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1.
BMC Health Serv Res ; 22(1): 696, 2022 May 24.
Article in English | MEDLINE | ID: covidwho-1862130

ABSTRACT

OBJECTIVES: To determine the impact of the Coronavirus disease-2019 (COVID-19) pandemic on the length of stay (LOS) and prognosis of patients in the resuscitation area. METHODS: A retrospective analysis of case data of patients in the resuscitation area during the early stages of the COVID-19 pandemic (January 15, 2020- January 14, 2021) was performed and compared with the pre-COVID-19 period (January 15, 2019 - January 14, 2020) in the First Affiliated Hospital of Soochow University. The patients' information, including age, sex, length of stay, and death, was collected. The Wilcoxon Rank sum test was performed to compare the LOS difference between the two periods. Fisher's Exact test and Chi-Squared test were used to analyze the prognosis of patients. The LOS and prognosis in different departments of the resuscitation area (emergency internal medicine, emergency surgery, emergency neurology, and other departments) were further analyzed. RESULTS: Of the total 8278 patients, 4159 (50.24%) were enrolled in the COVID-19 pandemic period group, and 4119 (49.76%) were enrolled pre-COVID-19 period group. The length of stay was prolonged significantly in the COVID-19 period compared with the pre-COVID-19 period (13h VS 9.8h, p < 0.001). The LOS in the COVID-19 period was prolonged in both emergency internal medicine (15.3h VS 11.3h, p < 0.001) and emergency surgery (8.7h VS 4.9h, p < 0.001) but not in emergency neurology or other emergency departments. There was no significant difference in mortality between the two cohorts (4.8% VS 5.3%, p = 0.341). CONCLUSION: The COVID-19 pandemic was associated with a significant increase in the length of resuscitation area stay, which may lead to resuscitation area crowding. The influence of the COVID-19 pandemic on patients of different departments was variable. There was no significant impact on the LOS of emergency neurology. According to different departments of the resuscitation area, the COVID-19 pandemic didn't significantly impact the prognosis of patients.


Subject(s)
COVID-19 , Emergency Service, Hospital , Length of Stay , SARS-CoV-2 , COVID-19/epidemiology , COVID-19/therapy , China/epidemiology , Humans , Pandemics , Prognosis , Resuscitation/statistics & numerical data , Retrospective Studies
6.
J Anesth ; 36(1): 158, 2022 02.
Article in English | MEDLINE | ID: covidwho-1689476
7.
Curr Opin Pediatr ; 34(2): 170-177, 2022 04 01.
Article in English | MEDLINE | ID: covidwho-1672398

ABSTRACT

PURPOSE OF REVIEW: For over a decade, the International Liaison Committee on Resuscitation has recommended delayed cord clamping (DCC), but implementation has been variable due to lack of consensus on details of technique and concerns for risks in certain patient populations. This review summarizes recent literature on the benefits and risks of DCC in term and preterm infants and examines alternative approaches such as physiologic-based cord clamping or intact cord resuscitation (ICR) and umbilical cord milking (UCM). RECENT FINDINGS: DCC improves hemoglobin/hematocrit among term infants and may promote improved neurodevelopment. In preterms, DCC improves survival compared to early cord clamping; however, UCM has been associated with severe intraventricular hemorrhage in extremely preterm infants. Infants of COVID-19 positive mothers, growth-restricted babies, multiples, and some infants with cardiopulmonary anomalies can also benefit from DCC. Large randomized trials of ICR will clarify safety and benefits in nonvigorous neonates. These have the potential to dramatically change the sequence of events during neonatal resuscitation. SUMMARY: Umbilical cord management has moved beyond simple time-based comparisons to nuances of technique and application in vulnerable sub-populations. Ongoing research highlights the importance of an individualized approach that recognizes the physiologic equilibrium when ventilation is established before cord clamping.


Subject(s)
COVID-19 , Infant, Premature , COVID-19/prevention & control , Female , Hematocrit , Hemoglobins , Humans , Infant, Newborn , Pregnancy , Pregnancy Complications, Infectious , Resuscitation , SARS-CoV-2 , Time Factors , Umbilical Cord/physiology , Umbilical Cord/surgery
8.
J Clin Lab Anal ; 36(3): e24264, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1653267

ABSTRACT

OBJECTIVE: The purpose of this study was to evaluate the impact of COVID-19 outbreaks on emergency patients in a resuscitation room in Nanning, China. METHODS: A single-center cross-sectional retrospective study was conducted in the emergency department of a tertiary public hospital from January 1, 2019, to December 31, 2020, in Nanning, Guangxi, China. We collected the data of patients in the resuscitation room to investigate the number of patients accessing emergency services during the study period. Data in 2020 were compared to the data during the same period in 2019. RESULTS: The number of emergency patients in the resuscitation room during the COVID-19 pandemic has decreased in intrinsic diseases, extrinsic diseases, and pediatric cases, especially in the early stages of the pandemic. Additionally, the length of stay of emergency patients in the resuscitation room was reduced. CONCLUSIONS: The number of emergency patients in the resuscitation room during the pandemic of COVID-19 in 2020 was reduced compared to that in the same period in 2019 in Nanning, China. This situation shows a serious social problem, which should arouse the attention of the medical profession and the government.


Subject(s)
COVID-19/epidemiology , Emergency Service, Hospital/statistics & numerical data , Resuscitation/statistics & numerical data , Adult , Aged , China , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Retrospective Studies , SARS-CoV-2
9.
Am J Emerg Med ; 53: 122-126, 2022 03.
Article in English | MEDLINE | ID: covidwho-1638161

ABSTRACT

BACKGROUND: Endotracheal intubation (ETI) is still the gold standard of airway management, but in cases of sudden cardiac arrest in patients with suspected SARS-CoV-2 infection, ETI is associated with risks for both the patient and the medical personnel. We hypothesized that the Vie Scope® is more useful for endotracheal intubation of suspected or confirmed COVID-19 cardiac arrest patients than the conventional laryngoscope with Macintosh blade when operators are wearing personal protective equipment (PPE). METHODS: Study was designed as a prospective, multicenter, randomized clinical trial performed by Emergency Medical Services in Poland. Patients with suspected or confirmed COVID-19 diagnosis who needed cardiopulmonary resuscitation in prehospital setting were included. Patients under 18 years old or with criteria predictive of impossible intubation under direct laryngoscopy, were excluded. Patients were randomly allocated 1:1 to Vie Scope® versus direct laryngoscopy with a Macintosh blade. Study groups were compared on success of intubation attempts, time to intubation, glottis visualization and number of optimization maneuvers. RESULTS: We enrolled 90 out-of-hospital cardiac arrest (OHCA) patients, aged 43-92 years. Compared to the VieScope® laryngoscope, use of the Macintosh laryngoscope required longer times for tracheal intubation with an estimated mean difference of -48 s (95%CI confidence interval [CI], -60.23, -35.77; p < 0.001). Moreover VieScope® improved first attempt success rate, 93.3% vs. 51.1% respectively (odds ratio [OR] = 13.39; 95%CI: 3.62, 49.58; p < 0.001). CONCLUSIONS: The use of the Vie Scope® laryngoscope in OHCA patients improved the first attempt success rate, and reduced intubation time compared to Macintosh laryngoscope in paramedics wearing PPE for against aerosol generating procedures. TRIAL REGISTRATION: ClinicalTrials registration number NCT04365608.


Subject(s)
Allied Health Personnel/statistics & numerical data , Intubation, Intratracheal/instrumentation , Laryngoscopes/standards , Adult , Aged , Aged, 80 and over , Airway Management/instrumentation , Airway Management/methods , Airway Management/statistics & numerical data , Allied Health Personnel/standards , Female , Humans , Intubation, Intratracheal/methods , Intubation, Intratracheal/statistics & numerical data , Laryngoscopes/statistics & numerical data , Male , Middle Aged , Personal Protective Equipment/adverse effects , Personal Protective Equipment/standards , Personal Protective Equipment/statistics & numerical data , Prospective Studies , Resuscitation/instrumentation , Resuscitation/methods , Resuscitation/statistics & numerical data
11.
Med Educ Online ; 26(1): 1892017, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1575053

ABSTRACT

Introduction: Telesimulation may allow simulationists to continue with essential simulation-based training programs during the COVID-19 pandemic. Hence, we investigated the feasibility of telesimulation for neonatal resuscitation training, assessed participants' attitudes towards telesimulation as well as its effect on neonatal resuscitation knowledge, and compared results between medical students and neonatal nurses. Methods: For this prospective observational pilot study, medical students and neonatal nursing staff were recruited on a voluntary basis. Pre- and post-training knowledge was assessed using a 20-question questionnaire. Following the educational intervention, participants further answered a six-item questionnaire on their perception of telesimulation. For the telesimulation session, participants received a simulation package including a low-fidelity mannequin and medical equipment. The one-hour telesimulation session was delivered by an experienced instructor and broadcasted via Cisco Webex for groups of 2-3 participants, covering all elements of the neonatal resuscitation algorithm and including deliberate technical skills practice. Results: Nine medical students and nine neonatal nurses participated in a total of seven telesimulation sessions. In general, participants enjoyed the telesimulation session, acknowledged a positive learning effect and found telesimulation suitable for neonatal resuscitation training, but were critical of potential technical issues, training logistics, and the quality of supervision and feedback. Neonatal resuscitation knowledge scores increased significantly after the educational intervention both for medical students and nurses. Conclusions: Telesimulation is feasible for neonatal resuscitation training and associated with significant improvements in knowledge of current resuscitation guidelines, without differences between medical students and neonatal nurses.


Subject(s)
COVID-19/epidemiology , Resuscitation/education , Simulation Training/methods , Students, Medical/psychology , Students, Nursing/psychology , Telemedicine/methods , Adult , Attitude of Health Personnel , Clinical Competence , Female , Humans , Infant, Newborn , Learning , Male , Pandemics , Pilot Projects , Prospective Studies , SARS-CoV-2 , Surveys and Questionnaires
12.
Annu Int Conf IEEE Eng Med Biol Soc ; 2021: 4998-5004, 2021 11.
Article in English | MEDLINE | ID: covidwho-1566232

ABSTRACT

MIT's Emergency-Vent Project was launched in March 2020 to develop safe guidance and a reference design for a bridge ventilator that could be rapidly produced in a distributed manner worldwide. The system uses a novel servo-based robotic gripper to automate the squeezing of a manual resuscitator bag evenly from both sides to provide ventilation according to clinically specified parameters. In just one month, the team designed and built prototype ventilators, tested them in a series of porcine trials, and collaborated with industry partners to enable mass production. We released the design, including mechanical drawings, design spreadsheets, circuit diagrams, and control code into an open source format and assisted production efforts worldwide.Clinical relevance- This work demonstrated the viability of automating the compression of a manual resuscitator bag, with pressure feedback, to provide bridge ventilation support.


Subject(s)
COVID-19 , Animals , Humans , Respiration , Resuscitation , SARS-CoV-2 , Swine , Ventilators, Mechanical
13.
Curr Opin Crit Care ; 27(6): 663-667, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1511080

ABSTRACT

PURPOSE OF REVIEW: Sudden out-of-hospital cardiac arrest (OHCA) is still one of the top reasons for death in industrialized countries. Bystander resuscitation rates differ significantly across the world despite bystanders being easily able to save lives in this situation. In the 4 years since initiation of the International Liaison Committee on Resuscitation (ILCOR) World Restart a Heart (WRAH), the initiative helped educating millions of people and thus enabled them to save lives. RECENT FINDINGS: WRAH Day has gained more and more reach, partners and impact over the years. It has the potential of saving hundreds of thousands of lives, changing legislation and inspiring research. During the last year, new strategies had to be developed because of the COVID-pandemic. The importance of educating laypeople is underlined in recent publications and international guidelines. SUMMARY: The WRAH awareness campaign has reached 194 countries and more than 200 million people in the last years. The success of it could even be kept going in the pandemic due to social media and digital/virtual programmes. International guidelines recommend raising awareness and name ILCOR WRAH as a way to do it.


Subject(s)
COVID-19 , Cardiopulmonary Resuscitation , Out-of-Hospital Cardiac Arrest , Humans , Out-of-Hospital Cardiac Arrest/therapy , Resuscitation , SARS-CoV-2
15.
Am J Emerg Med ; 51: 64-68, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1458554

ABSTRACT

OBJECTIVE: A decline in OHCA performance metrics during the pandemic has been reported in the literature but the cause is still not known. The Montgomery County Fire and Rescue Service (MCFRS) observed a decline in both the rate of return of spontaneous circulation (ROSC) and the proportion of resuscitations that resulted in cerebral performance category (CPC) 1 or 2 discharge of the patient beginning in March of 2020. This study examines whether the decline in these performance metrics persists when known COVID positive patients are excluded from the analysis. METHODS: Two samples of OHCA patients for similar time periods (one year apart) before and after the start of the COVID pandemic were developed. A database of known COVID positive patients among EMS encounters was used to identify and exclude COVID positive patients. OHCA outcomes in these two groups were then compared using a Chi-square test and Fisher's exact test for difference in proportions and Analysis of Variance (ANOVA) for difference in means. A two-stage multivariable logistic regression model was used to develop odds ratios for achieving ROSC and CPC 1 or 2 discharge in each period. RESULTS: After excluding known COVID patients, 32.5% of the patients in the pre-COVID period achieved ROSC compared to 25.1% in the COVID period (p = 0.007). 6% of patients in the pre-COVID period were discharged with CPC 1 or 2 compared to 3.2% from the COVID era (p = 0.026). Controlling for all available patient characteristics, patients undergoing OHCA resuscitation prior to be beginning of the pandemic were 1.2 times more likely to achieve ROSC and 1.6 times more likely to be discharged with CPC 1 or 2 than non-COVID patients in the pandemic era sample. CONCLUSIONS: When known COVID patients are excluded, pre-pandemic OHCA resuscitation patients were more likely to achieve ROSC and CPC 1 or 2 discharge. The prevalence of known COVID positive patients among all OHCA resuscitations during the pandemic was not sufficient to fully account for the marked decrease in both ROSC and CPC 1 or 2 discharges. Other causative factors must be sought.


Subject(s)
Benchmarking , Emergency Medical Services/statistics & numerical data , Out-of-Hospital Cardiac Arrest/epidemiology , Patient Discharge/statistics & numerical data , Aged , Aged, 80 and over , Analysis of Variance , COVID-19 , Chi-Square Distribution , Female , Humans , Logistic Models , Male , Maryland , Middle Aged , Odds Ratio , Pandemics , Resuscitation , Retrospective Studies , Return of Spontaneous Circulation
16.
Pancreatology ; 21(8): 1405-1410, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1454404

ABSTRACT

INTRODUCTION: Fluid resuscitation is the keystone of treatment for acute pancreatitis. Though clinical guidelines and expert opinions agree on large volume resuscitation, debate remains on the optimal fluid type. The most commonly used fluids are Lactated Ringer's (LR) and Normal Saline (NS), but the studies published to date comparing LR vs NS yield conflicting results. We aimed to identify and quantitatively synthesize existing high quality data of the topic of fluid type or acute pancreatitis resuscitation. METHODS: In collaboration with the study team, an information specialist performed a comprehensive literature review to identify reports addressing type of fluid resuscitation. Studies were screened using the Covidence system by two independent reviewers in order to identify Randomized controlled trials comparing LR versus NS. The main outcome was the development of moderately severe or severe pancreatitis and additional outcomes included local complications, ICU admission, and length of stay. Pooled odds ratios were estimated using the random effects model and standardized mean difference to compare continuous variables. RESULTS: We reviewed 7964 abstracts and 57 full text documents. Four randomized controlled trials were identified and included in our meta-analyses. There were a total of 122 patients resuscitated with LR versus 126 with NS. Patients resuscitated with LR were less likely to develop moderately severe/severe pancreatitis (OR 0.49; 95 % CI 0.25-0.97). There was no difference in development of SIRS at 24 or 48 h or development of organ failure between the two groups. Patients resuscitated with LR were less likely to require ICU admission (OR 0.33; 95 % CI 0.13-0.81) and local complications (OR 0.42; 95 % CI 0.2-0.88). While there was a trend towards shorter hospitalizations for LR (SMD -0.18, 99 % CI -0.44-0.07), it was not statistically significant. CONCLUSION: Resuscitation with LR reduces the development of moderately severe-severe pancreatitis relative to NS. Nevertheless, no difference in SIRS development or organ failure underscores the need for further studies to verify this finding and define its mechanism.


Subject(s)
Pancreatitis , Saline Solution , Acute Disease , Fluid Therapy , Humans , Isotonic Solutions/therapeutic use , Pancreatitis/therapy , Randomized Controlled Trials as Topic , Resuscitation , Ringer's Lactate , Systemic Inflammatory Response Syndrome
17.
Am J Emerg Med ; 50: 683-692, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1439822

ABSTRACT

Given the dramatic increase in critically ill patients who present to the emergency department for care, along with the persistence of boarding of critically ill patients, it is imperative for the emergency physician to be knowledgeable about recent developments in resuscitation and critical care medicine. This review summarizes important articles published in 2020 that pertain to the resuscitation and care of select critically ill patients. These articles have been selected based on the authors annual review of key critical care, emergency medicine and medicine journals and their opinion of the importance of study findings as it pertains to the care of critically ill ED patients. Several key findings from the studies discussed in this paper include the administration of dexamethasone to patients with COVID-19 infection who require mechanical ventilation or supplemental oxygen, the use of lower levels of positive end-expiratory pressure for patients without acute respiratory distress syndrome, and early initiation of extracorporeal membrane oxygenation for out-of-hospital cardiac arrest patients with refractory ventricular fibrillation if resources are available. Furthermore, the emergency physician should not administer tranexamic acid to patients with acute gastrointestinal bleeding or administer the combination of vitamin C, thiamine, and hydrocortisone for patients with septic shock. Finally, the emergency physician should titrate vasopressor medications to more closely match a patient's chronic perfusion pressure rather than target a mean arterial blood pressure of 65 mmHg for all critically ill patients.


Subject(s)
COVID-19/therapy , Critical Care , Humans , Respiration, Artificial , Resuscitation , Vasoconstrictor Agents/therapeutic use
18.
Arch Dis Child Fetal Neonatal Ed ; 107(2): 211-215, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1398607

ABSTRACT

BACKGROUND AND OBJECTIVE: Healthcare providers should use personal protective equipment (PPE) when performing aerosol-generating medical procedures during highly infectious respiratory pandemics. We aimed to compare the timing of neonatal resuscitation procedures in a manikin model with or without PPE for prevention of SARS-COVID-19 transmission. METHODS: A randomised controlled cross-over (AB/BA) trial of resuscitation with or without PPE in a neonatal resuscitation scenario. Forty-eight participants were divided in 12 consultant-nurse teams and 12 resident-nurse teams. The primary outcome measure was the time of positive pressure ventilation (PPV) initiation. The secondary outcome measures were duration of tracheal intubation procedure, time of initiation of chest compressions, correct use of PPE and discomfort/limitations using PPE. RESULTS: There were significant differences in timing of PPV initiation (consultant-nurse teams: mean difference (MD) 6.0 s, 95% CI 1.1 to 10.9 s; resident-nurse teams: MD 11.0 s, 95% CI 1.9 to 20.0 s), duration of tracheal intubation (consultant-nurse teams: MD 22.0 s, 95% CI 7.0 to 36.9 s; resident-nurse teams: MD 9.1 s, 95% CI 0.1 to 18.1 s) and chest compressions (consultant-nurse teams: MD 32.3 s, 95% CI 14.4 to 50.1 s; resident-nurse teams: MD 9.1 s, 95% CI 0.1 to 18.1 s). Twelve participants completed the dressing after entering the delivery room. PPE was associated with visual limitations (43/48 participants), discomfort in movements (42/48), limitations in communication (32/48) and thermal discomfort (29/48). CONCLUSIONS: In a manikin model, using PPE delayed neonatal resuscitation procedures with potential clinical impact. Healthcare workers reported limitations and discomfort when wearing PPE. TRIAL REGISTRATION NUMBER: NCT04666233.


Subject(s)
COVID-19/epidemiology , COVID-19/prevention & control , Personal Protective Equipment , Resuscitation/methods , Consultants , Cross-Over Studies , Humans , Infant, Newborn , Intensive Care Units, Neonatal , Internship and Residency , Intubation, Intratracheal/methods , Manikins , Nursing Staff, Hospital , Pandemics , Positive-Pressure Respiration/methods , SARS-CoV-2 , Time Factors
19.
Crit Care Nurs Clin North Am ; 33(3): 263-274, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1300065

ABSTRACT

Sepsis is recognized as a major health care problem worldwide. In the United States, mortality from severe sepsis and septic shock remains a serious health problem; yet, the early recognition of sepsis by nurses reduces can reduce mortality, morbidity, and long-term consequences of sepsis for patients. Improving the knowledge of nurses to first recognize the early signs of sepsis and then how to apply the most up-to-date evidence-based treatments can improve outcomes. Enhanced monitoring includes the use of computerized early warning systems to alert nurses of worrisome clinical patterns and promote the early recognition of sepsis.


Subject(s)
Nursing Care , Sepsis , Shock, Septic , Humans , Resuscitation , Sepsis/diagnosis , Sepsis/therapy , Shock, Septic/diagnosis , Shock, Septic/therapy , United States
20.
Am J Emerg Med ; 49: 148-152, 2021 11.
Article in English | MEDLINE | ID: covidwho-1316366

ABSTRACT

BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C) is a dangerous pediatric complication of COVID-19. OBJECTIVE: The purpose of this review article is to provide a summary of the diagnosis and management of MIS-C with a focus on management in the acute care setting. DISCUSSION: MIS-C is an inflammatory syndrome which can affect nearly any organ system. The most common symptoms are fever and gastrointestinal symptoms, though neurologic and dermatologic findings are also well-described. The diagnosis includes a combination of clinical and laboratory testing. Patients with MIS-C will often have elevated inflammatory markers and may have an abnormal electrocardiogram or echocardiogram. Initial treatment involves resuscitation with careful assessment for cardiac versus vasodilatory shock using point-of-care ultrasound. Treatment should include intravenous immunoglobulin, anticoagulation, and consideration of corticosteroids. Interleukin-1 and/or interleukin-6 blockade may be considered for refractory cases. Aspirin is recommended if there is thrombocytosis or Kawasaki disease-like features on echocardiogram. Patients will generally require admission to an intensive care unit. CONCLUSION: MIS-C is a condition associated with morbidity and mortality that is increasingly recognized as a potential complication in pediatric patients with COVID-19. It is important for emergency clinicians to know how to diagnose and treat this disorder.


Subject(s)
COVID-19/complications , Systemic Inflammatory Response Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/therapy , Adolescent , Adrenal Cortex Hormones/therapeutic use , Aspirin/therapeutic use , COVID-19/diagnosis , COVID-19/mortality , COVID-19/therapy , Child , Child, Preschool , Emergency Service, Hospital , Humans , Immunoglobulins, Intravenous , Infant , Infant, Newborn , Point-of-Care Systems , Resuscitation , SARS-CoV-2 , Shock/physiopathology , Systemic Inflammatory Response Syndrome/mortality , Ultrasonography
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