ABSTRACT
PurposeThe effect of vasopressors on mortality of critically ill patients with COVID-19 has not been studied extensively. Materials and MethodsA systematic search of PubMed, Scopus, and clinicaltrials.gov was conducted for relevant articles until January 2022. Eligibility criteria were randomized controlled and non-randomized trials. The primary outcome was mortality at latest follow-up. The quality of studies was assessed using the MINORS tool. Paired meta-analysis was used to estimate the pooled risk ratios along with their 95% Confidence Interval. ResultsAnalyses of 21 studies (n=7900) revealed that vasopressor use is associated with mortality in patients who receive vasopressors compared to those who do not receive vasopressor therapy [RR (95%CI): 4.26 (3.15, 5.76); p<0.001]. In-hospital and 30-day mortality are significantly higher in patients who receive vasopressors [RR (95%CI): 4.60 (2.47, 8.55); p<0.001 and RR (95%CI): 2.97 (1.72, 5.14); p<0.001, respectively]. The highest mortality rate was observed with vasopressin or epinephrine, while the lowest mortality rate was observed with angiotensin-II. Also, analyses of data from 10 studies (n=3519) revealed that vasopressor use is associated with acute kidney injury [RR (95%CI): 3.17 (2.21, 4.54); p<0.001]. ConclusionVasopressor use was associated with an increase in in-hospital mortality, 30-day mortality, and acute kidney injury in critically ill patients with COVID-19.
ABSTRACT
AimTo estimate the incidence of in-hospital cardiac arrest (IHCA) and return of spontaneous circulation (ROSC) in COVID-19 patients, as well as to compare the incidence and outcomes of IHCA in Intensive Care Unit (ICU) versus non-ICU patients with COVID-19. MethodsWe systematically reviewed the PubMed, Scopus and clinicaltrials.gov databases to identify relevant studies. ResultsEleven studies were included in our study. The pooled prevalence/incidence, pooled odds ratios (OR) and 95% Confidence Intervals (95% CI) were calculated, as appropriate. The quality of the included studies was assessed using appropriate tools. The pooled incidence of IHCA in COVID-19 patients was 7% [95% CI: 4 - 11%; P < 0.0001] and 44% [95% CI: 30 - 58%; P < 0.0001] achieved ROSC. Of those that survived, 58% [95% CI: 42 - 74%; P < 0.0001] had a good neurological outcome (Cerebral Performance Category 1 or 2) and the mortality at the last follow-up was 59% [95% CI: 37 - 81%; P < 0.0001]. A statistically significant higher percentage of ROSC [OR (95% CI): 5.088 (2.852, 9.079); P < 0.0001] was found among ICU patients versus those in the general wards. ConclusionThe incidence of IHCA amongst hospitalized COVID-19 patients is 7%, with 44% of them achieving ROSC. Patients in the ICU were more likely to achieve ROSC than those in the general wards, however the mortality did not differ. What this paper addsSection 1: What is already known on this subject O_LIMortality in COVID-19 patients ranges between 20% and 40%. C_LIO_LIit has been reported that patients with COVID-19 have a high incidence of IHCA and higher mortality. C_LIO_LIThis paper aimed to calculate the proportion of COVID-19 patients who experience IHCA and their outcome, as well as compare the outcome of IHCA between ICU and non-ICU patients. C_LI Section 2: What this study adds O_LIApproximately 7% of hospitalized COVID-19 patients suffer from IHCA and 44% of those achieve ROSC. C_LIO_LIThe rate of ROSC was higher in ICU patients, but the rate of mortality did not differe between ICU and non-ICU patients. C_LI
ABSTRACT
RationaleThe progress of COVID-19 from moderate to severe may be precipitous, while the heterogenous characteristics of the disease pose challenges to the management of these patients. ObjectivesTo characterize the clinical course and outcomes of critically ill patients with COVID-19 during two successive waves. MethodsWe leveraged the multi-center SuPAR in Adult Patients With COVID-19 (SPARCOL) study and collected data from consecutive patients requiring admission to the intensive care unit from April 1st to December 31st, 2020. Measurements and Main ResultsOf 252 patients, 81 (32%) required intubation and mechanical ventilation. Of them, 17 (20.9%) were intubated during the first wave, while 64 (79%) during the second wave. The most prominent difference between the two waves was the overall survival (first wave 58.9% vs. second wave 15.6%, adjusted p-value=0.006). This difference is reflected in the prolonged hospitalization during the first wave. The mean ICU length of stay (19.1 vs. 11.7 days, p=0.022), hospital length of stay (28.5 vs. 17.1 days, p=0.012), and days on ventilator (16.7 vs. 11.5, p=0.13) were higher during the first wave. A significant difference between the two waves was the development of bradycardia. In the first wave, 2 (11.7%) patients developed sinus bradycardia only after admission to the intensive care unit, while in the second wave, 63 (98.4%) patients developed sinus bradycardia during hospitalization. ConclusionsSurvival of critically ill patients with COVID-19 was significantly lower during the second wave. The majority of these patients developed sinus bradycardia during hospitalization.
