Transthoracic echocardiography outcomes in critical COVID-19 and association with symptom burden - a longitudinal cohort study

Objective: To look for any relationship between severe/critical coronavirus disease 2019 (COVID-19) illness and post-discharge cardiac function, and also assess any correlation between this and post-COVID symptom burden. Design: Observational cohort study with both retrospective and prospective components. Setting: Intensive Care Unit (ICU) and subsequent outpatient clinic at a tertiary hospital in Western Sydney, New South Wales (NSW), Australia. Patients: All patients admitted to the ICU with COVID-19 infection between 01 July 2021 and 31 December 2021 were included (n=89). Interventions: The cohort was divided into survivors (n=61) and non-survivors (n=28). Those who underwent transthoracic echocardiography (TTE) (survivors, n=22;and non-survivors, n=23). The survivors who had an inpatient TTE were invited back for a repeat TTE and standardised symptom assessment questionnaire (COVID-19 Yorkshire Rehabilitation Scale [C19-YRS]). For all patients, demographic, clinical, biochemical, and pharmacologic data was collected. Measurements and results: Eighty-nine patients were included in the initial dataset, of which 45 had a TTE whilst acutely unwell, and 22/45 survived to hospital discharge. There were no significant differences in the measured TTE parameters between survivors and non-survivors. Of the survivors with a follow-up TTE, the majority of the changes seen in the initial study had resolved. Despite this, there was still an appreciable symptom burden in the domains of fatigue, breathlessness, ability to independently do activities of daily living, and overall reduced perception of health. Conclusions: In a cohort of critically unwell COVID-19 patients, there were no significant echocardiographic differences between survivors and non-survivors. For the survivors, whilst the majority of acute cardiac changes associated with COVID-19 infection resolved over time, however, there remained a significant symptom burden, including breathlessness and fatigability, suggesting a non-cardiac aetiology of these symptoms.

The first Australian experience with ward-based continuous positive airway pressure for COVID-19 respiratory failure: a retrospective cohort study.

We present the first Australian cohort of patients with COVID-19 respiratory failure managed with escalating respiratory support including continuous positive airway pressure (CPAP) on a standard medical ward at a tertiary Sydney hospital during the 2021 COVID-19 Delta variant outbreak. We demonstrate an equivalent mortality to CPAP delivered in intensive care unit and outline our ward structure and management during the pandemic.

Echocardiography findings in COVID-19 patients admitted to intensive care units: a multi-national observational study (the ECHO-COVID study).

PURPOSE: Severely ill patients affected by coronavirus disease 2019 (COVID-19) develop circulatory failure. We aimed to report patterns of left and right ventricular dysfunction in the first echocardiography following admission to intensive care unit (ICU). METHODS: Retrospective, descriptive study that collected echocardiographic and clinical information from severely ill COVID-19 patients admitted to 14 ICUs in 8 countries. Patients admitted to ICU who received at least one echocardiography between 1st February 2020 and 30th June 2021 were included. Clinical and echocardiographic data were uploaded using a secured web-based electronic database (REDCap). RESULTS: Six hundred and seventy-seven patients were included and the first echo was performed 2 [1, 4] days after ICU admission. The median age was 65 [56, 73] years, and 71% were male. Left ventricle (LV) and/or right ventricle (RV) systolic dysfunction were found in 234 (34.5%) patients. 149 (22%) patients had LV systolic dysfunction (with or without RV dysfunction) without LV dilatation and no elevation in filling pressure. 152 (22.5%) had RV systolic dysfunction. In 517 patients with information on both paradoxical septal motion and quantitative RV size, 90 (17.4%) had acute cor pulmonale (ACP). ACP was associated with mechanical ventilation (OR > 4), pulmonary embolism (OR > 5) and increased PaCO2. Exploratory analyses showed that patients with ACP and older age were more likely to die in hospital (including ICU). CONCLUSION: Almost one-third of this cohort of critically ill COVID-19 patients exhibited abnormal LV and/or RV systolic function in their first echocardiography assessment. While LV systolic dysfunction appears similar to septic cardiomyopathy, RV systolic dysfunction was related to pressure overload due to positive pressure ventilation, hypercapnia and pulmonary embolism. ACP and age seemed to be associated with mortality in this cohort.

COVID-US: A simplified approach to cardiopulmonary ultrasound in suspected and confirmed COVID-19 patients in surge crisis.

The severe acute respiratory syndrome coronavirus 2 (COVID-19) pandemic has placed an unprecedented challenge on healthcare systems across the globe. Rapid assessment of the cardiorespiratory function to monitor disease progression and guide treatment is essential. Therefore, we have designed the COVID-US: a simplified cardiopulmonary ultrasound approach to use in suspected and confirmed COVID-19 patients, to aid front-line health workers in their decision-making in a surge crisis.