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2.
JAMA Netw Open ; 5(2): e2147078, 2022 02 01.
Article in English | MEDLINE | ID: covidwho-1669329

ABSTRACT

Importance: Resuscitation is a niche example of how the COVID-19 pandemic has affected society in the long term. Those trained in cardiopulmonary resuscitation (CPR) face the dilemma that attempting to save a life may result in their own harm. This is most of all a problem for drowning, where hypoxia is the cause of cardiac arrest and ventilation is the essential first step in reversing the situation. Objective: To develop recommendations for water rescue organizations in providing their rescuers with safe drowning resuscitation procedures during the COVID-19 pandemic. Evidence Review: Two consecutive modified Delphi procedures involving 56 participants from 17 countries with expertise in drowning prevention research, resuscitation, and programming were performed from March 28, 2020, to March 29, 2021. In parallel, PubMed and Google Scholar were searched to identify new emerging evidence relevant to each core element, acknowledge previous studies relevant in the new context, and identify knowledge gaps. Findings: Seven core elements, each with their own specific recommendations, were identified in the initial consensus procedure and were grouped into 4 categories: (1) prevention and mitigation of the risks of becoming infected, (2) resuscitation of drowned persons during the COVID-19 pandemic, (3) organizational responsibilities, and (4) organizations unable to meet the recommended guidelines. The common measures of infection risk mitigation, personal protective equipment, and vaccination are the base of the recommendations. Measures to increase drowning prevention efforts reduce the root cause of the dilemma. Additional infection risk mitigation measures include screening all people entering aquatic facilities, defining criteria for futile resuscitation, and avoiding contact with drowned persons by rescuers with a high-risk profile. Ventilation techniques must balance required skill level, oxygen delivery, infection risk, and costs of equipment and training. Bag-mask ventilation with a high-efficiency particulate air filter by 2 trained rescuers is advised. Major implications for the methods, facilities, and environment of CPR training have been identified, including nonpractical skills to avoid being infected or to infect others. Most of all, the organization is responsible for informing their members about the impact of the COVID-19 pandemic and taking measures that maximize rescuer safety. Research is urgently needed to better understand, develop, and implement strategies to reduce infection transmission during drowning resuscitation. Conclusions and Relevance: This consensus document provides an overview of recommendations for water rescue organizations to improve the safety of their rescuers during the COVID-19 pandemic and balances the competing interests between a potentially lifesaving intervention and risk to the rescuer. The consensus-based recommendations can also serve as an example for other volunteer organizations and altruistic laypeople who may provide resuscitation.


Subject(s)
COVID-19/transmission , Cardiopulmonary Resuscitation , Drowning/prevention & control , Emergency Medical Services/organization & administration , Emergency Medical Technicians , Heart Arrest/therapy , Infectious Disease Transmission, Patient-to-Professional/prevention & control , COVID-19/prevention & control , Emergency Medical Services/standards , Heart Arrest/etiology , Humans , Pandemics , Personal Protective Equipment , SARS-CoV-2
4.
Eur Heart J ; 42(11): 1053-1056, 2021 03 14.
Article in English | MEDLINE | ID: covidwho-1472268
5.
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.
Jpn J Infect Dis ; 74(3): 236-239, 2021 May 24.
Article in English | MEDLINE | ID: covidwho-1241340

ABSTRACT

The 2019 novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused a global outbreak of infection. In general, children with coronavirus disease-2019 have been reported to show milder respiratory symptoms than adult patients. Here, we have described a case of a SARS-CoV-2-infected infant who presented to our hospital with a severe episode of an apparent life-threatening event (ALTE). An 8-month-old, otherwise healthy female infant presented to our hospital because of a sudden cardiopulmonary arrest. Approximately 1 h before this episode, the patient showed no symptoms, except a worse humor than usual. On arrival at our hospital, the patient had severe acidosis, but there were no clear signs of inflammatory response. Chest computed tomography showed weak consolidations in the upper right lung and atelectasis in the lower left lung. No signs of congenital heart disease or cardiomyopathy were observed on echocardiography, and no significant arrhythmia was observed during the clinical course. However, SARS-CoV-2 RNA was detected by real-time reverse transcription polymerase chain reaction in tracheal aspirate and urine samples. Although the assessment of further similar cases is indispensable, this case suggests that SARS-CoV-2 infection may be an underlying factor in the pathophysiology of ALTE.


Subject(s)
Brief, Resolved, Unexplained Event/etiology , COVID-19/etiology , Brief, Resolved, Unexplained Event/diagnostic imaging , COVID-19/diagnosis , COVID-19 Nucleic Acid Testing , Electrocardiography , Female , Heart Arrest/etiology , Hematologic Tests , Humans , Infant , Tomography, X-Ray Computed
9.
Am J Emerg Med ; 47: 244-247, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1217508

ABSTRACT

BACKGROUND: In-hospital cardiac arrest (IHCA) carries a high mortality and providing resuscitation to COVID-19 patients presents additional challenges for emergency physicians. Our objective was to describe outcomes of COVID-19 patients suffering IHCA at a rural hospital in Southern California. METHODS: Single-center retrospective observational study. A hospital registry of COVID-19 patients was queried for all patients who suffered IHCA and received cardiopulmonary resuscitation (CPR) between May 1st and July 31st, 2020. A manual chart review was performed to obtain patient demographics, oxygen requirement prior to cardiac arrest (CA), details of the resuscitation including presence of an emergency physician, and final disposition. RESULTS: Twenty-one patients were identified, most of whom were Hispanic, male, and aged 50-70. The most common medical comorbidities were diabetes and hypertension. Most patients suffered respiratory arrest, with an initial rhythm of pulseless electrical activity or asystole. Return of spontaneous circulation (ROSC) was achieved in 3/9 patients already receiving mechanical ventilation, but all 3 expired within the following 24 h. ROSC was achieved in 10/12 patients not already intubated, though most also expired within a few days. The only 2 patients who survived to discharge suffered respiratory arrest after their oxygen delivery device dislodged. CONCLUSION: At a small rural hospital with limited resources and a predominantly Hispanic population, cardiac arrest in a COVID-19 patient portends an extremely poor prognosis. A better appreciation of these outcomes should help inform emergency providers and patients when discussing code status and attempts at resuscitation, particularly in resource limited settings.


Subject(s)
COVID-19/complications , Cardiopulmonary Resuscitation/methods , Heart Arrest/mortality , Hospital Mortality , SARS-CoV-2 , Aged , California , Comorbidity , Female , Heart Arrest/etiology , Heart Arrest/therapy , Hospitals, Rural , Humans , Male , Middle Aged , Prognosis , Retrospective Studies , Return of Spontaneous Circulation
10.
Prehosp Emerg Care ; 26(3): 450-454, 2022.
Article in English | MEDLINE | ID: covidwho-1211354

ABSTRACT

We report a case of a previously healthy 47-year-old female with syncope due to multiple episodes of nodal dysfunction and asystole. During these brief episodes, she was hypoxic in the mid-80's as a result of COVID-19 pneumonia. The patient was admitted and treated for viral pneumonia and found to have normal electrocardiograms (ECG's), normal troponin levels and a normal echocardiogram during her hospital stay. As she recovered from COVID-19, no further episodes of bradycardia or bradyarrhythmia were noted. This case highlights a growing body of evidence that arrhythmias, specifically bradycardia, should be anticipated by prehospital providers as a potential cardiac complication of SARS-CoV-2 infection.


Subject(s)
COVID-19 , Emergency Medical Services , Heart Arrest , Arrhythmias, Cardiac , Bradycardia/etiology , Bradycardia/therapy , COVID-19/complications , Female , Heart Arrest/etiology , Heart Arrest/therapy , Humans , Middle Aged , SARS-CoV-2 , Sick Sinus Syndrome/complications , Sick Sinus Syndrome/diagnosis , Sick Sinus Syndrome/therapy
11.
Can J Cardiol ; 37(8): 1267-1270, 2021 08.
Article in English | MEDLINE | ID: covidwho-1155438

ABSTRACT

Cardiac arrest is common in critically ill patients with coronavirus disease 2019 (COVID-19) and is associated with poor survival. Simulation is frequently used to evaluate and train code teams with the goal of improving outcomes. All participants engaged in training on donning and doffing of personal protective equipment for suspected or confirmed COVID-19 cases. Thereafter, simulations of in-hospital cardiac arrest of patients with COVID-19, so-called protected code blue, were conducted at a quaternary academic centre. The primary endpoint was the mean time-to-defibrillation. A total of 114 patients participated in 33 "protected code blue" simulations over 8 weeks: 10 were senior residents, 17 were attending physicians, 86 were nurses, and 5 were respiratory therapists. Mean time-to-defibrillation was 4.38 minutes. Mean time-to-room entry, time-to-intubation, time-to-first-chest compression and time-to-epinephrine were 2.77, 5.74, 6.31, and 6.20 minutes, respectively; 92.84% of the 16 criteria evaluating the proper management of patients with COVID-19 and cardiac arrest were met. Mean time-to-defibrillation was longer than guidelines-expected time during protected code blue simulations. Although adherence to the modified advanced cardiovascular life-support protocol was high, breaches that carry additional infectious risk and reduce the efficacy of the resuscitation team were observed.


Subject(s)
COVID-19 , Cardiopulmonary Resuscitation , Education, Medical , Heart Arrest , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Simulation Training/methods , Time-to-Treatment/standards , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/transmission , Canada/epidemiology , Cardiopulmonary Resuscitation/education , Cardiopulmonary Resuscitation/methods , Cardiopulmonary Resuscitation/standards , Clinical Protocols , Education, Medical/methods , Education, Medical/trends , Guideline Adherence/statistics & numerical data , Heart Arrest/etiology , Heart Arrest/therapy , Humans , Infection Control/methods , SARS-CoV-2/isolation & purification
13.
Am J Obstet Gynecol MFM ; 2(2): 100113, 2020 05.
Article in English | MEDLINE | ID: covidwho-1064728

ABSTRACT

At our institution, 2 of the initial 7 pregnant patients with confirmed coronavirus disease 2019 severe infection (28.6%; 95% CI, 8.2%-64.1%) developed cardiac dysfunction with moderately reduced left ventricular ejection fractions of 40%-45% and hypokinesis. Viral myocarditis and cardiomyopathy have also been reported in nonpregnant coronavirus disease 2019 patients. A case series of nonpregnant patients with coronavirus disease 2019 found that 33% of those in intensive care developed cardiomyopathy. More data are needed to ascertain the incidence of cardiomyopathy from coronavirus disease 2019 in pregnancy, in all pregnant women with coronavirus disease 2019, and those with severe disease (eg, pneumonia). We suggest an echocardiogram in pregnant women with coronavirus disease 2019 pneumonia, in particular those necessitating oxygen, or those who are critically ill, and we recommend the use of handheld, point-of-care devices where possible to minimize contamination of staff and traditional large echocardiogram machines.


Subject(s)
COVID-19/therapy , Cardiomyopathies/therapy , Cesarean Section , Heart Failure/therapy , Pregnancy Complications, Cardiovascular/therapy , Pregnancy Complications, Infectious/therapy , Respiration, Artificial , Adult , Anti-Arrhythmia Agents/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , Anticonvulsants/therapeutic use , Blood Gas Analysis , COVID-19/complications , COVID-19/diagnosis , COVID-19/physiopathology , COVID-19 Nucleic Acid Testing , Cardiomyopathies/diagnosis , Cardiomyopathies/etiology , Cardiomyopathies/physiopathology , Diabetes, Gestational , Diuretics/therapeutic use , Echocardiography , Enzyme Inhibitors/therapeutic use , Female , Fever , Furosemide/therapeutic use , Heart Arrest/etiology , Heart Arrest/therapy , Heart Failure/diagnosis , Heart Failure/etiology , Heart Failure/physiopathology , Humans , Hydroxychloroquine/therapeutic use , Hypoxia/etiology , Hypoxia/therapy , Intubation, Intratracheal , Magnesium Sulfate/therapeutic use , Metoprolol/therapeutic use , Middle Aged , Obesity, Maternal/complications , Oxygen Inhalation Therapy , Point-of-Care Systems , Pre-Eclampsia/drug therapy , Pre-Eclampsia/physiopathology , Pregnancy , Pregnancy Complications, Cardiovascular/diagnosis , Pregnancy Complications, Cardiovascular/physiopathology , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/physiopathology , Return of Spontaneous Circulation , SARS-CoV-2 , Severity of Illness Index , Stroke Volume , Tachycardia/drug therapy , Tachycardia/physiopathology , Tachycardia, Supraventricular/drug therapy , Tachycardia, Supraventricular/etiology
14.
Eur Heart J ; 42(11): 1094-1106, 2021 03 14.
Article in English | MEDLINE | ID: covidwho-1066308

ABSTRACT

AIM: To study the characteristics and outcome among cardiac arrest cases with COVID-19 and differences between the pre-pandemic and the pandemic period in out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA). METHOD AND RESULTS: We included all patients reported to the Swedish Registry for Cardiopulmonary Resuscitation from 1 January to 20 July 2020. We defined 16 March 2020 as the start of the pandemic. We assessed overall and 30-day mortality using Cox regression and logistic regression, respectively. We studied 1946 cases of OHCA and 1080 cases of IHCA during the entire period. During the pandemic, 88 (10.0%) of OHCAs and 72 (16.1%) of IHCAs had ongoing COVID-19. With regards to OHCA during the pandemic, the odds ratio for 30-day mortality in COVID-19-positive cases, compared with COVID-19-negative cases, was 3.40 [95% confidence interval (CI) 1.31-11.64]; the corresponding hazard ratio was 1.45 (95% CI 1.13-1.85). Adjusted 30-day survival was 4.7% for patients with COVID-19, 9.8% for patients without COVID-19, and 7.6% in the pre-pandemic period. With regards to IHCA during the pandemic, the odds ratio for COVID-19-positive cases, compared with COVID-19-negative cases, was 2.27 (95% CI 1.27-4.24); the corresponding hazard ratio was 1.48 (95% CI 1.09-2.01). Adjusted 30-day survival was 23.1% in COVID-19-positive cases, 39.5% in patients without COVID-19, and 36.4% in the pre-pandemic period. CONCLUSION: During the pandemic phase, COVID-19 was involved in at least 10% of all OHCAs and 16% of IHCAs, and, among COVID-19 cases, 30-day mortality was increased 3.4-fold in OHCA and 2.3-fold in IHCA.


Subject(s)
COVID-19/mortality , Heart Arrest/mortality , Aged , Aged, 80 and over , COVID-19/complications , Cardiopulmonary Resuscitation , Female , Heart Arrest/etiology , Humans , Male , Middle Aged , Out-of-Hospital Cardiac Arrest/etiology , Registries , Survival Rate , Sweden
16.
Am J Emerg Med ; 43: 83-87, 2021 May.
Article in English | MEDLINE | ID: covidwho-1032962

ABSTRACT

INTRODUCTION: The endpoint of resuscitative interventions after traumatic injury resulting in cardiopulmonary arrest varies across institutions and even among providers. The purpose of this study was to examine survival characteristics in patients suffering torso trauma with no recorded vital signs (VS) in the emergency department (ED). METHODS: The National Trauma Data Bank was analyzed from 2007 to 2015. Inclusion criteria were patients with blunt and penetrating torso trauma without VS in the ED. Patients with head injuries, transfers from other hospitals, or those with missing values were excluded. The characteristics of survivors were evaluated, and statistical analyses performed. RESULTS: A total of 24,191 torso trauma patients without VS were evaluated in the ED and 96.6% were declared dead upon arrival. There were 246 survivors (1%), and 73 (0.3%) were eventually discharged home. Of patients who responded to resuscitation (812), the survival rate was 30.3%. Injury severity score (ISS), penetrating mechanism (odds ratio [OR] 1.99), definitive chest (OR 1.59) and abdominal surgery (OR 1.49) were associated with improved survival. Discharge to home (or police custody) was associated with lower ISS (OR 0.975) and shorter ED time (OR 0.99). CONCLUSION: Over a recent nine-year period in the United States, nearly 25,000 trauma patients were treated at trauma centers despite lack of VS. Of these patients, only 73 were discharged home. A trauma center would have to attempt over one hundred resuscitations of traumatic arrests to save one patient, confirming previous reports that highlight a grave prognosis. This creates a dilemma in treatment for front line workers and physicians with resource utilization and consideration of safety of exposure, particularly in the face of COVID-19.


Subject(s)
Cardiopulmonary Resuscitation/methods , Emergency Service, Hospital/statistics & numerical data , Heart Arrest/mortality , Torso/injuries , Wounds and Injuries/complications , Adult , Female , Heart Arrest/etiology , Heart Arrest/therapy , Humans , Incidence , Injury Severity Score , Male , Prognosis , Retrospective Studies , Survival Rate/trends , United States/epidemiology , Wounds and Injuries/epidemiology , Wounds and Injuries/therapy
17.
Shock ; 55(6): 742-751, 2021 06 01.
Article in English | MEDLINE | ID: covidwho-1006210

ABSTRACT

ABSTRACT: Extracorporeal life support (ECLS) is a support modality for patients with severe acute respiratory distress syndrome (ARDS) who have failed conventional treatments including low tidal volume ventilation, prone positioning, and neuromuscular blockade. In addition, ECLS can be used for hemodynamic support for patients with cardiogenic shock or following cardiac arrest. Injured patients may also require ECLS support for ARDS and other indications. We review the use of ECLS for ARDS patients, trauma patients, cardiogenic shock patients, and post-cardiac arrest patients. We then describe how these principles are applied in the management of the novel coronavirus disease 2019 pandemic. Indications, predictors, procedural considerations, and post-cannulation management strategies are discussed.


Subject(s)
COVID-19 , Extracorporeal Membrane Oxygenation , Heart Arrest , Respiratory Distress Syndrome , SARS-CoV-2 , COVID-19/complications , COVID-19/physiopathology , COVID-19/therapy , Heart Arrest/etiology , Heart Arrest/physiopathology , Heart Arrest/therapy , Humans , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/physiopathology , Respiratory Distress Syndrome/therapy
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