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OBJECTIVE: To find out differences in the presentation, management and outcomes of COVID-19 infected STEMI patients compared to age and sex-matched non-infected STEMI patients treated during the same period. METHODS: This was a retrospective multicentre observational registry in which we collected data of COVID-19 positive STEMI patients from selected tertiary care hospitals across India. For every COVID-19 positive STEMI patient, two age and sex-matched COVID-19 negative STEMI patients were enrolled as control. The primary endpoint was a composite of in-hospital mortality, re-infarction, heart failure, and stroke. RESULTS: 410 COVID-19 positive STEMI cases were compared with 799 COVID-19 negative STEMI cases. The composite of death/reinfarction/stroke/heart failure was significantly higher among the COVID-19 positive STEMI patients compared with COVID-19 negative STEMI cases (27.1% vs 20.7% p value = 0.01); though mortality rate did not differ significantly (8.0% vs 5.8% p value = 0.13). Significantly lower proportion of COVID-19 positive STEMI patients received reperfusion treatment and primary PCI (60.7% vs 71.1% p value=< 0.001 and 15.4% vs 23.4% p value = 0.001 respectively). Rate of systematic early PCI (pharmaco-invasive treatment) was significantly lower in the COVID-19 positive group compared with COVID-19 negative group. There was no difference in the prevalence of high thrombus burden (14.5% and 12.0% p value = 0.55 among COVID-19 positive and negative patients respectively) CONCLUSIONS: In this large registry of STEMI patients, we did not find significant excess in in-hospital mortality among COVID-19 co-infected patients compared with non-infected patients despite lower rate of primary PCI and reperfusion treatment, though composite of in-hospital mortality, re-infarction, stroke and heart failure was higher.
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BACKGROUND AND AIM: PIMS-TS is a multisystem inflammatory condition which has high morbidity requiring intensive care, most commonly due to the need for cardiovascular support. AIM: Review of patients managed on high dependency unit with PIMS-TS - who required inotropic support and their echocardiographic findings. METHOD(S): This is a retrospective analysis of the echocardiogram and inotropic support for all children admitted to HDU with a diagnosis of PIMS-TS, from October 2020-December 2021. RESULT(S): Thirty (10%) patients were admitted to HDU from the 300 patients diagnosed over the 15month period. Echocardiograms were performed on days 1, 3 and 7 to assess the coronaries and myocardial dysfunction. Echocardiogram was often performed when patients were already on inotropic support. Fifteen (50%) patients did not require any respiratory support. All patients required fluid resuscitation, between 20mls/kg to 70mls/kg. Ten (33%) out of thirty patients showed reduced fraction shortening on echocardiogram reflecting myocardial dysfunction. Patients with reduced myocardial function on echocardiogram required a median of 40mls/kg of resuscitation fluid, no difference when compared to other patients. Of those with myocardial dysfunction 50% patients required double inotropic agents rather than single agents. Two patients have coronary arteries ectasia - both patients only needed single agents. CONCLUSION(S): Patients with coronary ectasia or myocardial dysfunction did not require more support than patients with normal coronaries. Echocardiography findings provided reassurance when managing children requiring vasoactive therapy on HDU but ultimately clinician decision-making was a driver on management rather than echocardiographic findings.
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BACKGROUND AND AIM: Alder Hey is a tertiary children's hospital in North-West England with co-located Intensive Care and High Dependency units. PIMS-TS is a multisystem inflammatory condition which has led to an increased demand on critical care beds. AIM: review of all patients managed on Critical Care with PIMS-TS. METHOD(S): A daily PIMS-TS multidisciplinary meeting attended by paediatrics, infectious diseases, rheumatology, cardiology and critical care discussed all patients in the region. This is a retrospective analysis of all children admitted to HDU or PICU with a diagnosis of PIMS-TS, from October 2020-December 2021. RESULT(S): Thirty (10%) patients were admitted to HDU from the 300 patients discussed over the 15month period. 16 (53%) of patients were female. Mean age was 10 years (range 3-17). Median length of stay (LOS) on HDU was 2 days (range 1-8) with a median hospital LOS of 6 days (range 2-10). All patients admitted were monitored appropriately and had full echocardiography assessment. All but one patient admitted to HDU required cardiovascular support, twelve (40%) patients required a single agent and seventeen (57%) required double agents with a combination of adrenaline, noradrenaline and milrinone. Median fluid resuscitation was 40mls/kg (range 20-70mls/kg). Eight patients (27%) were escalated to PICU for either invasive ventilation (4) or higher vasopressor requirements than 0.2micrograms/kg/minute. There were no adverse events. CONCLUSION(S): Most children with PIMS-TS have low to moderate haemodynamic instability can be safely managed on HDU with appropriate monitoring and agreed limits to vasopressor therapy.
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BACKGROUND AND AIM: Alder Hey is a tertiary children's hospital in North-West England. The High Dependency Unit (HDU) is part of a large Critical Care unit consisting of 21 Paediatric Intensive Care beds and 15 HDU beds. All 120 HDU staff including medical, nursing and allied health professionals, were invited to become Wellbeing Champions and eleven members volunteered. Wellbeing Champions, supported by the two Clinical Psychologists, were introduced on HDU in February 2021 with the aim of promoting staff wellbeing, signposting to appropriate support services and developing innovative approaches to engage staff in conversations around their mental wellbeing. AIM: This evaluation aimed to determine utilisation of Wellbeing Champions and explore the perception of support offered. METHOD(S): A short-anonymised survey was circulated by email to all HDU staff and their responses collated. RESULT(S): 26 responses were returned. 92% of respondents were aware of the HDU Wellbeing Champions. 70% of respondents had taken part in psychology-led support session. 50% of respondents had received support from a HDU Wellbeing Champion. 88% of respondents felt supported at work during Covid-19 pandemic. 76% of respondents felt valued at work. Support and ease of accessibility were the top two descriptors for the Wellbeing Champions. CONCLUSION(S): The results show a positive response to the new role of the HDU Wellbeing Champions. HDU Wellbeing Champions have been a useful resource to support staff wellbeing and we aim to continue the staff support in the form staff support meetings every two weeks.
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BACKGROUND AND AIM: Alder Hey is a tertiary children's hospital in North-West England. Patients who require respiratory support in the form of non-invasive ventilation (NIV) are managed in the High Dependency Unit (HDU) jointly by the lead subspecialist teams and critical care service. Escalation and weaning strategies varied significantly between consultants. To provide consistent practice, a protocol was implemented with agreement from all the stakeholders and used from March 2020. AIMS: To evaluate the impact of using an agreed protocol on (1) ventilation days and (2) length of stay (LOS) in HDU. METHOD(S): A year's baseline data (March 2019-February 2020) was compared with the implementation year (March 2020-February 2021). Patients who deteriorated requiring invasive ventilation and those who progressed to long term ventilation were excluded. RESULT(S): In the pre-intervention year, 115 patients received 963 ventilation days over 1203 HDU days, with a mean of 8.4 ventilation days [IQR 5-9] and LOS of 10.5 days per patient. In the post-intervention year, 63 patients received 261 ventilation days over 667 HDU days, with a mean of 4.1 ventilation days [IQR 3-6] and LOS of 10.6 days per patient. CONCLUSION(S): COVID-19 lockdown restrictions almost halved the number of patients requiring NIV (63 vs 115), with reduced admissions across all specialties. Despite this, we demonstrated that unifying the management of NIV halved the ventilation days (4.1 vs 8.4) however, this reduction was not translated to a reduced length of stay on HDU.
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Aims Background Alder Hey is a tertiary children's hospital in North-West England with co-located Intensive Care and High Dependency units, covering North West England, North Wales and Isle of Man. PIMS-TS is a new multisystem inflammatory condition which has led to an increased demand on critical care beds. Some children presenting with PIMS-TS need haemodynamic support in the form of inotropes, which would traditionally need an PICU bed. Aim Review of all patients managed on Critical Care with PIMS-TS. Methods All patients in the region were discussed in a PIMSTS multidisciplinary meeting attended by Paediatrics, Infectious Diseases, Rheumatology, Cardiology and Critical Care daily. Patients across the region needing haemodynamic support or cardiology evaluation were highlighted as, in need of either HDU or PICU bed and transferred by the North West & Wales Paediatric Transport Service (NWTS). This is a retrospective analysis of all children admitted to HDU or PICU with a diagnosis of PIMS-TS, from October 2020-December 2021. Results Thirty (10%) patients were admitted to HDU from the 300 patients discussed over the 15month period. 16 (53%) of patients were female. Mean age was 10 years (range 3-17). Median length of stay (LOS) on HDU was 2 days (range 1-8) with a median hospital LOS of 6 days (range 2- 10). All patients admitted were monitored appropriately and had full echocardiography assessment. Twenty nine (97%) patients admitted to HDU required inotropic support, twelve (40%) patients required a single agent and seventeen (57%) required double agents with a combination of adrenaline, noradrenaline and milrinone. Median fluid resuscitation was 40mls/kg (range 20-70mls/ kg). Eight patients (27%) were escalated to PICU for either invasive ventilation (4) or higher inotropic requirements of 0.2micrograms/kg/minute. There were no adverse events. Conclusion Most children with PIMS-TS have low to moderate haemodynamic instability that can be safely managed on HDU with appropriate monitoring and agreed limits to vasopressor therapy. Our experience in managing with these patients successfully and safely in a high dependency setting has helped in the use of a critical care bed efficiently, thus reducing dependency on the availability of a PICU bed.
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AIM: This retrospective study compares admissions and outcomes due to acute decompensated heart failure (ADHF) during the COVID-19 pandemic from 25 March to 25 July 2020 with the historical patient control who were admitted during the same period in 2019. METHODS AND RESULTS: Data of the participating hospitals was collected and analysed from the ICC NHFR (Indian College of Cardiology National Heart Failure Registry) for 2019 and 2020. Total number of ADHF admissions, demographics, aetiology, co-morbid conditions and in-hospital mortality was compared and analysed. A significant decrease in the number of hospital admissions due to ADHF from 2019 to 2020 (1056 vs. 526 respectively) was noted. Incidence of admissions with <40% ejection fraction (EF) reduced in 2020 (72.4% and 80.2% in2020 and 2019)and >40% (EF) increased (27.6% and 19.8% in 2019 and 2020 respectively, p = 0.0005). Ischemic heart disease (IHD) was the most common aetiology (78.59% in 2019 and 80.98% in 2020, p = 0.268). The in-hospital mortality was numerically higher in 2020 (10%) than in 2019 (8%), but not statistically significant (p = 0.161). CONCLUSION: This study from the registry shows that the incidence of ADHF admissions during COVID-19 lockdown significantly reduced compared to the previous year. Demographic patterns remained similar but patients presenting with de-novo HF increased; IHD was the most common cause. The in-hospital mortality was numerically higher during the lockdown. The impact of lockdown perhaps led to fewer hospitalisations and this is to be factored in future strategies to address health care delivery during such crises.