1%). When compared with the pre-pandemic period, the likelihood of residential OHCAs doubled in both cities during the pandemic;in Singapore, OHCAs were more likely to be witnessed (aOR 1.95, 95% confidence interval (CI), 1.59-2.39) yet less likely to receive CPR (aOR 0.81, 95% CI, 0.65-0.99) during the pandemic. OHCAs occurring during the pandemic, compared with pre-pandemic, were less likely to be transported in Singapore and Atlanta (aOR 0.50, 95% CI, 0.42%-0.85%, and 0.36, 95% CI, 0.26-0.50, respectively), without significant differences in overall pre-hospital ROSC. Conclusion: Changes in OHCA characteristics and pre-hospital interventions during the pandemic were likely collateral consequences, with regional variations partly reflecting differences in systems of care and other sociocultural factors. These highlight opportunities for public education and the need for further study into lower transport rates during the pandemic.

14.
Hong Kong Journal of Emergency Medicine ; 29(1):84S-85S, 2022.
Article in English | EMBASE | ID: covidwho-1978653

ABSTRACT

Clinical problem or need: Since the outbreak of the COVID-19 pandemic, wearing personal protective equipment (PPE) has become a daily routine for most healthcare providers. However, wearing it is not only a troublesome thing but also time-consuming, which may affect the quality of patient care. In certain emergent scenarios (e.g. out-of-hospital cardiac arrest (OHCA) or respiratory failure), every second counts. We believed in that "Suit. Pro.";the new version of the traditional PPE will benefit the workflow in managing life-threatened patients and make them comfortable of wearing PPE during the pandemic. The concept of innovation and how it works: The "Suit. Pro." solves the problems while putting your lower extremities in the PPE, which is the rate-determining step in wearing PPE. We made three main adjustments: Widen the leg opening of PPE;Widen the opening of the shoe cover and use a cord lock and a cord to tighten it up instead of an elastic band;Shorten the pants to about 15cm below the knee and lengthen the shoe cover to about 5cm below the knee to make an adequate overlap without redundant length. These adjustments speed up the wearing process and will not compromise the effectiveness of protection. Feasibility and usability: We have performed multiple simulation studies (Film 1) to test the efficacy of the "Suit. Pro." Due to its user-friendly design, our colleagues can wear it smoothly and fast even if they have never used it before. You can wear the "Suit. Pro." running without loosening the shoe cover. Moreover, some colleagues wearing bigger shoes put "Suit. Pro." on easily without losing balance or making their shoes stuck in the pants. The "Suit. Pro." is so easy to wear and not only speeds up the wearing process but makes the whole wearing process more pleasant. Scalability and sustainability: The "Suit. Pro." definitely can be mass-produced by companies because it was redesigned with easily accessible materials. It took us an extra USD2 to remake one suit. There is no concern about sustainability because PPE is disposable.

15.
Resuscitation ; 179: 29-35, 2022 Aug 03.
Article in English | MEDLINE | ID: covidwho-1967081

ABSTRACT

INTRODUCTION: Prior research shows a greater disease burden, lower BCPR rates, and worse outcomes in Black and Hispanic patients after OHCA. Female OHCA patients have lower rates of BCPR compared to men and other survival outcomes vary. The influence of the COVID-19 pandemic on OHCA incidence and outcomes in different health disparity populations is unknown. METHODS: We used data from the Texas Cardiac Arrest Registry to Enhance Survival (CARES). We determined the association of both prehospital characteristics and survival outcomes with the pandemic period in each study group through Pearson's χ2 test or Fisher's exact tests. We created mixed multivariable logistic regression models to compare odds of cardiac arrest care and outcomes between 2019 and 2020 for the study groups. RESULTS: Black OHCA patients (aOR = 0.73; 95% CI: 0.65 - 0.82) had significantly lower odds of BCPR compared to White OHCA patients, were less likely to achieve ROSC (aOR = 0.86; 95% CI: 0.74 - 0.99) or have a good CPC score (aOR = 0.47; 95% CI: 0.29 - 0.75). Compared to White patients with OHCA, Hispanic persons were less likely to have a field TOR (aOR = 0.86; 95% CI: 0.75 - 0.99) or receive BCPR (aOR = 0.78; 95% CI: 0.69 - 0.87). Female OHCA patients had higher odds of surviving to hospital admission compared to males (aOR = 1.29; 95% CI: 1.15 - 1.44). CONCLUSION: Many OHCA outcomes worsened for Black and Hispanic patients. While some aspects of care worsened for women, their odds of survival improved compared to males.

16.
Cardiol Clin ; 40(3): 355-364, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1944433

ABSTRACT

The incidence of both out-of-hospital and in-hospital cardiac arrest increased during the coronavirus disease 2019 (COVID-19) pandemic. Patient survival and neurologic outcome after both out-of-hospital and in-hospital cardiac arrest were reduced. Direct effects of the COVID-19 illness combined with indirect effects of the pandemic on patient's behavior and health care systems contributed to these changes. Understanding the potential factors offers the opportunity to improve future response and save lives.


Subject(s)
COVID-19 , Cardiopulmonary Resuscitation , Emergency Medical Services , Out-of-Hospital Cardiac Arrest , COVID-19/epidemiology , Humans , Out-of-Hospital Cardiac Arrest/epidemiology , Out-of-Hospital Cardiac Arrest/etiology , Out-of-Hospital Cardiac Arrest/therapy , Pandemics
17.
J Am Coll Emerg Physicians Open ; 3(4): e12773, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1935365

ABSTRACT

Objectives: The Interdisciplinary Cardiac Arrest Research Review (ICARE) group was formed in 2018 to conduct an annual search of peer-reviewed literature relevant to cardiac arrest. Now in its third year, the goals of the review are to highlight annual updates in the interdisciplinary world of clinical cardiac arrest research with a focus on clinically relevant and impactful clinical and population-level studies from 2020. Methods: A search of PubMed using keywords related to clinical research in cardiac arrest was conducted. Titles and abstracts were screened for relevance and sorted into 7 categories: Epidemiology & Public Health Initiatives; Prehospital Resuscitation, Technology & Care; In-Hospital Resuscitation & Post-Arrest Care; Prognostication & Outcomes; Pediatrics; Interdisciplinary Guidelines & Reviews; and a new section dedicated to the coronavirus disease 2019 (COVID-19) pandemic. Screened manuscripts underwent standardized scoring of methodological quality and impact on the respective fields by reviewer teams lead by a subject matter expert editor. Articles scoring higher than 99 percentiles by category were selected for full critique. Systematic differences between editors' and reviewers' scores were assessed using Wilcoxon signed-rank test. Results: A total of 3594 articles were identified on initial search; of these, 1026 were scored after screening for relevance and deduplication, and 51 underwent full critique. The leading category was Prehospital Resuscitation, Technology & Care representing 35% (18/51) of fully reviewed articles. Four COVID-19 related articles were included for formal review that was attributed to a relative lack of high-quality data concerning cardiac arrest and COVID-19 specifically by the end of the 2020 calendar year. No significant differences between editor and reviewer scoring were found among review articles (P = 0.697). Among original research articles, section editors scored a median 1 point (interquartile range, 0-3; P < 0.01) less than reviewers. Conclusions: Several clinically relevant studies have added to the evidence base for the management of cardiac arrest patients including methods for prognostication of neurologic outcome following arrest, airway management strategy, timing of coronary intervention, and methods to improve expeditious performance of key components of resuscitation such as chest compressions in adults and children.

18.
J Clin Med ; 11(14)2022 Jul 16.
Article in English | MEDLINE | ID: covidwho-1938862

ABSTRACT

An investigation of the chronobiology of out-of-hospital cardiac arrest (OHCA) during the coronavirus disease 2019 (COVID-19) pandemic and the differences in comparison to the 6-year pre-pandemic period. A retrospective analysis of the dispatch cards from the Emergency Medical Service between January 2014 and December 2020 was performed within the OSCAR-POL registry. The circadian, weekly, monthly, and seasonal variabilities of OHCA were investigated. A comparison of OHCA occurrence between the year 2020 and the 6-year pre-pandemic period was made. A total of 416 OHCAs were reported in 2020 and the median of OHCAs during the pre-pandemic period was 379 (interquartile range 337-407) cases per year. Nighttime was associated with a decreased number of OHCAs (16.6%) in comparison to afternoon (31.5%, p < 0.001) and morning (30.0%, p < 0.001). A higher occurrence at night was observed in 2020 compared to 2014-2019 (16.6% vs. 11.7%, p = 0.001). Monthly and seasonal variabilities were observed in 2020. The months with the highest OHCA occurrence in 2020 were November (13.2%) and October (11.1%) and were significantly higher compared to the same months during the pre-pandemic period (9.1%, p = 0.002 and 7.9%, p = 0.009, respectively). Autumn was the season with the highest rate of OHCA, which was also higher compared to the pre-pandemic period (30.5% vs. 25.1%, p = 0.003). The COVID-19 pandemic was related to a higher occurrence of OHCA. The circadian, monthly, and seasonal variabilities of OHCA occurrence were confirmed. In 2020, the highest occurrence of OHCA was observed in October and November, which coincided with the highest occurrence of COVID-19 infections in Poland.

19.
Int J Emerg Med ; 15(1): 26, 2022 Jun 09.
Article in English | MEDLINE | ID: covidwho-1938286

ABSTRACT

BACKGROUND: The impact of the coronavirus disease 2019 (COVID-19) outbreak on out-of-hospital cardiac arrest (OHCA) has been of interest worldwide. However, evidence from low-resource emergency medical service systems is limited. This study investigated the effects of the COVID-19 outbreak on the prehospital management and outcomes of OHCA in Thailand. METHODS: This multicentered, retrospective, observational study compared the management and outcomes of OHCA for 2 periods: pre-COVID-19 (January-September 2019) and during the outbreak (January-September 2020). Study data were obtained from the Thai OHCA Network Registry. The primary outcome was survival rate to hospital discharge. Data of other OHCA outcomes and prehospital care during the two periods were also compared. RESULTS: The study enrolled 691 patients: 341 (49.3%) in the pre-COVID-19 period and 350 (50.7%) in the COVID-19 period. There was a significant decrease in the survival rate to discharge during the COVID-19 outbreak (7.7% vs 2.2%; adjusted odds ratio [aOR], 0.34; 95% confidence interval [CI], 0.15-0.95). However, there were no significant differences between the 2 groups in terms of their rates of sustained return of spontaneous circulation (33.0% vs 31.3%; aOR, 1.01; 95% CI, 0.68-1.49) or their survival to intensive care unit/ward admission (27.8% vs 19.8%; aOR, 0.78; 95% CI, 0.49-1.15). The first-responder response interval was significantly longer during the COVID-19 outbreak (median [interquartile range] 5.3 [3.2-9.3] min vs 10 [6-14] min; P < 0.001). There were also significant decreases in prehospital intubation (66.7% vs 48.2%; P < 0.001) and prehospital drug administration (79.5% vs 70.6%; P = 0.024) during the COVID-19 outbreak. CONCLUSION: There was a significant decrease in the rate of survival to hospital discharge of patients with OHCA during the COVID-19 outbreak in Thailand. Maintaining the first responder response quality and encouraging prehospital advanced airway insertion might improve the survival rate during the COVID-19 outbreak.

20.
Cureus ; 14(5): e25010, 2022 May.
Article in English | MEDLINE | ID: covidwho-1924632

ABSTRACT

E-cigarettes or vaping products became available in the market in 2004. Since then, their use has rapidly increased in all sections of society. They have been increasingly used as a "safer" alternative for combustible cigarettes and as an aid toward smoking cessation. Over time, the acceptability of e-cigarettes in public spaces increased. Lack of regulatory control also led to a rapid rise in the rate of e-cigarette/vaping product users. We report a case of a 35-year-old female who recently switched from conventional cigarettes to e-cigarette usage, and who presented to the emergency department after an out-of-hospital cardiac arrest. She was found to have bilateral extensive nodular ground-glass opacities on a CT angiogram of the chest. She needed non-invasive ventilation and was initially started on broad-spectrum antibiotic treatment for possible pneumonia. Due to a worsening clinical status, e-cigarette or vaping product associated lung injury (EVALI) diagnosis was considered, and she was started on parenteral steroid therapy, leading to rapid recovery in respiratory status. With a tapering course of steroid therapy and cessation of e-cigarette use, there was complete clinical and radiological recovery. This case highlights that EVALI can have varied clinical presentations, and the diagnosis should be considered in anyone who presents with an acute cardio-pulmonary decline and a concomitant history of e-cigarette use.

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