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1.
Irish Medical Journal ; 114(10), 2021.
Article in English | GIM | ID: covidwho-1837364

ABSTRACT

Aim: To optimise preparation for and reduce the stress of managing critically ill patients with suspected COVID-19 in the Emergency Department at Cork University Hospital using locally designed medical grab bags.

2.
Journal of Pediatric Surgery ; 2022.
Article in English | ScienceDirect | ID: covidwho-1819552

ABSTRACT

Objective To characterize practices surrounding pediatric eCPR in the U.S. and Canada Methods Cross-sectional survey of U.S. and Canadian hospitals with non-cardiac eCPR programs. Variables included hospital and surgical group demographics, eCPR inclusion/exclusion criteria, cannulation approaches, and outcomes (survival to decannulation and survival to discharge) Results Surveys were completed by 40 hospitals in the United States (37) and Canada (3) among an estimated 49 programs (82% response rate). Respondents tended to work in >200 bed free-standing children's hospitals (27, 68%). Pediatric general surgeons respond to activations in 32 (80%) cases, with a median group size of 7 (IQR 5,9.5);8 (20%) responding institutions take in-house call and 63% have a formal back-up system for eCPR. Dedicated simulation programs were reported by 22 (55%) respondents. Annual eCPR activations average approximately 6/year;approximately 39% of patients survived to decannulation, with 35% surviving to discharge. Cannulations occurred in a variety of settings and were mostly done through the neck at the purview of cannulating surgeon/proceduralist. Exclusion criteria used by hospitals included pre-hospital arrest (21, 53%), COVID+ (5, 13%), prolonged CPR (18, 45%), lethal chromosomal anomalies (15, 38%) and terminal underlying disease (14, 35%). Conclusions While there are some similarities regarding inclusion/exclusion criteria, cannulation location and modality and follow-up in pediatric eCPR, these are not standard across multiple institutions. Survival to discharge after eCPR is modest but data on cost and long-term neurologic sequela are lacking. Codification of indications and surgical approaches may help clarify the utility and success of eCPR. Level of Evidence 4

3.
Geriatric Orthopaedic Surgery and Rehabilitation ; 12:14-15, 2021.
Article in English | EMBASE | ID: covidwho-1817121

ABSTRACT

Introduction: In January 2021, Ireland was undergoing the 'Third Wave' of COVID-19, with almost 2,000 persons hospitalised with COVID-19. Over 50% of all COVID-19-related deaths in the EU have occurred in those aged 80 years and older. The same patient cohort is also at high risk sustaining a fragility fracture, leading to an admission to the orthopaedic rehabilitation ward. This study examines a patient group in whom these two scenarios coincided, describing a patient cohort who having sustained a fragility fracture, later contracted COVID-19. This study aims to describe the characteristics and outcomes of orthopaedic rehabilitation patients with COVID-19 and to examine the response of an orthopaedic rehabilitation ward to an outbreak of COVID-19. Methods: This is a retrospective observational study. Data from 26 hospitalised patients aged over 65 years with COVID-19 at an Irish orthopaedic rehabilitation ward was collected. Symptom profile, degree of COVID-19 severity, Clinical Frailty Scale (CFS), Charleston co-morbidity scores, laboratory and radiological data were reviewed. Individual treatment pathways were recorded for each patient. Infection control records were reviewed to examine the response of the ward to an outbreak of COVID-19. Results: Patient mortality rate was 7.7% (n = 2). Median survivor age was 79.5 years (IQR 70-85.5). Mean CFS and Charleston Co-morbidity scores were 4.15;(SD1.6) and 5.08, respectively. The majority of patients (n = 25, 96%) were categorised as mild COVID-19 cases. Delirium was noted in more than 10% of patients (n = 3, 11.6%). One patient (n = 1, 3.8%) required non-invasive ventilation. In those whose disease was classifies as severe (n = 2, 7.7%), intubation/resuscitation were not deemed appropriate and when they deteriorated, comfort measures were taken. The majority of patients (n = 21, 81%) were able to return home upon discharge. Three patients (11.5%) had increased care needs and required long term care to be arranged. Conclusion: An outbreak of COVID-19 requires a multidisciplinary approach with a focus on not only medical management but also clinical workforce management, patient flow, management of access to the wards and information and communications management. The overall outcomes in this group, including mortality and proportion discharged to long term care, were positive when compared to similar cohorts of elderly hospitalised patients with COVID-19. These outcomes support a multidisciplinary model of care.

4.
Brazilian Neurosurgery ; 2022.
Article in English | EMBASE | ID: covidwho-1815661

ABSTRACT

Plain Language SummaryHaving the issue of coronavirus disease 2019 (COVID-19) in mind, there is always a dilemma surrounding elective and non-urgent neurosurgical operations. The unanswered question is regarding whether there is any post-COVID-19 complications that hinder a patient from becoming a candidate for a neurosurgical operation. If that is the case, what should we do?In the present article, we report our single-center experience with an unusual bleeding during the operation of a huge cerebellar tumor in a girl previously infected with COVID-19. In the end, we recommend our experience to our colleagues. There are still some conditions that pediatric neurosurgeons may face in the context of coronavirus disease 2019 (COVID-19) which have not been fully addressed so far. Authors have postulated an ongoing inflammatory myocardial status in a significant proportion of patients who have recovered from COVID-19. We report our experience with a 10-month-old girl who had recovered form COVID-19 and had a case of fourth-ventricle mass in the midline of the posterior fossa. She was scheduled for microneurosurgical resection of the mass following the insertion of a ventriculoperitoneal shunt. There were no significant issues regarding the induction of anesthesia. A midline suboccipital approach was chosen, and the patient was fully prepared and draped. Suboccipital soft tissues and muscles were dissected layer by layer through the midline avascular line. A marked gush of blood off the midline was observed during the opening in Y of the dura mater. Then, we started to approach the occipital sinus. However, there was an unusual loss of ∼ 200 mL of blood lost from this area. Despite the proper packed-cell transfusion, the patient developed bradycardia and a sudden rhythm of asystole. The cardiopulmonary cerebral resuscitation (CPCR) was initiated immediately. Despite the maximal effort, the heart rate did not change and remained asystole. We recommend that pediatric neurosurgeons postpone the procedures to be performed in patients who have recovered from COVID-19 for more than one month after a thorough preoperative cardiac evaluation has been performed.

5.
Notf Rett Med ; : 1-6, 2021 Aug 24.
Article in German | MEDLINE | ID: covidwho-1813691

ABSTRACT

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide. Consequences of infection prevention measures during such contagion events can cause disadvantages especially for patients in out-of-hospital cardiac arrest (OHCA). METHODS: Retrospective analysis of OHCAs in one county from January-May in 2018, 2019 and 2020, with the first appearance of the SARS-CoV­2 pandemic in 2020 and a high incidence of the influenza virus in 2018. RESULTS: A total of 497 OHCAs were investigated (2018 n = 173; 2019 n = 149; 2020 n = 175). In this study, a constant resuscitation incidence (85-99 resuscitations/100,000 population/year) and locally typical patients (mean 70 years, 66% male; median PES 3) were found. There were no statistically significant differences in the initial situation of the patients (number of observed OHCAs, frequency of lay resuscitations, suspected causes of OHCAs, initial ECG rhythm) and the treatment course (frequency of return of spontaneous circulation [ROSC]/hospital admission/survival to hospital discharge, neurological outcome). None of the OHCA patients in 2020 tested positive for SARS-CoV­2 and 3 patients in 2018 tested positive for the influenza virus. DISCUSSION: The lockdown during the first wave of SARS-CoV­2 pandemic does not seem to have affected the outcome of OHCA patients without coronavirus disease 2019 (COVID-19) in the end.

6.
Circ Cardiovasc Qual Outcomes ; 15(4): e008900, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1807749
7.
Am J Emerg Med ; 57: 114-123, 2022 Apr 27.
Article in English | MEDLINE | ID: covidwho-1803389

ABSTRACT

INTRODUCTION: Coronavirus disease of 2019 (COVID-19) has resulted in millions of cases worldwide. As the pandemic has progressed, the understanding of this disease has evolved. Its impact on the health and welfare of the human population is significant; its impact on the delivery of healthcare is also considerable. OBJECTIVE: This article is another paper in a series addressing COVID-19-related updates to emergency clinicians on the management of COVID-19 patients with cardiac arrest. DISCUSSION: COVID-19 has resulted in significant morbidity and mortality worldwide. From a global perspective, as of February 23, 2022, 435 million infections have been noted with 5.9 million deaths (1.4%). Current data suggest an increase in the occurrence of cardiac arrest, both in the outpatient and inpatient settings, with corresponding reductions in most survival metrics. The frequency of out-of-hospital lay provider initial care has decreased while non-shockable initial cardiac arrest rhythms have increased. While many interventions, including chest compressions, are aerosol-generating procedures, the risk of contagion to healthcare personnel is low, assuming appropriate personal protective equipment is used; vaccination with boosting provides further protection against contagion for the healthcare personnel involved in cardiac arrest resuscitation. The burden of the COVID-19 pandemic on the delivery of cardiac arrest care is considerable and, despite multiple efforts, has adversely impacted the chain of survival. CONCLUSION: This review provides a focused update of cardiac arrest in the setting of COVID-19 for emergency clinicians.

8.
Intensive Care Med ; 48(1): 1-15, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1800370

ABSTRACT

Rates of survival with functional recovery for both in-hospital and out-of-hospital cardiac arrest are notably low. Extracorporeal cardiopulmonary resuscitation (ECPR) is emerging as a modality to improve prognosis by augmenting perfusion to vital end-organs by utilizing extracorporeal membrane oxygenation (ECMO) during conventional CPR and stabilizing the patient for interventions aimed at reversing the aetiology of the arrest. Implementing this emergent procedure requires a substantial investment in resources, and even the most successful ECPR programs may nonetheless burden healthcare systems, clinicians, patients, and their families with unsalvageable patients supported by extracorporeal devices. Non-randomized and observational studies have repeatedly shown an association between ECPR and improved survival, versus conventional CPR, for in-hospital cardiac arrest in select patient populations. Recently, randomized controlled trials suggest benefit for ECPR over standard resuscitation, as well as the feasibility of performing such trials, in out-of-hospital cardiac arrest within highly coordinated healthcare delivery systems. Application of these data to clinical practice should be done cautiously, with outcomes likely to vary by the setting and system within which ECPR is initiated. ECPR introduces important ethical challenges, including whether it should be considered an extension of CPR, at what point it becomes sustained organ replacement therapy, and how to approach patients unable to recover or be bridged to heart replacement therapy. The economic impact of ECPR varies by health system, and has the potential to outstrip resources if used indiscriminately. Ideally, studies should include economic evaluations to inform health care systems about the cost-benefits of this therapy.


Subject(s)
Cardiopulmonary Resuscitation , Extracorporeal Membrane Oxygenation , Out-of-Hospital Cardiac Arrest , Adult , Cardiopulmonary Resuscitation/methods , Cost-Benefit Analysis , Extracorporeal Membrane Oxygenation/methods , Humans , Out-of-Hospital Cardiac Arrest/therapy
9.
Eastern Mediterranean Health Journal ; 28(3):173-243, 2022.
Article in English | WHOIRIS | ID: covidwho-1800411

ABSTRACT

Eastern Mediterranean Health Journal is the official health journal published by the Eastern Mediterranean Regional Office of the World Health Organization. It is a forum for the presentation and promotion of new policies and initiatives in health services;and for the exchange of ideas concepts epidemiological data research findings and other information with special reference to the Eastern Mediterranean Region. It addresses all members of the health profession medical and other health educational institutes interested NGOs WHO Collaborating Centres and individuals within and outside the Region المجلة الصحية لشرق المتوسط هى المجلة الرسمية التى تصدرعن المكتب الاقليمى لشرق المتوسط بمنظمة الصحة العالمية. وهى منبر لتقديم السياسات والمبادرات الجديدة فى الصحة العامة والخدمات الصحية والترويج لها، و لتبادل الاراء و المفاهيم والمعطيات الوبائية ونتائج الابحاث وغير ذلك من المعلومات، و خاصة ما يتعلق منها باقليم شرق المتوسط. وهى موجهة الى كل اعضاء المهن الصحية، والكليات الطبية وسائر المعاهد التعليمية، و كذا المنظمات غير الحكومية المعنية، والمراكز المتعاونة مع منظمة الصحة العالمية والافراد المهتمين بالصحة فى الاقليم و خارجه La Revue de Santé de la Méditerranée Orientale est une revue de santé officielle publiée par le Bureau régional de l’Organisation mondiale de la Santé pour la Méditerranée orientale. Elle offre une tribune pour la présentation et la promotion de nouvelles politiques et initiatives dans le domaine de la santé publique et des services de santé ainsi qu’à l’échange d’idées de concepts de données épidémiologiques de résultats de recherches et d’autres informations se rapportant plus particulièrement à la Région de la Méditerranée orientale. Elle s’adresse à tous les professionnels de la santé aux membres des instituts médicaux et autres instituts de formation médico-sanitaire aux ONG Centres collaborateurs de l’OMS et personnes concernés au sein et hors de la Région.

10.
Critical Care ; 26(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1793856

ABSTRACT

Introduction: Cardiac function is known to be negatively impacted by sepsis. Monitoring Cardiac Output (CO) trends over the course of treatment may provide insight into cardiac function and may be used to predict patient outcome. The goal of this study was to explore the relationship between the change in stroke volume and outcome in critically ill patients. Methods: The Starling Registry study is an observational registry study evaluating trends in CO and SV (Stroke Volume) over time as related to patient outcome (NCT04648293). Patients that exhibited an overall improvement in CO (first CO measurement compared to last CO measurement) were compared to those who did not exhibit improvement. Results: A total of 229 critical care patients received hemodynamic monitoring during their ICU stay across three different hospitals. 48% were female, and the average age was 64 years. 64% of the patients had sepsis, and 17% of patients were positive for COVID. Notably, patients who exhibited an overall improvement in CO exhibited a decrease need for mechanical ventilation (4.8% vs 15%, p = 0.041) and a trend toward a decrease in mortality (16.4%) compared to those who did not improve (28.0%, p = 0.080) (Fig. 1). Conclusions: We have previously shown that patients who show an improvement in CO in response to the resuscitation exhibited improved outcome. Trending cardiac output over a 1-3 day monitoring period revealed additional usefulness in predicting patients with improved outcome. These results highlight the importance of trending hemodynamics in therapy. (Figure Presented).

11.
Critical Care ; 26(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1793851

ABSTRACT

Introduction: The Coronavirus disease 2019 (COVID-19) is a pandemic responsible for 3 million deaths worldwide according to the World Health Organization (WHO) hence considered as a “ global health emergency”. The aim of the present study was to describe the demographic characteristics, clinical presentation, of COVID-19 death cases in the emergency department Taher Sfar Mahdia. Methods: We did a retrospective study over a period of 1 year, from August 2020 to August 2021, carried out at Taher Sfar Mahdia hospital, in the Emergency Department, on patients over 18 years old with COVID 19 confirmed by either RT-PCR and or SARS-COV-2 rapid antigen test and dead in emergency room. Results: A total of 976 cases were detected over the study period including 308 (29,9%) COVID-19 deaths among them dead in emergency department. The median age of those patients was 76 years [IQR 69-83]. The sex ratio (M / W) was 1.3. 57 (56%) patients had at least one comorbidity mainly arterial hypertension (57%) followed by diabetes (38%). The median time from symptoms onset to patient's admission was 5 days [IQR 4-10], they had a median SpO2 of 81% [IQR 75%-88. While their hospitalization, these patients required high flows of O2, mainly HCM: 148 (48%);NIV 49 (15%) and MV 101 (33%). The median length of stay was 4 days [IQR 2-7]. Conclusions: This descriptive retrospective study shows also a high mortality rate in the emergency department. These deaths could be avoided if the intensive care department accepted them, but the advanced age, several comorbidities, a severe clinical form were the reasons why the medical resuscitation department refused to take them in charge preferring to save the few places they have for patients with better prognosis.

12.
Int J Gen Med ; 15: 3943-3950, 2022.
Article in English | MEDLINE | ID: covidwho-1793335

ABSTRACT

Introduction: Japan went through five surges of coronavirus disease 2019 (COVID-19) or "waves". However, their impacts on the do not attempt cardiopulmonary resuscitation (DNACPR) of the patients are not known. Methods: A retrospective single-center cohort study was conducted for all hospitalized patients with COVID-19 from March 1, 2020, to September 30, 2021. Their code status was retrieved, and its association with the waves and other parameters, such as in-hospital mortality, was investigated. The relationship between DNACPR status and each wave was examined, as well as the effect on in-hospital mortality. Results: A total of 1153 patients were hospitalized with the diagnosis of COVID-19 during the study period. On admission, 117 patients (10.1%) had DNACPR orders, 373 patients (32.4%) were on full code, 45 patients (3.9%) stated that they cannot decide code status. DNACPR rate appeared to increase at the summit of each wave. Subsequently, 160 patients (13.9%) became DNACPR status, 385 patients (33.4%) became full code, and 12 patients (1.0%) stated that they remained unable to decide code status. There was no association between DNACPR status and each wave, and DNACPR status was not associated with higher mortality (P = 0.87), both by logistic regression analysis. Conclusion: DNACPR status among hospitalized COVID-19 patients appeared to have changed over multiple waves in Japan, but it is more likely due to the change of the patients' demographics, particularly their age. DNACPR was common among the elderly, but it was not independently associated with higher mortality.

13.
PLoS ONE Vol 16(6), 2021, ArtID e0252841 ; 16(6), 2021.
Article in English | APA PsycInfo | ID: covidwho-1790608

ABSTRACT

Background: Outbreaks of emerging infectious diseases, such as COVID-19, have negative impacts on bystander cardiopulmonary resuscitation (BCPR) for fear of transmission while breaking social distancing rules. The latest guidelines recommend hands-only cardiopulmonary resuscitation (CPR) and facemask use. However, public willingness in this setup remains unknown. Methods: A cross-sectional, unrestricted volunteer Internet survey was conducted to assess individuals' attitudes and behaviors toward performing BCPR, pre-existing CPR training, occupational identity, age group, and gender. The raking method for weights and a regression analysis for the predictors of willingness were performed. Results: Among 1,347 eligible respondents, 822 (61%) had negative attitudes toward performing BCPR. Healthcare providers (HCPs) and those with pre-existing CPR training had fewer negative attitudes (p < 0.001);HCPs and those with pre-existing CPR training and unchanged attitude showed more positive behaviors toward BCPR (p < 0.001). Further, 9.7% of the respondents would absolutely refuse to perform BCPR. In contrast, 16.9% would perform BCPR directly despite the outbreak. Approximately 9.9% would perform it if they were instructed, 23.5%, if they wore facemasks, and 40.1%, if they were to perform hands-only CPR. Interestingly, among the 822 respondents with negative attitudes, over 85% still tended to perform BCPR in the abovementioned situations. The weighted analysis showed similar results. The adjusted predictors for lower negative attitudes toward BCPR were younger age, being a man, and being an HCP;those for more positive behaviors were younger age and being an HCP. Conclusions: Outbreaks of emerging infectious diseases, such as COVID-19, have negative impacts on attitudes and behaviors toward BCPR. Younger individuals, men, HCPs, and those with pre-existing CPR training tended to show fewer negative attitudes and behaviors. Meanwhile, most individuals with negative attitudes still expressed positive behaviors under safer measures such as facemask protection, hands-only CPR, and available dispatch instructions. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

14.
Anesteziologie a Intenzivni Medicina ; 33(1):7-13, 2022.
Article in Czech | EMBASE | ID: covidwho-1780464

ABSTRACT

Study objective: Administration of systemic corticosteroids in patients with severe COVID-19 (Coronavirus Disease 2019) has been recommended by World Health Organization (WHO) according to the RECOVERY trial results. However, there is still ongoing debate regarding the evidence supporting the dose, timing, route of administration and type of corticosteroid. This survey aimed to describe the current clinical practice of administration of systemic corticosteroids for patients with COVID-19 within Intensive Care Units (ICU) in Czech Republic. Study design: cross-sectional survey Material and methods: Electronic survey containing 15 questions was sent to the members of Czech Society of Anaesthesiol-ogy, Resuscitation and Intensive Care, Czech Society of Intensive care and Czech Pneumological and Phthisiological Society members. The results were analysed by descriptive statistic methods. Results: The survey fulfilled 233 respondents and 231 answers were eligible for analysis. The most prevalent group was attending physician with completed training in anaesthesiology and intensive care medicine (AIM) (32 %, n = 74). The most prevalent indication for initiation of corticosteroid treatment was oxygen therapy (face mask or nasal cannula) (59,3 %, n = 137) and high-flow nasal oxygen therapy (HFNC) (21,6 %, n = 50). The most preferred corticosteroid was dexamethasone (75,8 %, n = 175) at dose of 8 mg intravenously (i. v.) (48,6 %, n = 85), or dose of 6 mg i. v. (32,0 %, n = 56) followed by methylprednis-olone (25,5 %, n= 59) at dose of 80 mg i. v. (35,6 %, n = 21), and 40 mg i. v. (13,6 %, n = 8), respectively. The preferred duration of therapy was 10 days (dexamethasone 60,6 %, n = 106, methylprednisolone 20,3 %, n = 12). Conclusion: Administration of corticosteroid was dominantly initiated in patients with severe COVID-19 receiving supplemental oxygen. The corticosteroid of first choice was intravenous dexamethasone at dose of 8 mg and 6 mg for 10 days, respectively.

15.
J Intern Med ; 2022 Apr 05.
Article in English | MEDLINE | ID: covidwho-1774862

ABSTRACT

BACKGROUND: Previous studies reported regional differences in end-of-life care (EoLC) for critically ill patients in Europe. OBJECTIVES: The purpose of this post-hoc analysis of the prospective multicentre COVIP study was to investigate variations in EoLC practices among older patients in intensive care units during the coronavirus disease 2019 pandemic. METHODS: A total of 3105 critically ill patients aged 70 years and older were enrolled in this study (Central Europe: n = 1573; Northern Europe: n = 821; Southern Europe: n = 711). Generalised estimation equations were used to calculate adjusted odds ratios (aORs) to population averages. Data were adjusted for patient-specific variables (demographic, disease-specific) and health economic data (gross domestic product, health expenditure per capita). The primary outcome was any treatment limitation, and 90-day mortality was a secondary outcome. RESULTS: The frequency of the primary endpoint (treatment limitation) was highest in Northern Europe (48%), intermediate in Central Europe (39%) and lowest in Southern Europe (24%). The likelihood for treatment limitations was lower in Southern than in Central Europe (aOR 0.39; 95% confidence interval [CI] 0.21-0.73; p = 0.004), even after multivariable adjustment, whereas no statistically significant differences were observed between Northern and Central Europe (aOR 0.57; 95%CI 0.27-1.22; p = 0.15). After multivariable adjustment, no statistically relevant mortality differences were found between Northern and Central Europe (aOR 1.29; 95%CI 0.80-2.09; p = 0.30) or between Southern and Central Europe (aOR 1.07; 95%CI 0.66-1.73; p = 0.78). CONCLUSION: This study shows a north-to-south gradient in rates of treatment limitation in Europe, highlighting the heterogeneity of EoLC practices across countries. However, mortality rates were not affected by these results.

16.
Trauma Monthly ; 27:1-7, 2022.
Article in English | EMBASE | ID: covidwho-1772139

ABSTRACT

Introduction: There is a need to prepare clinical guidelines for conducting elective or emergency spinal cord surgeries in people who may be carriers of the COVID-19. Therefore, the study aimed to design a guideline for conducting elective spinal cord surgeries during the COVID-19 pandemic. Methods: The clinical guidelines and systematic reviews providing recommendations for elective and emergency spinal cord surgeries were collected by an initial search. A group of nine experts were designed a domestic preliminary guideline using six available guidelines presented in four studies. Scoring was conducted based on the AGREE (Appraisal of Guidelines Research and Evaluation) tool. Results: The guideline was prepared in eight subscales, including outpatient visit and counseling, protective measures for health personnel, surgical considerations during the coronavirus pandemic, intraoperative considerations, managing aerosol producing activities, elective and emergency spinal cord surgery, and patient intubation and cardiopulmonary resuscitation. Each of these subscales included several specific recommendations. Conclusion: It recommended to reduce the capacity of inpatient wards to half during the coronavirus pandemic, give priority only to emergency surgeries, presence of skilled residents (senior year residents), use personal protective equipment, use the least number of people in the operating room, and reduce the length of surgery without compromising its quality.

17.
British Journal of Surgery ; 109(SUPPL 1):i13, 2022.
Article in English | EMBASE | ID: covidwho-1769137

ABSTRACT

Aim: Patients undergoing surgical repair of neck-of-femur (NOF) fractures are at higher risk of acute kidney injury (AKI). NICE and BOAST have published guidelines to help prevent the occurrence of AKI, including adequate fluid resuscitation pre- and post-operatively. An audit was conducted during the COVID-19 pandemic to explore whether the department was adhering to NICE guidelines. Method: AKI was defined, as per NICE Clinical Knowledge Summaries, as an increase in serum creatinine levels by 26 μmol/L or greater. Data was collected prospectively starting from December 2020 to February 2021 in the Princess Royal Hospital during the COVID-19 pandemic. All patients with NOFs were included and data on sex, age, comorbidities, and type of surgery were collected. Results: In total, 32 patients were included in the audit with an average age of 82 years;of these, eleven patients had dynamic hip screws and eighteen patients had hemiarthroplasties. Five patients had chronic kidney disease, six patients had previous myocardial infarctions and thirteen patients had hypertension. Two patients (6.3%) were found to have an AKI post-surgery with increased creatinine levels of 27 and 28 μmol/L. Both had hypertension and underwent hemiarthroplasties. Conclusions: Complications such as AKIs are reversible and preventable. Especially during the COVID-19 pandemic such complications can increase morbidity and mortality of patients suffering from NOF leading to longer hospital stays. The low rate of AKI following NOF repair in our Department of Trauma and Orthopaedic is attributable to adherence to NICE and BOAST fluid resuscitation guidelines.

18.
Resusc Plus ; 9: 100209, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1768486

ABSTRACT

AIMS: The aims were to examine patient and hospital characteristics associated with Do-Not-Attempt-Cardiopulmonary-Resuscitation (DNACPR) decisions for adult admissions through the emergency department (ED), for patients with DNACPR decisions to examine patient and hospital characteristics associated with hospital mortality, and to explore changes in CPR status. METHODS: This was a retrospective observational study of adult patients admitted through the ED at Karolinska University Hospital 1 January to 31 October 2015. RESULTS: The cohort included 25,646 ED admissions, frequency of DNACPR decisions was 11% during hospitalisation. Patients with DNACPR decisions were older, with an overall higher burden of chronic comorbidities, unstable triage scoring, hospital mortality and one-year mortality compared to those without. For patients with DNACPR decisions, 63% survived to discharge and one-year mortality was 77%. Age and comorbidities for patients with DNACPR decisions were similar regardless of hospital mortality, those who died showed signs of more severe acute illness on ED arrival. Change in CPR status during hospitalisation was 5% and upon subsequent admission 14%. For patients discharged with DNACPR decisions, reversal of DNACPR status upon subsequent admission was 32%, with uncertainty as to whether this reversal was active or a consequence of a lack of consideration. CONCLUSION: For a mixed population of adults admitted through the ED, frequency of DNACPR decisions was 11%. Two-thirds of patients with DNACPR decisions were discharged, but one-year mortality was high. For patients discharged with DNACPR decisions, reversal of DNACPR status was substantial and this should merit further attention.

19.
Acute Med Surg ; 9(1): e745, 2022.
Article in English | MEDLINE | ID: covidwho-1763181

ABSTRACT

Aim: To evaluate Japanese medical students' awareness of newly recommended cardiopulmonary resuscitation (CPR) and airway management procedures in the context of the coronavirus disease (COVID-19) pandemic. Methods: An online survey was sent in December 2020 to all medical students at Hirosaki University in Japan. The survey included 15 questions and quizzes regarding prior experience of learning the new CPR guidelines in response to COVID-19, knowledge of conventional CPR, and COVID-19 context CPR and airway management procedures. Results: Of all medical students at the university, 457 (57.1%) responded to the survey. Among these, 22% reported that they were knowledgeable about CPR procedure in the COVID-19 pandemic setting. Prior knowledge of CPR in the context of COVID-19 was a significant positive predictor of quiz score regarding the CPR procedure (ß = 0.60, P < 0.01) and the airway management procedure (ß = 0.34, P = 0.02) in the context of the COVID-19 pandemic. Conclusions: Medical students with experience learning the new COVID-19 context CPR guidelines had sufficient knowledge of CPR and advanced airway management procedures in the setting of the COVID-19 pandemic. Implementation of a formal medical education curriculum based on the newly recommended CPR and advanced life support guidelines is needed to improve medical students' awareness and skills of CPR and airway management in the context of the COVID-19 pandemic.

20.
J Glob Infect Dis ; 14(1): 3-9, 2022.
Article in English | MEDLINE | ID: covidwho-1760988

ABSTRACT

Introduction: Coronavirus disease 2019 (COVID-19) is a highly contagious disease transmitted by contact, droplets, and aerosols. Front line health-care workers (HCWs), particularly emergency physicians and acute care providers, are vulnerable to being exposed while treating their sick patients. Despite appropriate personal protective equipment use, HCW gets infected, suggesting the need for multiple layers of protection such as barrier devices. Methods: We aimed to determine the effectiveness of our novel "Resuscitation Cover All"(RCA) in reducing the exposure of HCW to simulated respiratory particles and its feasibility during cardio pulmonary resuscitation (CPR). This was a pilot simulation-based study. Five CPR simulation sessions were performed in Standard and RCA protocols, individually. Exposures through contact, droplets, and aerosols were simulated using a standardized volume of liquid detergent. Under Wood's lamp illumination, exposures of participants were compared between the protocols. Rate and depth of chest compressions, time taken to intubate, interruptions in CPR, and first-pass success were analyzed. Results: Overall mean exposure in standard protocol was 4950.4 ± 1461.6 (95%confidence interval [CI]:3135.7-6765.2) sq.pixels and RCA protocol was 2203.6 ± 1499.0 (95%CI: 342.4-4064.9) sq.pixels (P = 0.019). In standard, chest compressor had the highest exposure of 3066.6 ± 1419.2 (95%CI: 2051.3-4081.9) sq.pixels followed by defibrillator assistant 1166.4 ± 767.4 (95%CI: 617.4-1715.4) sq.pixels. Chest compressor of RCA had reduced exposure compared to that of standard (P < 0.001). Hands were the most frequently exposed body part. Airway manager of RCA had no exposure over head and neck in any session. No significant difference in CPR performance metrics was observed. Conclusion: This pilot simulation-based study shows that the novel RCA device could minimize the exposure of HCW to simulated respiratory particles during CPR. Also, it might not alter the high-quality CPR performance metrics. We need more real-life evidence.

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