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3.
Am J Cardiol ; 183: 109-114, 2022 11 15.
Article in English | MEDLINE | ID: covidwho-2031089

ABSTRACT

Many case reports have indicated that myocarditis could be a prognostic factor for predicting morbidity and mortality among patients with COVID-19. In this study, using a large database we examined the association between myocarditis among COVID-19 hospitalizations and in-hospital mortality and other adverse hospital outcomes. The present study was a retrospective analysis of data collected in the California State Inpatient Database during 2020. All hospitalizations for COVID-19 were included in the analysis and grouped into those with and without myocarditis. The outcomes were in-hospital mortality, cardiac arrest, cardiogenic shock, mechanical ventilation, and acute respiratory distress syndrome. Propensity score matching, followed by conditional logistic regression, was performed to find the association between myocarditis and outcomes. Among 164,417 COVID-19 hospitalizations, 578 (0.4%) were with myocarditis. After propensity score matching, the rate of in-hospital mortality was significantly higher among COVID-19 hospitalizations with myocarditis (30.0% vs 17.5%, p <0.001). Survival analysis with log-rank test showed that 30-day survival rates were significantly lower among those with myocarditis (39.5% vs 46.3%, p <0.001). Conditional logistic regression analysis showed that the odds of cardiac arrest (odds ratio [OR] 1.90, 95% confidence interval [CI] 1.16 to 3.14), cardiogenic shock (OR 4.13, 95% CI 2.14 to 7.99), mechanical ventilation (OR 3.30, 95% CI 2.47 to 4.41), and acute respiratory distress syndrome (OR 2.49, 95% CI 1.70 to 3.66) were significantly higher among those with myocarditis. Myocarditis was associated with greater rates of in-hospital mortality and adverse hospital outcomes among patients with COVID-19, and early suspicion is important for prompt diagnosis and management.


Subject(s)
COVID-19 , Heart Arrest , Myocarditis , Respiratory Distress Syndrome , COVID-19/epidemiology , COVID-19/therapy , Heart Arrest/complications , Heart Arrest/epidemiology , Heart Arrest/therapy , Hospital Mortality , Hospitalization , Hospitals , Humans , Inpatients , Myocarditis/complications , Myocarditis/epidemiology , Myocarditis/therapy , Retrospective Studies , Shock, Cardiogenic/complications , Shock, Cardiogenic/epidemiology
4.
Pediatr Crit Care Med ; 23(11): 908-918, 2022 Nov 01.
Article in English | MEDLINE | ID: covidwho-2018352

ABSTRACT

OBJECTIVES: The COVID-19 pandemic resulted in adaptations to pediatric resuscitation systems of care. The objective of this study was to determine the temporal association between the pandemic and pediatric in-hospital cardiac arrest (IHCA) process of care metrics, cardiopulmonary resuscitation (cardiopulmonary resuscitation) quality, and patient outcomes. DESIGN: Multicenter retrospective analysis of a dataset comprising observations of IHCA outcomes pre pandemic (March 1, 2019 to February 29, 2020) versus pandemic (March 1, 2020 to February 28, 2021). SETTING: Data source was the ICU-RESUScitation Project ("ICU-RESUS;" NCT028374497), a prospective, multicenter, cluster randomized interventional trial. PATIENTS: Children (≤ 18 yr) who received cardiopulmonary resuscitation while admitted to the ICU and were enrolled in ICU-RESUS. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among 429 IHCAs meeting inclusion criteria, occurrence during the pandemic period was associated with higher frequency of hypotension as the immediate cause of arrest. Cardiac arrest physiology, cardiopulmonary resuscitation quality metrics, and postarrest physiologic and quality of care metrics were similar between the two periods. Survival with favorable neurologic outcome (Pediatric Cerebral Performance Category score 1-3 or unchanged from baseline) occurred in 102 of 195 subjects (52%) during the pandemic compared with 140 of 234 (60%) pre pandemic ( p = 0.12). Among survivors, occurrence of IHCA during the pandemic period was associated with a greater increase in Functional Status Scale (FSS) (i.e., worsening) from baseline (1 [0-3] vs 0 [0-2]; p = 0.01). After adjustment for confounders, IHCA survival during the pandemic period was associated with a greater increase in FSS from baseline (+1.19 [95% CI, 0.35-2.04] FSS points; p = 0.006) and higher odds of a new FSS-defined morbidity (adjusted odds ratio, 1.88 [95% CI, 1.03-3.46]; p = 0.04). CONCLUSIONS: Using the ICU-RESUS dataset, we found that relative to the year prior, pediatric IHCA during the first year of the COVID-19 pandemic was associated with greater worsening of functional status and higher odds of new functional morbidity among survivors.


Subject(s)
COVID-19 , Cardiopulmonary Resuscitation , Heart Arrest , Child , Humans , Pandemics , COVID-19/epidemiology , COVID-19/therapy , Retrospective Studies , Prospective Studies , Cardiopulmonary Resuscitation/methods , Heart Arrest/epidemiology , Heart Arrest/therapy
5.
R I Med J (2013) ; 105(7): 58-61, 2022 Sep 01.
Article in English | MEDLINE | ID: covidwho-2012170

ABSTRACT

Throughout the COVID-19 pandemic, there has been growing but limited data describing the poor mortality outcomes in COVID-19 patients who experienced In-Hospital Cardiac Arrest (IHCA). This study evaluated the baseline characteristics and outcomes of COVID-19 patients who underwent cardiopulmonary resuscitation (CPR) during hospitalization in the early phases of the pandemic and compared them to that of several national and international centers. A list of all the IHCA events in the Lifespan hospital network from March 2020 to April 2021 was generated, and data, including de-identified patient characteristics, comorbidities, and details of the IHCA event, were examined. The primary outcome of all-cause mortality was then calculated. Forty-three patients with COVID-19 who experienced an IHCA event and underwent CPR were identified. Return of spontaneous circulation (ROSC) was achieved in 23 (53%) patients, and all-cause in-hospital mortality was 97.67%, with only one patient surviving until discharge. During the early pandemic, experiencing an IHCA event while admitted with COVID-19 carried an extremely poor prognosis, even if ROSC was achieved. This outcome likely reflects the lack of clear management guidelines or established therapeutic agents and the prevalence of the Delta strain during this time period.


Subject(s)
COVID-19 , Cardiopulmonary Resuscitation , Heart Arrest , Heart Arrest/etiology , Heart Arrest/therapy , Hospitals , Humans , Pandemics
6.
Minerva Anestesiol ; 88(7-8): 541-543, 2022.
Article in English | MEDLINE | ID: covidwho-1934886
7.
Pediatrics ; 150(3)2022 09 01.
Article in English | MEDLINE | ID: covidwho-1933416

ABSTRACT

This article aims to provide guidance to health care workers for the provision of basic and advanced life support to children and neonates with suspected or confirmed coronavirus disease 2019 (COVID-19). It aligns with the 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular care while providing strategies for reducing risk of transmission of severe acute respiratory syndrome coronavirus 2 to health care providers. Patients with suspected or confirmed COVID-19 and cardiac arrest should receive chest compressions and defibrillation, when indicated, as soon as possible. Because of the importance of ventilation during pediatric and neonatal resuscitation, oxygenation and ventilation should be prioritized. All CPR events should therefore be considered aerosol-generating procedures. Thus, personal protective equipment (PPE) appropriate for aerosol-generating procedures (including N95 respirators or an equivalent) should be donned before resuscitation, and high-efficiency particulate air filters should be used. Any personnel without appropriate PPE should be immediately excused by providers wearing appropriate PPE. Neonatal resuscitation guidance is unchanged from standard algorithms, except for specific attention to infection prevention and control. In summary, health care personnel should continue to reduce the risk of severe acute respiratory syndrome coronavirus 2 transmission through vaccination and use of appropriate PPE during pediatric resuscitations. Health care organizations should ensure the availability and appropriate use of PPE. Because delays or withheld CPR increases the risk to patients for poor clinical outcomes, children and neonates with suspected or confirmed COVID-19 should receive prompt, high-quality CPR in accordance with evidence-based guidelines.


Subject(s)
COVID-19 , Cardiopulmonary Resuscitation , Heart Arrest , Child , Heart Arrest/etiology , Heart Arrest/therapy , Humans , Infant, Newborn , Personal Protective Equipment , Respiratory Aerosols and Droplets , SARS-CoV-2
8.
J Contin Educ Health Prof ; 42(2): 78-80, 2022 04 01.
Article in English | MEDLINE | ID: covidwho-1860942

ABSTRACT

INTRODUCTION: Different organizations have recommended changes in life support in the COVID-19 pandemic, just when maintaining the competence in cardiopulmonary resuscitation is compromised because on-site training must be avoided. We developed a pilot teaching-learning experience to promote cardiopulmonary resuscitation skills acquisition in this situation. The aim of this study was to describe that tool and to analyze its usefulness. METHODS: The experience consisted of three phases: first, reviewing the scientific literature; second, defining written local recommendations and recording a short video simulating the initial attention to a cardiac arrest in this COVID-19 context; third, creating a test to be answered by hospital health professionals. RESULTS: The final sample was 121 subjects; 66.1% were women; the mean age was 45.8 years (SD = 10.24). Among them, 43% were doctors, 43% nurses, 4.1% nursing assistants, and 9.9% others. 89.3% participants had received prior training in life support. In the test, questions 1, 2, 5, 6, 7, and 8 were answered correctly by more than 80%; questions 3 and 4 were answered correctly by 57.9% and 41.3%, respectively. All participants expressed that the video helped them to refresh their knowledge and skills in life support. DISCUSSION: When on-site training is not possible, distance learning-as in our teaching-learning innovation because of the COVID-19 pandemic-may be a valid option to acquire/refresh cardiopulmonary resuscitation skills.


Subject(s)
COVID-19 , Cardiopulmonary Resuscitation , Heart Arrest , COVID-19/epidemiology , Cardiopulmonary Resuscitation/education , Clinical Competence , Female , Heart Arrest/therapy , Humans , Male , Middle Aged , Pandemics
10.
Intern Emerg Med ; 17(6): 1759-1768, 2022 09.
Article in English | MEDLINE | ID: covidwho-1763470

ABSTRACT

Intravenous vitamin C (IV-VitC) has been suggested as a treatment for severe sepsis and acute respiratory distress syndrome; however, there are limited studies evaluating its use in severe COVID-19. Efficacy and safety of high-dose IV-VitC (HDIVC) in patients with severe COVID-19 were evaluated. This observational cohort was conducted at a single-center, 530 bed, community teaching hospital and took place from March 2020 through July 2020. Inverse probability treatment weighting (IPTW) was utilized to compare outcomes in patients with severe COVID-19 treated with and without HDIVC. Patients were enrolled if they were older than 18 years of age and were hospitalized secondary to severe COVID-19 infection, indicated by an oxygenation index < 300. Primary study outcomes included mortality, mechanical ventilation, intensive care unit (ICU) admission, and cardiac arrest. From a total of 100 patients enrolled, 25 patients were in the HDIVC group and 75 patients in the control group. The average time to death was significantly longer for HDIVC patients (P = 0.0139), with an average of 22.9 days versus 13.7 days for control patients. Patients who received HDIVC also had significantly lower rates of mechanical ventilation (52.93% vs. 73.14%; ORIPTW = 0.27; P = 0.0499) and cardiac arrest (2.46% vs. 9.06%; ORIPTW = 0.23; P = 0.0439). HDIVC may be an effective treatment in decreasing the rates of mechanical ventilation and cardiac arrest in hospitalized patients with severe COVID-19. A longer hospital stay and prolonged time to death may suggest that HDIVC may protect against clinical deterioration in severe COVID-19.


Subject(s)
Antineoplastic Agents , COVID-19 , Heart Arrest , Ascorbic Acid/therapeutic use , COVID-19/complications , COVID-19/drug therapy , Heart Arrest/therapy , Humans , Respiration, Artificial , SARS-CoV-2
11.
Oxid Med Cell Longev ; 2022: 1630918, 2022.
Article in English | MEDLINE | ID: covidwho-1714452

ABSTRACT

BACKGROUND: The impairment of microcirculation is associated with the unfavorable outcome for extracorporeal membrane oxygenation (ECMO) patients. Studies revealed that pulsatile modification improves hemodynamics and attenuates inflammation during ECMO support. However, whether flow pattern impacts microcirculation and endothelial integrity is rarely documented. The objective of this work was to explore how pulsatility affects microcirculation during ECMO. METHODS: Canine animal models with cardiac arrest were supported by ECMO, with the i-Cor system used to generate nonpulsatile or pulsatile flow. The sublingual microcirculation parameters were examined using the CytoCam microscope system. The expression of hsa_circ_0007367, a circular RNA, was measured during ECMO support. In vitro validation was performed in pulmonary vascular endothelial cells (PMVECs) exposed to pulsatile or nonpulsatile flow, and the expressions of hsa_circ_0007367, endothelial tight junction markers, endothelial adhesive molecules, endothelial nitric oxide synthases (eNOS), and NF-κB signaling activity were analyzed. RESULTS: The pulsatile modification of ECMO enhanced microcirculatory perfusion, attenuated pulmonary inflammation, and stabilized endothelial integrity in animal models; meanwhile, the expression of hsa_circ_0007367 was significantly upregulated both in animals and PMVECs exposed to pulsatile flow. In particular, upregulation of hsa_circ_0007367 stabilized the expressions of endothelial tight junction markers zonula occludens- (ZO-) 1 and occludin, followed by modulating the endothelial nitric oxide synthases (eNOS) activity and inhibiting the NF-κB signaling pathway. CONCLUSION: The modification of pulsatility contributes to microcirculatory perfusion and endothelial integrity during ECMO. The expression of hsa_circ_0007367 plays a pivotal role in this protective mechanism.


Subject(s)
Cell-Free Nucleic Acids/genetics , Endothelial Cells/physiology , Extracorporeal Membrane Oxygenation/methods , Heart Arrest/therapy , Animals , Cell Adhesion Molecules/metabolism , Cells, Cultured , Dogs , Endothelial Cells/metabolism , Heart Arrest/genetics , Heart Arrest/pathology , Heart Arrest/physiopathology , Inflammation , Lung/blood supply , Lung/pathology , Microcirculation , Nitric Oxide Synthase Type III/metabolism , Occludin/genetics , Occludin/metabolism , Pulsatile Flow , Rats , Zonula Occludens-1 Protein/genetics , Zonula Occludens-1 Protein/metabolism
13.
Resuscitation ; 173: 71-75, 2022 04.
Article in English | MEDLINE | ID: covidwho-1707007

ABSTRACT

BACKGROUND: Early studies found low survival rates for adults with COVID-19 infection and in-hospital cardiac arrest (IHCA). We evaluated the association of COVID-19 infection on survival outcomes in pediatric patients undergoing cardiopulmonary resuscitation (CPR). METHODS: Within Get-With-The-Guidelines®-Resuscitation, we identified pediatric patients who underwent CPR for an IHCA or bradycardia with poor perfusion between March and December, 2020. We compared survival outcomes (survival to discharge and return of spontaneous circulation for ≥20 minutes [ROSC]) between patients with suspected/confirmed COVID-19 infection and non-COVID-19 patients using multivariable hierarchical regression, with hospital site as a random effect and patient and cardiac arrest variables with a significant (p < 0.05) bivariate association as fixed effects. RESULTS: Overall, 1328 pediatric in-hospital CPR events were identified (590 IHCA, 738 bradycardia with poor perfusion), of which 46 (32 IHCA, 14 bradycardia) had suspected/confirmed COVID-19 infection. Rates of survival to discharge were similar between those with and without COVID-19 infection (39.1% vs. 44.9%; adjusted RR, 1.14 [95% CI: 0.55-2.36]), and these estimates were similar for those with IHCA and bradycardia with poor perfusion (adjusted RRs of 1.03 and 1.05; interaction p = 0.96). Rates of ROSC were also similar between pediatric patients with and without COVID-19 overall (67.4% vs. 76.9%; adjusted RR, 0.87 [0.43, 1.77]), and for the subgroups with IHCA or bradycardia requiring CPR (adjusted RRs of 0.95 and 0.86, interaction p = 0.26). CONCLUSIONS: In a large multicenter national registry of CPR events, COVID-19 infection was not associated with lower rates of ROSC or survival to hospital discharge in pediatric patients undergoing CPR.


Subject(s)
COVID-19 , Cardiopulmonary Resuscitation , Heart Arrest , Adult , COVID-19/therapy , Child , Heart Arrest/therapy , Hospitals, Pediatric , Humans , Survival Rate
15.
Resuscitation ; 173: 4-11, 2022 04.
Article in English | MEDLINE | ID: covidwho-1676901

ABSTRACT

AIMS: To compare in-hospital cardiac arrest (IHCA) rates and patient outcomes during the first COVID-19 wave in the United Kingdom (UK) in 2020 with the same period in previous years. METHODS: A retrospective, multicentre cohort study of 154 UK hospitals that participate in the National Cardiac Arrest Audit and have intensive care units participating in the Case Mix Programme national audit of intensive care. Hospital burden of COVID-19 was defined by the number of patients with confirmed SARS-CoV2 infection admitted to critical care per 10,000 hospital admissions. RESULTS: 16,474 patients with IHCA where a resuscitation team attended were included. Patients admitted to hospital during 2020 were younger, more often male, and of non-white ethnicity compared with 2016-2019. A decreasing trend in IHCA rates between 2016 and 2019 was reversed in 2020. Hospitals with higher burden of COVID-19 had the greatest difference in IHCA rates (21.8 per 10,000 admissions in April 2020 vs 14.9 per 10,000 in April 2019). The proportions of patients achieving ROSC ≥ 20 min and surviving to hospital discharge were lower in 2020 compared with 2016-19 (46.2% vs 51.2%; and 21.9% vs 22.9%, respectively). Among patients with IHCA, higher hospital burden of COVID-19 was associated with reduced survival to hospital discharge (OR = 0.95; 95% CI 0.93 to 0.98; p < 0.001). CONCLUSIONS: In comparison with 2016-2019, the first COVID-19 wave in 2020 was associated with a higher rate of IHCA and decreased survival among patients attended by resuscitation teams. These changes were greatest in hospitals with the highest COVID-19 burden.


Subject(s)
COVID-19 , Cardiopulmonary Resuscitation , Heart Arrest , COVID-19/epidemiology , Cohort Studies , Heart Arrest/epidemiology , Heart Arrest/therapy , Hospitals , Humans , Male , Pandemics , RNA, Viral , Retrospective Studies , SARS-CoV-2 , United Kingdom/epidemiology
16.
Arch Cardiol Mex ; 91(Supl): 64-73, 2021.
Article in English | MEDLINE | ID: covidwho-1675526

ABSTRACT

La pandemia de COVID-19 ha infligido grandes estragos a la población y en especial al personal de salud. Los esfuerzos de reanimación exigen modificaciones potenciales de las guías internacionales existentes de reanimación cardiopulmonar (RCP) debido al elevado índice de contagiosidad del virus SARS-CoV-2. Se considera que hasta 15% de los casos de COVID-19 tiene una enfermedad grave y 5% padece un trastorno crítico con una mortalidad promedio del 3%, la cual varía según sean el país y las características de los pacientes. La edad y las comorbilidades como la hipertensión arterial, enfermedad cardiovascular, obesidad y diabetes incrementan la mortalidad hasta 24%. También se ha informado un aumento reciente del número de casos de paro cardíaco extrahospitalario (PCEH). Aunque el paro cardíaco (PC) puede ser efecto de factores diversos en estos pacientes, en la mayoría de los casos se ha demostrado que el origen es respiratorio, con muy pocos casos de causa cardíaca. Se debe considerar la indicación de iniciar o continuar las maniobras de RCP por dos razones fundamentales: la posibilidad de sobrevida de las víctimas, que hasta la fecha se ha registrado muy baja, y el riesgo de contagiar al personal de salud, que es muy alto.The COVID-19 pandemic is having a large impact on the general population, but it has taken a specially high toll on healthcare personnel. Resuscitation efforts require potential modifications of the present Cardiopulmonary Resuscitation (CPR) international guidelines because of the transmissibility rate of the new SARS-CoV 2 virus. It has been seen that up to 15% of COVID-19 patients have a severe disease, 5% have a critical form of infection and the mean death rate is 3%, although there are significant differences according to the country that reports it and patients' baseline conditions that include age, presence of arterial hypertension, cardiovascular disease, diabetes or obesity. In these high risk subjects, mortality might go up to 24%. There are also reports of a recent increase in out-of-hospital cardiopulmonary arrest (OHCA) victims. Cardiac arrest (CA) in these subjects might be related to many causes, but apparently, that phenomenon is related to respiratory diseases rather than cardiac issues. In this context, the decision to start or continue CPR maneuvers has to be carefully assessed, because of the low survival rate reported so far and the high contagion risk among healthcare personnel.


Subject(s)
COVID-19 , Heart Arrest , Adult , COVID-19/complications , Cardiology , Child , Heart Arrest/therapy , Heart Arrest/virology , Humans , Infant, Newborn , Mexico , Pandemics , Retrospective Studies , SARS-CoV-2
17.
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
18.
Circ Cardiovasc Qual Outcomes ; 15(2): e008420, 2022 02.
Article in English | MEDLINE | ID: covidwho-1662367

ABSTRACT

BACKGROUND: Recent reports on challenges in resuscitation care at hospitals severely affected by the novel coronavirus disease 2019 (COVID-19) pandemic raise questions about how the pandemic affected outcomes for in-hospital cardiac arrest throughout the United States. METHODS: Within Get With The Guidelines-Resuscitation, we conducted a retrospective cohort study to compare in-hospital cardiac arrest survival during the presurge (January 1-February 29), surge (March 1-May 15) and immediate postsurge (May 16-June 30) periods in 2020 compared to 2015 to 2019. Monthly COVID-19 mortality rates for each hospital's county were categorized, per 1 000 000 residents, as low (0-10), moderate (11-50), high (51-100), or very high (>100). Using hierarchical regression models, we compared rates of survival to discharge in 2020 versus 2015 to 2019 for each period. RESULTS: Of 61 586 in-hospital cardiac arrests, 21 208 (4309 in 2020), 26 459 (5949 in 2020), and 13 919 (2686 in 2020) occurred in the presurge, surge, and postsurge periods, respectively. During the presurge period, 24.2% survived to discharge in 2020 versus 24.7% in 2015 to 2019 (adjusted odds ratio, 1.12 [95% CI, 1.02-1.22]). In contrast, during the surge period, 19.6% survived to discharge in 2020 versus 26.0% in 2015 to 2019 (adjusted odds ratio, 0.81 [0.75-0.88]). Lower survival was most pronounced in communities with high (28% lower survival) and very high (42% lower survival) monthly COVID-19 mortality rates (interaction P<0.001). Resuscitation times were shorter (median: 22 versus 25 minutes; P<0.001), and delayed epinephrine treatment was more prevalent (11.3% versus 9.9%; P=0.004) during the surge period. Survival was lower even when patients with confirmed/suspected COVID-19 infection were excluded from analyses. During the postsurge period, survival rates were similar in 2020 versus 2015 to 2019 (22.3% versus 25.8%; adjusted odds ratio, 0.93 [0.83-1.04]), including communities with high COVID-19 mortality (interaction P=0.16). CONCLUSIONS: Early during the pandemic, rates of survival to discharge for IHCA decreased, even among patients without COVID-19 infection, highlighting the early impact of the COVID-19 pandemic on in-hospital resuscitation.


Subject(s)
COVID-19 , Cardiopulmonary Resuscitation , Heart Arrest , Heart Arrest/diagnosis , Heart Arrest/epidemiology , Heart Arrest/therapy , Hospitals , Humans , Pandemics , Registries , Retrospective Studies , SARS-CoV-2 , Survival Rate , United States/epidemiology
20.
Am J Emerg Med ; 52: 128-131, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1561972

ABSTRACT

AIM OF THE STUDY: In this study we aimed to investigate whether changing rescuers wearing N95 masks every 1 min instead of the standard CPR change over time of 2 min would make a difference in effective chest compressions. METHODS: This study was a randomized controlled mannequin study. Participants were selected from healthcare staff. They were divided into two groups of two people in each group. The scenario was implemented on CPR mannequin representing patient with asystolic arrest, that measured compression depth, compression rate, recoil, and correct hand position. Two different scenarios were prepared. In Scenario 1, the rescuers were asked to change chest compression after 1 min. In Scenario 2, standard CPR was applied. The participants' vital parameters, mean compression rate, correct compression rate/ratio, total number of compressions, compression depth, correct recoil/ratio, correct hand position/ratio, mean no-flow time, and total CPR time were recorded. RESULTS: The study hence included 14 teams each for scenarios, with a total of 56 participants. In each scenario, 14 participants were physicians and 14 participants were women. Although there was no difference in the first minute of the cycles starting from the fourth cycle, a statistically significant difference was observed in the second minute in all cycles except the fifth cycle. CONCLUSION: Changing the rescuer every 1 min instead of every 2 min while performing CPR with full PPE may prevent the decrease in compression quality that may occur as the resuscitation time gets longer.


Subject(s)
Cardiopulmonary Resuscitation/methods , Cardiopulmonary Resuscitation/standards , Emergency Service, Hospital/standards , Fatigue/prevention & control , Heart Arrest/therapy , Medical Staff, Hospital , N95 Respirators , Adult , Female , Humans , Male , Manikins , Turkey
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