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1.
Cardiol J ; 28(6): 816-824, 2021.
Article in English | MEDLINE | ID: covidwho-1603899

ABSTRACT

BACKGROUND: The main purposes of this meta-analysis are to update the information about the impact of coronavirus disease 2019 (COVID-19) pandemic on outcomes of in-hospital cardiac arrest (IHCA) and to investigate the impact of being infected by by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) on IHCA outcomes. METHODS: The current meta-analysis is an update and follows the recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). RESULTS: In analyses, pre- and intra-COVID-19 periods were observed for: shockable rhythms in 17.6% vs. 16.2% (odds ratio [OR]: 1.11; 95% confidence interval [CI]: 0.71-1.72; p = 0.65), return of spontaneous circulation (ROSC) in 47.4% vs. 44.0% (OR: 1.36; 95% CI: 0.90-2.07; p = 0.15), 30-day mortality in 59.8% vs. 60.9% (OR: 0.95; 95% CI: 0.75-1.22; p = 0.69) and overall mortality 75.8% vs. 74.7% (OR: 0.80; 95% CI: 0.49-1.28; p = 0.35), respectively. In analyses, SARS-CoV-2 positive and negative patients were observed for: shockable rhythms in 9.6% vs. 19.8% (OR: 0.51; 95% CI: 0.35-0.73; p < 0.001), ROSC in 33.9% vs. 52.1% (OR: 0.47; 95% CI: 0.30-0.73; p < 0.001), 30-day mortality in 77.2% vs. 59.7% (OR: 2.08; 95% CI: 1.28-3.38; p = 0.003) and overall mortality in 94.9% vs. 76.7% (OR: 3.20; 95% CI: 0.98-10.49; p = 0.05), respectively. CONCLUSIONS: Despite ROSC, 30-day and overall mortality rate were not statistically different in pre- vs. intra-COVID-19 periods, a lower incidence of ROSC and higher 20-day mortality rate were observed in SARS-CoV-2 (+) compared to SARS-CoV-2 (-) patients.


Subject(s)
COVID-19 , Cardiopulmonary Resuscitation , Heart Arrest , Hospitals , Humans , SARS-CoV-2
2.
Orv Hetil ; 162(46): 1831-1841, 2021 11 14.
Article in Hungarian | MEDLINE | ID: covidwho-1523487

ABSTRACT

Összefoglaló. A koronavírus-betegség (COVID-19) okozta közvetlen mortalitáson túl, a járvány közvetett úton is hatással lehet a hirtelen szívhalálra. Egyre növekvo számú közlemény foglalkozik a járványnak a hirtelen szívhalálra kifejtett közvetett hatásával. A kijárási korlátozások és az egészségügyi rendszerek átszervezése hozzájárulhatott ahhoz, hogy a járvány alatt mind a kórházon kívüli, mind a kórházon belüli szívhalál elofordulása megemelkedett. Közegészségügyi intézkedések, mint a korlátozások és a kórházak átszervezése, megváltoztathatják az egészségügyi szolgáltatásokhoz való hozzáférést, ezért hozzájárulhattak az elmúlt évben tapasztalt emelkedett számú szívmegálláshoz. Közleményünk célja a SARS-CoV-2-járvány hirtelen szívhalálra kifejtett hatására vonatkozó, a nemzetközi irodalomban jelenleg megtalálható tanulmányok összefoglalása, melyek a kórházon kívüli szívmegállás elofordulásának háromszoros emelkedésérol számoltak be a járványt megelozo évhez képest. Általánosságban elmondható, hogy a kórházon kívüli szívmegállás a járvány ideje alatt nagyobb gyakorisággal járt nem sokkolandó ritmussal, hosszabb ido telt el a mentok kiérkezéséig, alacsonyabb volt a szemtanú által megkezdett újraélesztés, a spontán keringés visszatérésének, valamint a kórházi elbocsátásnak a gyakorisága. A járványnak a kórházon belüli szívmegállásra kifejtett hatása kevésbé vizsgált az irodalomban. Míg a hirtelen szívhalált követo mortalitás néhány kutatásban jelentos emelkedést mutatott, addig máshol nem volt különbség a járványt megelozo idoszakhoz képest. A COVID-19-pandémia ideje alatt jelentosen megnövekedett kórházon kívüli és belüli szívmegállás hátterében a járványnak közvetett úton is szerepe lehet, a fertozés közvetlen hatása mellett. A túlélési lánc megbomlását számos helyen tapasztalták, ami hozzájárulhatott a kedvezotlen kimenetelhez. Mind a prehospitális, mind pedig a hospitális ellátás gyakorlatában bekövetkezo jelentos változások magyarázhatják a világ különbözo pontjain megfigyelt eltéréseket. Orv Hetil. 2021; 162(46): 1831-1841. Summary. The direct effect of COVID-19 on mortality through acute respiratory failure is well-established. However, there are a growing number of publications suggesting that the prevalence and outcome of sudden cardiac death may also be indirectly affected by the pandemic. Public health measures, such as lockdowns and reorganisation of hospitals, can alter the access to healthcare services and therefore might have contributed to the excess number of cardiac arrests which were seen over the last year. Our aim was to review the currently available publications regarding the impact of the COVID-19 pandemic on out-of-hospital and in-hospital cardiac arrests. A recent study reported a 3-fold growth in the incidence of out-of-hospital cardiac arrests during the 2020 COVID-19 period compared to the year before. In general, the number of non-shockable rhythms increased, bystander-witnessed cases and bystander-initiated cardiopulmonary resuscitation were reduced and ambulance response times were significantly delayed during the pandemic. Return of spontaneous circulation and survival to discharge substantially decreased compared to the time before the pandemic. The difference between the rate of mortality following in-hospital cardiac arrest during and before the pandemic is controversial according to published data. The incidence of out-of-hospital and in-hospital cardiac arrests significantly increased during the pandemic compared to previous years suggesting direct effects of COVID-19 infection and indirect effects from new public health measures. The disruption of the chain of survival could have contributed to the increased mortality following out-of-hospital cardiac arrest. Orv Hetil. 2021; 162(46): 1831-1841.


Subject(s)
COVID-19 , Heart Arrest , Communicable Disease Control , Hospitals , Humans , Hungary , Pandemics , SARS-CoV-2
5.
Resuscitation ; 167: 12-21, 2021 10.
Article in English | MEDLINE | ID: covidwho-1479724

ABSTRACT

AIM: We aimed to characterize extracorporeal CPR (ECPR) outcomes in our center and to model prediction of severe functional impairment or death at discharge. METHODS: All ECPR events between 2011 and 2019 were reviewed. The primary outcome measure was severe functional impairment or death at discharge (Functional Status Score [FSS] ≥ 16). Organ dysfunction was graded using the Pediatric Logistic Organ Dysfunction Score-2, neuroimaging using the modified Alberta Stroke Program Early Computed Tomography Score. Multivariable logistic regression was used to model FSS ≥ 16 at discharge. RESULTS: Of the 214 patients who underwent ECPR, 182 (median age 148 days, IQR 14-827) had an in-hospital cardiac arrest and congenital heart disease and were included in the analysis. Of the 110 patients who underwent neuroimaging, 52 (47%) had hypoxic-ischemic injury and 45 (41%) had hemorrhage. In-hospital mortality was 52% at discharge. Of these, 87% died from the withdrawal of life-sustaining therapies; severe neurologic injury was a contributing factor in the decision to withdraw life-sustaining therapies in 50%. The median FSS among survivors was 8 (IQR 6-8), and only one survivor had severe functional impairment. At 6 months, mortality was 57%, and the median FSS among survivors was 6 (IQR 6-8, n = 79). Predictive models identified FSS at admission, single ventricle physiology, extracorporeal membrane oxygenation (ECMO) duration, mean PELOD-2, and worst mASPECTS (or DWI-ASPECTS) as independent predictors of FSS ≥ 16 (AUC = 0.931) and at 6 months (AUC = 0.924). CONCLUSION: Mortality and functional impairment following ECPR in children remain high. It is possible to model severe functional impairment or death at discharge with high accuracy using daily post-ECPR data up to 28 days. This represents a prognostically valuable tool and may identify endpoints for future interventional trials.


Subject(s)
Cardiopulmonary Resuscitation , Extracorporeal Membrane Oxygenation , Heart Arrest , Heart Defects, Congenital , Aged, 80 and over , Child , Humans , Retrospective Studies , Treatment Outcome
6.
Eur Heart J ; 42(11): 1053-1056, 2021 03 14.
Article in English | MEDLINE | ID: covidwho-1472268
7.
Lancet ; 398(10307): 1257-1268, 2021 10 02.
Article in English | MEDLINE | ID: covidwho-1447236

ABSTRACT

Cardiopulmonary resuscitation prioritises treatment for cardiac arrests from a primary cardiac cause, which make up the majority of treated cardiac arrests. Early chest compressions and, when indicated, a defibrillation shock from a bystander give the best chance of survival with a good neurological status. Cardiac arrest can also be caused by special circumstances, such as asphyxia, trauma, pulmonary embolism, accidental hypothermia, anaphylaxis, or COVID-19, and during pregnancy or perioperatively. Cardiac arrests in these circumstances represent an increasing proportion of all treated cardiac arrests, often have a preventable cause, and require additional interventions to correct a reversible cause during resuscitation. The evidence for treating these conditions is mostly of low or very low certainty and further studies are needed. Irrespective of the cause, treatments for cardiac arrest are time sensitive and most effective when given early-every minute counts.


Subject(s)
Anaphylaxis/therapy , Asphyxia/therapy , Cardiopulmonary Resuscitation/methods , Heart Arrest/therapy , Hypothermia/therapy , Pregnancy Complications, Cardiovascular/therapy , Pulmonary Embolism/therapy , Wounds and Injuries/therapy , Anaphylaxis/complications , Asphyxia/complications , COVID-19/complications , COVID-19/therapy , Electric Countershock , Female , Heart Arrest/etiology , Humans , Hypothermia/complications , Intraoperative Complications/therapy , Out-of-Hospital Cardiac Arrest/etiology , Out-of-Hospital Cardiac Arrest/therapy , Personal Protective Equipment , Postoperative Complications/therapy , Practice Guidelines as Topic , Pregnancy , Pulmonary Embolism/complications , Return of Spontaneous Circulation , SARS-CoV-2 , Wounds and Injuries/complications
8.
Rev Esp Anestesiol Reanim (Engl Ed) ; 68(8): 437-442, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1428377

ABSTRACT

OBJECTIVES: The disease COVID-19 produces serious complications that can lead to cardiorespiratory arrest. Quality cardiopulmonary resuscitation (CPR) can improve patient prognosis. The objective of this study is to evaluate the performance of the specialty of Anesthesiology in the management of CPR during the pandemic. METHODS: A survey was carried out with Google Forms consisting of 19 questions. The access link to the questionnaire was sent by email by the Spanish Society of Anesthesia (SEDAR) to all its members. RESULTS: 225 responses were obtained. The regions with the highest participation were: Madrid, Catalonia, Valencia and Andalusia. 68.6%% of the participants work in public hospitals. 32% of the participants habitually work in intensive care units (ICU), however, 62.1% have attended critical COVID-19 in the ICU and 72.6% have anesthetized them in the operating room. 26,3% have attended some cardiac arrest, 16,8% of the participants admitted to lead the manoeuvres, 16,8% detailed that it had been another department, and 66,2% was part of the team, but did not lead the assistance. Most of the CPR was performed in supine, only 5% was done in prone position. 54.6% of participants had not taken any course of Advance Life Support (ALS) in the last 2 years. 97.7% of respondents think that Anesthesia should lead the in-hospital CPR. CONCLUSION: The specialty of Anesthesiology has actively participated in the care of the critically ill patient and in the management of CPR during the COVID-19 pandemic. However, training and/or updating in ALS is required.


Subject(s)
COVID-19 , Cardiopulmonary Resuscitation , Heart Arrest , Heart Arrest/therapy , Humans , Pandemics , Prognosis , SARS-CoV-2 , Spain/epidemiology
9.
Eur J Clin Invest ; 51(11): e13679, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1405172

ABSTRACT

BACKGROUND: COVID-19 has a wide spectrum of cardiovascular sequelae including myocarditis and pericarditis; however, the prevalence and clinical impact are unclear. We investigated the prevalence of new-onset myocarditis/pericarditis and associated adverse cardiovascular events in patients with COVID-19. METHODS AND RESULTS: A retrospective cohort study was conducted using electronic medical records from a global federated health research network. Patients were included based on a diagnosis of COVID-19 and new-onset myocarditis or pericarditis. Patients with COVID-19 and myocarditis/pericarditis were 1:1 propensity score matched for age, sex, race and comorbidities to patients with COVID-19 but without myocarditis/pericarditis. The outcomes of interest were 6-month all-cause mortality, hospitalisation, cardiac arrest, incident heart failure, incident atrial fibrillation and acute myocardial infarction, comparing patients with and without myocarditis/pericarditis. Of 718,365 patients with COVID-19, 35,820 (5.0%) developed new-onset myocarditis and 10,706 (1.5%) developed new-onset pericarditis. Six-month all-cause mortality was 3.9% (n = 702) in patients with myocarditis and 2.9% (n = 523) in matched controls (p < .0001), odds ratio 1.36 (95% confidence interval (CI): 1.21-1.53). Six-month all-cause mortality was 15.5% (n = 816) for pericarditis and 6.7% (n = 356) in matched controls (p < .0001), odds ratio 2.55 (95% CI: 2.24-2.91). Receiving critical care was associated with significantly higher odds of mortality for patients with myocarditis and pericarditis. Patients with pericarditis seemed to associate with more new-onset cardiovascular sequelae than those with myocarditis. This finding was consistent when looking at pre-COVID-19 data with pneumonia patients. CONCLUSIONS: Patients with COVID-19 who present with myocarditis/pericarditis associate with increased odds of major adverse events and new-onset cardiovascular sequelae.


Subject(s)
Atrial Fibrillation/epidemiology , COVID-19/epidemiology , Heart Arrest/epidemiology , Heart Failure/epidemiology , Mortality , Myocardial Infarction/epidemiology , Myocarditis/epidemiology , Pericarditis/epidemiology , Adult , Aged , COVID-19/complications , Case-Control Studies , Cause of Death , Cohort Studies , Critical Care , Female , Hospitalization/statistics & numerical data , Humans , Incidence , Male , Middle Aged , Myocarditis/complications , Pericarditis/complications , Propensity Score , Retrospective Studies , SARS-CoV-2 , Severity of Illness Index , United States/epidemiology
14.
J Am Heart Assoc ; 10(16): e021204, 2021 08 17.
Article in English | MEDLINE | ID: covidwho-1352600

ABSTRACT

Background Limited information is available regarding in-hospital cardiac arrest (IHCA) in patients with COVID-19. Methods and Results We leveraged the American Heart Association COVID-19 Cardiovascular Disease (AHA COVID-19 CVD) Registry to conduct a cohort study of adults hospitalized for COVID-19. IHCA was defined as those with documentation of cardiac arrest requiring medication or electrical shock for resuscitation. Mixed effects models with random intercepts were used to identify independent predictors of IHCA and mortality while accounting for clustering at the hospital level. The study cohort included 8518 patients (6080 not in the intensive care unit [ICU]) with mean age of 61.5 years (SD 17.5). IHCA occurred in 509 (5.9%) patients overall with 375 (73.7%) in the ICU and 134 (26.3%) patients not in the ICU. The majority of patients at the time of ICHA were not in a shockable rhythm (76.5%). Independent predictors of IHCA included older age, Hispanic ethnicity (odds ratio [OR], 1.9; CI, 1.4-2.4; P<0.001), and non-Hispanic Black race (OR, 1.5; CI, 1.1-1.9; P=0.004). Other predictors included oxygen use on admission, quick Sequential Organ Failure Assessment score on admission, and hypertension. Overall, 35 (6.9%) patients with IHCA survived to discharge, with 9.1% for ICU and 0.7% for non-ICU patients. Conclusions Older age, Black race, and Hispanic ethnicity are independent predictors of IHCA in patients with COVID-19. Although the incidence is much lower than in ICU patients, approximately one-quarter of IHCA events in patients with COVID-19 occur in non-ICU settings, with the latter having a substantially lower survival to discharge rate.


Subject(s)
African Americans , COVID-19 , Heart Arrest/ethnology , Inpatients , Intensive Care Units , Patient Admission , Age Factors , Aged , Aged, 80 and over , Death, Sudden, Cardiac/ethnology , Death, Sudden, Cardiac/prevention & control , Female , Heart Arrest/diagnosis , Heart Arrest/mortality , Heart Arrest/therapy , Hospital Mortality/ethnology , Humans , Incidence , Male , Middle Aged , Prognosis , Race Factors , Registries , Risk Assessment , Risk Factors , Time Factors , United States/epidemiology
15.
Med Hypotheses ; 154: 110648, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1331101

ABSTRACT

Aerosols generated from chest compressions and ventilation attempts in patients with cardiac arrest may cause airborne infections. Accordingly, the interim international resuscitation guidelines have restricted basic life support by lay rescuers to compression only and the use of an automated external defibrillator during the COVID-19 pandemic. Although these measures may diminish the risk of infection for laypersons, the missing respiratory support can be detrimental for patients with hypoxia-related cardiac arrest. To overcome this shortcoming we want to introduce a special tool that allows ventilation during barrier resuscitation by laypersons. We hypothesize that the application of a device made of a polyvinyl chloride shield with a centrally installed S-shaped ventilation pipe with integrated filter can provide adequate ventilation while concurrently protecting patient and rescuer from airborne agents. Aerosols from air leakage are removed by adhesion and drainage below the barrier. No specific training other than basic life support is needed. We suggest that a tool of this kind be considered essential equipment and stored together with disposable gloves in public access locations.


Subject(s)
COVID-19 , Cardiopulmonary Resuscitation , Heart Arrest , Humans , Pandemics , SARS-CoV-2
16.
Emerg Med Clin North Am ; 39(3): 493-508, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1262904

ABSTRACT

Anatomically, the airway is ever changing in size, anteroposterior alignment, and point of most narrow dimension. Special considerations regarding obesity, chronic and acute illness, underlying developmental abnormalities, and age can all affect preparation and intervention toward securing a definitive airway. Mechanical ventilation strategies should focus on limiting peak inspiratory pressures and optimizing lung protective tidal volumes. Emergency physicians should work toward minimizing risk of peri-intubation hypoxemia and arrest. With review of anatomic and physiologic principles in the setting of a practical approach toward evaluating and managing distress and failure, emergency physicians can successfully manage critical pediatric airway encounters.


Subject(s)
Respiratory Distress Syndrome/therapy , Respiratory Insufficiency/therapy , Airway Management , COVID-19/therapy , Child , Craniofacial Abnormalities/complications , Critical Care , Equipment Design , Functional Residual Capacity , Heart Arrest/therapy , Humans , Hypnotics and Sedatives/therapeutic use , Intubation, Intratracheal/methods , Laryngoscopes , Laryngoscopy/methods , Larynx/anatomy & histology , Neuromuscular Diseases/therapy , Noninvasive Ventilation , Oxygen Inhalation Therapy , Pediatric Emergency Medicine , Pediatric Obesity/complications , Positive-Pressure Respiration , Video Recording
17.
Resuscitation ; 161: 1-60, 2021 04.
Article in English | MEDLINE | ID: covidwho-1284503

ABSTRACT

Informed by a series of systematic reviews, scoping reviews and evidence updates from the International Liaison Committee on Resuscitation, the 2021 European Resuscitation Council Guidelines present the most up to date evidence-based guidelines for the practice of resuscitation across Europe. The guidelines cover the epidemiology of cardiac arrest; the role that systems play in saving lives, adult basic life support, adult advanced life support, resuscitation in special circumstances, post resuscitation care, first aid, neonatal life support, paediatric life support, ethics and education.


Subject(s)
Cardiopulmonary Resuscitation , Heart Arrest , Adult , Child , Europe , First Aid , Heart Arrest/therapy , Humans , Infant, Newborn , Resuscitation , Systematic Reviews as Topic
20.
Crit Care Med ; 49(6): 901-911, 2021 06 01.
Article in English | MEDLINE | ID: covidwho-1266195

ABSTRACT

OBJECTIVES: To investigate the incidence, characteristics, and outcomes of in-hospital cardiac arrest in patients with coronavirus disease 2019 and to describe the characteristics and outcomes for patients with in-hospital cardiac arrest within the ICU, compared with non-ICU patients with in-hospital cardiac arrest. Finally, we evaluated outcomes stratified by age. DATA SOURCES: A systematic review of PubMed, EMBASE, and preprint websites was conducted between January 1, 2020, and December 10, 2020. Prospective Register of Systematic Reviews identification: CRD42020203369. STUDY SELECTION: Studies reporting on consecutive in-hospital cardiac arrest with a resuscitation attempt among patients with coronavirus disease 2019. DATA EXTRACTION: Two authors independently performed study selection and data extraction. Study quality was assessed with the Newcastle-Ottawa Scale. Data were synthesized according to the Preferred Reporting Items for Systematic Reviews guidelines. Discrepancies were resolved by consensus or through an independent third reviewer. DATA SYNTHESIS: Eight studies reporting on 847 in-hospital cardiac arrest were included. In-hospital cardiac arrest incidence varied between 1.5% and 5.8% among hospitalized patients and 8.0-11.4% among patients in ICU. In-hospital cardiac arrest occurred more commonly in older male patients. Most initial rhythms were nonshockable (83.9%, [asystole = 36.4% and pulseless electrical activity = 47.6%]). Return of spontaneous circulation occurred in 33.3%, with a 91.7% in-hospital mortality. In-hospital cardiac arrest events in ICU had higher incidence of return of spontaneous circulation (36.6% vs 18.7%; p < 0.001) and relatively lower mortality (88.7% vs 98.1%; p < 0.001) compared with in-hospital cardiac arrest in non-ICU locations. Patients greater than or equal to 60 years old had significantly higher in-hospital mortality than those less than 60 years (93.1% vs 87.9%; p = 0.019). CONCLUSIONS: Approximately, one in 20 patients hospitalized with coronavirus disease 2019 received resuscitation for an in-hospital cardiac arrest. Hospital survival after in-hospital cardiac arrest within the ICU was higher than non-ICU locations and seems comparable with prepandemic survival for nonshockable rhythms. Although the data provide guidance surrounding prognosis after in-hospital cardiac arrest, it should be interpreted cautiously given the paucity of information surrounding treatment limitations and resource constraints during the pandemic. Further research is into actual causative mechanisms is needed.


Subject(s)
COVID-19/mortality , COVID-19/therapy , Heart Arrest/mortality , Heart Arrest/therapy , Hospital Mortality , Treatment Outcome , Cause of Death , Humans , Incidence
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