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1.
Biomedica ; 40(Supl. 2): 180-187, 2020 10 30.
Article in English, Spanish | MEDLINE | ID: covidwho-914761

ABSTRACT

The pandemic caused by COVID19 is associated with an increase in the number of cases of cardiorespiratory arrest, which has resulted in ethical concerns regarding the enforceability of cardiopulmonary resuscitation, as well as the conditions to carry it out. The risk of aerosol transmission and the clinical uncertainties about the efficacy, the potential sequelae, and the circumstances that could justify limiting this procedure during the pandemic have multiplied the ethical doubts on how to proceed in these cases. Based on ethical and legal grounds, this paper offers a practical guide on how to proceed in the clinical setting in cases of cardiopulmonary arrest during the pandemic. The criteria of justice, benefit, no harm, respect for autonomy, precaution, integrity, and transparency are asserted in an organized and practical framework for decision-making regarding cardiopulmonary resuscitation.


Subject(s)
Betacoronavirus , Cardiopulmonary Resuscitation/ethics , Coronavirus Infections/complications , Heart Arrest/therapy , Pandemics , Pneumonia, Viral/complications , Practice Guidelines as Topic , Advance Directives , Aerosols , Air Microbiology , Cardiopulmonary Resuscitation/methods , Clinical Decision-Making , Colombia/epidemiology , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Heart Arrest/etiology , Humans , Infection Control/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Medical Futility , Occupational Exposure , Pandemics/prevention & control , Personal Autonomy , Personal Protective Equipment , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Social Justice
2.
Rev. enferm. UERJ ; 28: e50721, jan.-dez. 2020.
Article in English, Portuguese | LILACS (Americas) | ID: covidwho-828134

ABSTRACT

Objetivo: apresentar atualizações para a ressuscitação cardiopulmonar em pacientes suspeitos e confirmados com COVID-19. Método: revisão compreensiva da literatura, com síntese narrativa das evidências de diretrizes e recomendações da Organização Mundial de Saúde, Associação de Medicina Intensiva Brasileira, American Heart Association, Resuscitation Council UK, American College of Surgions Committee on Trauma e National Association of Emergency Medical Technicians. Resultados: as principais atualizações trazem informações sobre especificidades das manobras de ressuscitação cardiopulmonar; preparação do ambiente, recursos humanos e materiais, reconhecimento da parada cardiorrespiratória e ações iniciais; estratégias de ventilação e acesso invasivo da via aérea; ajustes do ventilador mecânico e manobras de ressuscitação cardiopulmonar em pacientes pronados. Considerações finais: profissionais de saúde envolvidos no atendimento à parada cardiorrespiratória de pacientes suspeitos e/ou confirmados com COVID-19 podem encontrar inúmeros desafios, portanto devem seguir com rigor o protocolo estabelecido para maximizar a efetividade das manobras de ressuscitação e minimizar o risco de contágio pelo vírus e sua disseminação.


Objective: to present updates for cardiopulmonary resuscitation in suspected and confirmed patients with COVID-19. Method: comprehensive literature review with narrative synthesis of the evidence of guidelines and recommendations from World Health Organization, Associação de Medicina Intensiva Brasileira, American Heart Association, Resuscitation Council UK, American College of Surgions Committee on Trauma and National Association of Emergency Medical Technicians. Results: the main updates bring information about the specifics of cardiopulmonary resuscitation maneuvers; preparation of the environment and human and material resources, recognition of cardiorespiratory arrest and initial actions; ventilation and invasive airway access strategies; mechanical ventilator adjustments and cardiopulmonary resuscitation maneuvers in patients in the prone position. Final considerations: health professionals involved in the care of cardiorespiratory arrest of suspected and/or confirmed patients with COVID-19 can face numerous challenges, so they must strictly follow the protocol established to maximize the effectiveness of resuscitation maneuvers and minimize the risk of contagion by the virus and its spread.


Objetivo: apresentar actualizaciones para la reanimación cardiopulmonar en pacientes sospechos os y confirmados con COVID-19. Método: revisión exhaustiva de la literatura con síntesis narrativa de la evidencia de guías y recomendaciones de la Organización Mundial de la Salud, Associação de Medicina Intensiva Brasileira, American Heart Association, Resuscitation Council UK, American College of Surgions Committee on Trauma and National Association of Emergency Medical Technicians. Resultados: las principales actualizaciones aportan información sobre los detalles de las maniobras de reanimación cardiopulmonar; preparación del medio ambiente y recursos humanos y materiales, reconocimiento de paro cardiorrespiratorio y acciones iniciales; estrategias de ventilación y acceso invasivo a las vías aéreas; ajustes del ventilador mecánico y maniobras de reanimación cardiopulmonar en pacientes en decúbito prono. Consideraciones finales: los profesionales de la salud involucrados en la atención del paro cardiorrespiratorio de pacientes sospechosos y/o confirmados con COVID-19 pueden enfrentar numerosos desafíos, por lo que deben seguir estrictamente el protocolo establecido para maximizar la efectividad de las maniobras de reanimación y minimizar el riesgo de contagio por el virus y supropagación.


Subject(s)
Humans , Male , Female , Cardiopulmonary Resuscitation/standards , Coronavirus Infections/complications , Betacoronavirus , Heart Arrest/etiology , Respiration, Artificial/methods , Clinical Protocols/standards , Cardiopulmonary Resuscitation/methods , Containment of Biohazards/standards , Heart Arrest/rehabilitation , Heart Massage/methods , Nursing, Team/standards
3.
Food Chem Toxicol ; 145: 111742, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-753584

ABSTRACT

SARS-CoV-2 (Covid-19) infection has recently become a worldwide challenge with dramatic global economic and health consequences. As the pandemic is still spreading, new data concerning Covid-19 complications and related mechanisms become increasingly available. Accumulating data suggest that the incidence of cardiac arrest and its outcome are adversely affected during the Covid-19 period. This may be further exacerbated by drug-related cardiac toxicity of Covid-19 treatment regimens. Elucidating the underlying mechanisms that lead to Covid-19 associated cardiac arrest is imperative, not only in order to improve its effective management but also to maximize preventive measures. Herein we discuss available epidemiological data on cardiac arrest during the Covid-19 pandemic as well as possible associated causes and pathophysiological mechanisms and highlight gaps in evidence warranting further investigation. The risk of transmission during cardiopulmonary resuscitation (CPR) is also discussed in this review. Finally, we summarize currently recommended guidelines on CPR for Covid-19 patients including CPR in patients with cardiac arrest due to suspected drug-related cardiac toxicity in an effort to underscore the most important common points and discuss discrepancies proposed by established international societies.


Subject(s)
Arrhythmias, Cardiac/epidemiology , Arrhythmias, Cardiac/physiopathology , Betacoronavirus , Coronavirus Infections/complications , Heart Arrest/epidemiology , Heart Arrest/physiopathology , Pneumonia, Viral/complications , Arrhythmias, Cardiac/etiology , Cardiopulmonary Resuscitation/standards , Cardiotoxicity/epidemiology , Cardiotoxicity/etiology , Cardiotoxicity/physiopathology , Coronavirus Infections/drug therapy , Disease Transmission, Infectious/prevention & control , Heart Arrest/etiology , Humans , Pandemics , Pneumonia, Viral/drug therapy
5.
Acta Neuropathol Commun ; 8(1): 147, 2020 08 26.
Article in English | MEDLINE | ID: covidwho-730088

ABSTRACT

We document the neuropathologic findings of a 73-year old man who died from acute cerebellar hemorrhage in the context of relatively mild SARS-CoV2 infection. The patient developed sudden onset of headache, nausea, and vomiting, immediately followed by loss of consciousness on the day of admission. Emergency medical services found him severely hypoxemic at home, and the patient suffered a cardiac arrest during transport to the emergency department. The emergency team achieved return of spontaneous circulation after over 17 min of resuscitation. A chest radiograph revealed hazy bilateral opacities; and real-time-PCR for SARS-CoV-2 on the nasopharyngeal swab was positive. Computed tomography of the head showed a large right cerebellar hemorrhage, with tonsillar herniation and intraventricular hemorrhage. One day after presentation, he was transitioned to comfort care and died shortly after palliative extubation. Autopsy performed 3 h after death showed cerebellar hemorrhage and acute infarcts in the dorsal pons and medulla. Remarkably, there were microglial nodules and neuronophagia bilaterally in the inferior olives and multifocally in the cerebellar dentate nuclei. This constellation of findings has not been reported thus far in the context of SARS-CoV-2 infection.


Subject(s)
Brain Stem Infarctions/pathology , Cerebellar Diseases/pathology , Coronavirus Infections/pathology , Intracranial Hemorrhages/pathology , Microglia/pathology , Neurons/pathology , Phagocytosis , Pneumonia, Viral/pathology , Aged , Betacoronavirus , Brain Stem Infarctions/complications , Brain Stem Infarctions/diagnostic imaging , Cerebellar Diseases/complications , Cerebellar Diseases/diagnostic imaging , Cerebellar Nuclei/pathology , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Headache/etiology , Heart Arrest/etiology , Humans , Hypoxia/etiology , Intracranial Hemorrhages/complications , Intracranial Hemorrhages/diagnostic imaging , Male , Medulla Oblongata/diagnostic imaging , Medulla Oblongata/pathology , Olivary Nucleus/pathology , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Pontine Tegmentum/diagnostic imaging , Pontine Tegmentum/pathology , Tomography, X-Ray Computed
6.
Am J Health Syst Pharm ; 77(23): 1961-1964, 2020 11 16.
Article in English | MEDLINE | ID: covidwho-706948

ABSTRACT

PURPOSE: Successful use of alteplase and argatroban to treat a patient with coronavirus disease 2019 (COVID-19)-associated massive pulmonary embolism with cardiac arrest is reported. SUMMARY: This case report describes a 42-year-old male with COVID-19 who developed a massive pulmonary embolism resulting in cardiac arrest after suspected failure of low-molecular-weight heparin therapy for a deep venous thrombosis. Administration of two 50-mg doses of intravenous alteplase resulted in return of spontaneous circulation, and low-dose argatroban was used as follow-up anticoagulation therapy without complications. This is the first case report of use of argatroban in a patient with COVID-19 with cardiac arrest-associated massive pulmonary embolism after failure of previous anticoagulation efforts. CONCLUSION: Argatroban may be used as an alternate anticoagulation strategy in COVID-19 patients who fail low-molecular weight therapy. A risk versus benefit discussion should be had regarding appropriateness of therapy as well as dosing. More data is needed to understand the unique hypercoagulable condition in COVID-19 patients as well as research that further highlights the role of argatroban and bivalirudin therapy in this patient population.


Subject(s)
Anticoagulants/therapeutic use , Coronavirus Infections/complications , Fibrinolytic Agents/therapeutic use , Pipecolic Acids/therapeutic use , Pneumonia, Viral/complications , Pulmonary Embolism/drug therapy , Pulmonary Embolism/etiology , Thrombolytic Therapy/methods , Adult , Arginine/analogs & derivatives , Heart Arrest/etiology , Heart Arrest/therapy , Heparin, Low-Molecular-Weight/therapeutic use , Humans , Male , Pandemics , Sulfonamides , Treatment Failure , Treatment Outcome
7.
J Neurol Sci ; 417: 117087, 2020 10 15.
Article in English | MEDLINE | ID: covidwho-696852

ABSTRACT

INTRODUCTION: The coronavirus disease 2019 (Covid-19) pandemic has led to challenges in provision of care, clinical assessment and communication with families. The unique considerations associated with evaluation of catastrophic brain injury and death by neurologic criteria in patients with Covid-19 infection have not been examined. METHODS: We describe the evaluation of six patients hospitalized at a health network in New York City in April 2020 who had Covid-19, were comatose and had absent brainstem reflexes. RESULTS: Four males and two females with a median age of 58.5 (IQR 47-68) were evaluated for catastrophic brain injury due to stroke and/or global anoxic injury at a median of 14 days (IQR 13-18) after admission for acute respiratory failure due to Covid-19. All patients had hypotension requiring vasopressors and had been treated with sedative/narcotic drips for ventilator dyssynchrony. Among these patients, 5 had received paralytics. Apnea testing was performed for 1 patient due to the decision to withdraw treatment (n = 2), concern for inability to tolerate testing (n = 2) and observation of spontaneous respirations (n = 1). The apnea test was aborted due to hypoxia and hypotension. After ancillary testing, death was declared in three patients based on neurologic criteria and in three patients based on cardiopulmonary criteria (after withdrawal of support (n = 2) or cardiopulmonary arrest (n = 1)). A family member was able to visit 5/6 patients prior to cardiopulmonary arrest/discontinuation of organ support. CONCLUSION: It is feasible to evaluate patients with catastrophic brain injury and declare brain death despite the Covid-19 pandemic, but this requires unique considerations.


Subject(s)
Betacoronavirus , Brain Death/diagnosis , Brain Injuries/etiology , Coronavirus Infections/complications , Pandemics , Pneumonia, Viral/complications , Aged , Apnea/etiology , Cerebral Hemorrhage/etiology , Contraindications, Procedure , Electroencephalography , Female , Heart Arrest/etiology , Humans , Hypoxia, Brain/etiology , Male , Middle Aged , Neuroimaging , Neurologic Examination , Professional-Family Relations , Tissue and Organ Procurement , Truth Disclosure
8.
Clin Rheumatol ; 39(9): 2811-2815, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-679749

ABSTRACT

In the midst of the COVID-19 pandemic, further understanding of its complications points towards dysregulated immune response as a major component. Systemic lupus erythematosus (SLE) is also a disease of immune dysregulation leading to multisystem compromise. We present a case of new-onset SLE concomitantly with COVID-19 and development of antiphospholipid antibodies. An 18-year-old female that presented with hemodynamic collapse and respiratory failure, progressed to cardiac arrest, and had a pericardial tamponade drained. She then progressed to severe acute respiratory distress syndrome, severe ventricular dysfunction, and worsening renal function with proteinuria and hematuria. Further studies showed bilateral pleural effusions, positive antinuclear and antidouble-stranded DNA antibodies, lupus anticoagulant, and anticardiolipin B. C3 and C4 levels were low. SARS-Cov-2 PCR was positive after 2 negative tests. She also developed multiple deep venous thrombosis, in the setting of positive antiphospholipid antibodies and lupus anticoagulant. In terms of pathophysiology, COVID-19 is believed to cause a dysregulated cytokine response which could potentially be exacerbated by the shift in Th1 to Th2 response seen in SLE. Also, it is well documented that viral infections are an environmental factor that contributes to the development of autoimmunity; however, COVID-19 is a new entity, and it is not known if it could trigger autoimmune conditions. Additionally, it is possible that SARS-CoV-2, as it happens with other viruses, might lead to the formation of antiphospholipid antibodies, potentially contributing to the increased rates of thrombosis seen in COVID-19.


Subject(s)
Antiphospholipid Syndrome/immunology , Coronavirus Infections/immunology , Lupus Erythematosus, Systemic/immunology , Pneumonia, Viral/immunology , Adolescent , Anemia/etiology , Antibodies, Anticardiolipin/immunology , Antibodies, Antinuclear/immunology , Antibodies, Monoclonal, Humanized/therapeutic use , Antiphospholipid Syndrome/complications , Antiphospholipid Syndrome/diagnosis , Antiphospholipid Syndrome/therapy , Anuria/etiology , Betacoronavirus , Cardiac Tamponade/diagnostic imaging , Cardiac Tamponade/etiology , Cardiac Tamponade/therapy , Complement C3/immunology , Complement C4/immunology , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , DNA/immunology , Echocardiography , Fatal Outcome , Female , Heart Arrest/etiology , Hematuria/etiology , Humans , Lupus Coagulation Inhibitor/immunology , Lupus Erythematosus, Systemic/blood , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/diagnosis , Pandemics , Patient Positioning , Pericardiocentesis , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Prone Position , Proteinuria/etiology , Renal Dialysis , Renal Insufficiency/etiology , Renal Insufficiency/therapy , Respiration, Artificial , /therapy , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , Thrombocytopenia/etiology , Venous Thrombosis/etiology , Ventricular Dysfunction, Left/diagnostic imaging
11.
Resuscitation ; 155: 103-111, 2020 10.
Article in English | MEDLINE | ID: covidwho-663439

ABSTRACT

AIM: To identify and summarize the available science on prone resuscitation. To determine the value of undertaking a systematic review on this topic; and to identify knowledge gaps to aid future research, education and guidelines. METHODS: This review was guided by specific methodological framework and reporting items (PRISMA-ScR). We included studies, cases and grey literature regarding prone position and CPR/cardiac arrest. The databases searched were MEDLINE, Embase, CINAHL, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, Scopus and Google Scholar. Expanded grey literature searching included internet search engine, targeted websites and social media. RESULTS: Of 453 identified studies, 24 (5%) studies met our inclusion criteria. There were four prone resuscitation-relevant studies examining: blood and tidal volumes generated by prone compressions; prone compression quality metrics on a manikin; and chest computed tomography scans for compression landmarking. Twenty case reports/series described the resuscitation of 25 prone patients. Prone compression quality was assessed by invasive blood pressure monitoring, exhaled carbon dioxide and pulse palpation. Recommended compression location was zero-to-two vertebral segments below the scapulae. Twenty of 25 cases (80%) survived prone resuscitation, although few cases reported long term outcome (neurological status at hospital discharge). Seven cases described full neurological recovery. CONCLUSION: This scoping review did not identify sufficient evidence to justify a systematic review or modified resuscitation guidelines. It remains reasonable to initiate resuscitation in the prone position if turning the patient supine would lead to delays or risk to providers or patients. Prone resuscitation quality can be judged using end-tidal CO2, and arterial pressure tracing, with patients turned supine if insufficient.


Subject(s)
Cardiopulmonary Resuscitation/methods , Coronavirus Infections/complications , Heart Arrest/therapy , Pandemics/statistics & numerical data , Patient Positioning/methods , Pneumonia, Viral/complications , Adult , Aged , Cardiopulmonary Resuscitation/mortality , Cause of Death , Coronavirus Infections/epidemiology , Female , Global Health , Gray Literature , Heart Arrest/etiology , Heart Arrest/mortality , Humans , Male , Middle Aged , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Prone Position , Risk Assessment , Survival Analysis , Treatment Outcome
13.
Resuscitation ; 153: 45-55, 2020 08.
Article in English | MEDLINE | ID: covidwho-548156

ABSTRACT

Coronavirus disease 2019 (COVID-19) has had a substantial impact on the incidence of cardiac arrest and survival. The challenge is to find the correct balance between the risk to the rescuer when undertaking cardiopulmonary resuscitation (CPR) on a person with possible COVID-19 and the risk to that person if CPR is delayed. These guidelines focus specifically on patients with suspected or confirmed COVID-19. The guidelines include the delivery of basic and advanced life support in adults and children and recommendations for delivering training during the pandemic. Where uncertainty exists treatment should be informed by a dynamic risk assessment which may consider current COVID-19 prevalence, the person's presentation (e.g. history of COVID-19 contact, COVID-19 symptoms), likelihood that treatment will be effective, availability of personal protective equipment (PPE) and personal risks for those providing treatment. These guidelines will be subject to evolving knowledge and experience of COVID-19. As countries are at different stages of the pandemic, there may some international variation in practice.


Subject(s)
Coronavirus Infections/complications , Heart Arrest/etiology , Heart Arrest/therapy , Pneumonia, Viral/complications , Betacoronavirus , Cardiopulmonary Resuscitation/standards , Europe , Humans , Pandemics , Personal Protective Equipment/supply & distribution , Risk Assessment , Societies, Medical
15.
Can J Cardiol ; 36(8): 1326.e9-1326.e11, 2020 08.
Article in English | MEDLINE | ID: covidwho-620915

ABSTRACT

A wide spectrum of cardiovascular manifestations has been documented in patients suffering from coronavirus disease-2019 (COVID-19). Usually associated with a poor prognoses, these manifestations include thromboembolic events, acute coronary syndrome, heart failure, and cardiogenic shock. We describe a patient with COVID-19 who presented with subacute myocardial infarction, biventricular thrombi, and bilateral pulmonary emboli. Biventricular thrombi are rare, and their presence raises concern for an underlying prothrombotic condition.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections , Heart Aneurysm , Heart Ventricles , Pandemics , Pneumonia, Viral , Pulmonary Embolism , ST Elevation Myocardial Infarction , Thrombosis , Anticoagulants/administration & dosage , Cardiopulmonary Resuscitation/methods , Clinical Deterioration , Coronary Angiography/methods , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/physiopathology , Fatal Outcome , Female , Heart Aneurysm/diagnosis , Heart Aneurysm/etiology , Heart Arrest/etiology , Heart Arrest/therapy , Heart Ventricles/diagnostic imaging , Heart Ventricles/pathology , Humans , Middle Aged , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Pneumonia, Viral/physiopathology , Pulmonary Embolism/diagnosis , Pulmonary Embolism/etiology , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/physiopathology , ST Elevation Myocardial Infarction/therapy , Thrombosis/diagnosis , Thrombosis/drug therapy , Thrombosis/etiology , Tomography, X-Ray Computed/methods , Ventricular Dysfunction, Left/diagnosis , Ventricular Dysfunction, Left/etiology
19.
JAMA ; 323(24): 2493-2502, 2020 06 23.
Article in English | MEDLINE | ID: covidwho-236223

ABSTRACT

Importance: Hydroxychloroquine, with or without azithromycin, has been considered as a possible therapeutic agent for patients with coronavirus disease 2019 (COVID-19). However, there are limited data on efficacy and associated adverse events. Objective: To describe the association between use of hydroxychloroquine, with or without azithromycin, and clinical outcomes among hospital inpatients diagnosed with COVID-19. Design, Setting, and Participants: Retrospective multicenter cohort study of patients from a random sample of all admitted patients with laboratory-confirmed COVID-19 in 25 hospitals, representing 88.2% of patients with COVID-19 in the New York metropolitan region. Eligible patients were admitted for at least 24 hours between March 15 and 28, 2020. Medications, preexisting conditions, clinical measures on admission, outcomes, and adverse events were abstracted from medical records. The date of final follow-up was April 24, 2020. Exposures: Receipt of both hydroxychloroquine and azithromycin, hydroxychloroquine alone, azithromycin alone, or neither. Main Outcomes and Measures: Primary outcome was in-hospital mortality. Secondary outcomes were cardiac arrest and abnormal electrocardiogram findings (arrhythmia or QT prolongation). Results: Among 1438 hospitalized patients with a diagnosis of COVID-19 (858 [59.7%] male, median age, 63 years), those receiving hydroxychloroquine, azithromycin, or both were more likely than those not receiving either drug to have diabetes, respiratory rate >22/min, abnormal chest imaging findings, O2 saturation lower than 90%, and aspartate aminotransferase greater than 40 U/L. Overall in-hospital mortality was 20.3% (95% CI, 18.2%-22.4%). The probability of death for patients receiving hydroxychloroquine + azithromycin was 189/735 (25.7% [95% CI, 22.3%-28.9%]), hydroxychloroquine alone, 54/271 (19.9% [95% CI, 15.2%-24.7%]), azithromycin alone, 21/211 (10.0% [95% CI, 5.9%-14.0%]), and neither drug, 28/221 (12.7% [95% CI, 8.3%-17.1%]). In adjusted Cox proportional hazards models, compared with patients receiving neither drug, there were no significant differences in mortality for patients receiving hydroxychloroquine + azithromycin (HR, 1.35 [95% CI, 0.76-2.40]), hydroxychloroquine alone (HR, 1.08 [95% CI, 0.63-1.85]), or azithromycin alone (HR, 0.56 [95% CI, 0.26-1.21]). In logistic models, compared with patients receiving neither drug cardiac arrest was significantly more likely in patients receiving hydroxychloroquine + azithromycin (adjusted OR, 2.13 [95% CI, 1.12-4.05]), but not hydroxychloroquine alone (adjusted OR, 1.91 [95% CI, 0.96-3.81]) or azithromycin alone (adjusted OR, 0.64 [95% CI, 0.27-1.56]), . In adjusted logistic regression models, there were no significant differences in the relative likelihood of abnormal electrocardiogram findings. Conclusions and Relevance: Among patients hospitalized in metropolitan New York with COVID-19, treatment with hydroxychloroquine, azithromycin, or both, compared with neither treatment, was not significantly associated with differences in in-hospital mortality. However, the interpretation of these findings may be limited by the observational design.


Subject(s)
Anti-Infective Agents/therapeutic use , Azithromycin/therapeutic use , Coronavirus Infections/drug therapy , Hospital Mortality , Hydroxychloroquine/therapeutic use , Pneumonia, Viral/drug therapy , Adolescent , Adult , Aged , Anti-Infective Agents/adverse effects , Arrhythmias, Cardiac/chemically induced , Azithromycin/adverse effects , Betacoronavirus , Coronavirus Infections/mortality , Drug Therapy, Combination , Female , Heart Arrest/etiology , Hospitalization , Humans , Hydroxychloroquine/adverse effects , Logistic Models , Male , Middle Aged , New York , Pandemics , Pneumonia, Viral/mortality , Proportional Hazards Models , Retrospective Studies , Young Adult
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