Emergency team competencies: scoping review for the development of a tool to support the briefing and debriefing activities of emergency healthcare providers.

Globally, at least one adverse event occurs in 10% of patients using emergency, inpatient, outpatient, surgical and primary care services. Particularly in emergency health care, this problem is exacerbated by additional variables such as patient criticality, high-risk diagnostic and therapeutic interventions and varying levels of healthcare provider training. In relation to the last point, briefing and debriefing activities during an emergency reinforce staff training and support them in managing work resources, planning interventions and improving future performance. The aim of the scoping review is to explore the state of the art in human factors applied to emergency situations and to develop a new tool to support healthcare professionals in conducting evidence-based briefings and debriefings. This review was developed using a search strategy based on the Arksey and O'Malley's six-step framework for scoping reviews. The literature analysed and the data identified, which are heterogeneous due to different study methodologies, objectives and types of interventions, suggest that human factors applied to emergency situations are still under-researched. At the end of the data extraction, analysis process, authors' reviews, discussion rounds and comparison with the multidisciplinary team of healthcare providers, 42 behaviours, 33 elements and 8 domains were considered relevant and included in the Emergency Team Comptencies (ETC) briefing and debriefing tool, ranked in order of priority as follows: communication, decision-making, clinical skills, situational awareness, leadership, task management, collaboration and stress and fatigue management. Further research is needed to investigate human factors applied to emergency situations and to generate new evidence to improve clinical practice and reduce the risk of error. In the near future, further studies will be conducted by the authors to test the validity of the Emergency Team Competencies tool in objectively measuring the performance of professionals and multidisciplinary teams.

Decline of Admission for Acute Coronary Syndromes and Acute Cardiovascular Conditions during COVID-19 Pandemic in Veneto Region.

Background: The present study aimed to examine longitudinal trends in hospitalizations for acute coronary syndrome (ACS) before and during the COVID-19 pandemic, by reviewing the data from 13 hospitals of the Veneto Region, in the north-east of Italy. Methods: We performed a multicenter, retrospective analysis including all the consecutive patients presenting with ACS and other acute cardiovascular (CV) conditions (defined as heart failure, arrhythmias, cardiac arrest and venous thromboembolism) hospitalized in 13 different hospitals of the Veneto Region covering a population of 2,554,818 inhabitants, during the first (between 15 March 2020 and 30 April 2020) and second (between 15 November 2020 and 30 December 2020) COVID-19 pandemic waves (the 2020 cohort). Data were compared with those obtained at the same time-windows of years 2018 and 2019 (the historical cohorts). Results: Compared to the historical cohorts, a significant decrease in the number of ACS cases was observed in 2020 (−27.3%, p = 0.01 and −32%, p < 0.001, comparing 2018 versus 2020 and 2019 and 2020, respectively). The proportion of patients hospitalized for acute CV conditions decreased during the first and second wave COVID-19 pandemic when compared to the historical cohorts (−36.5%, p < 0.001 and −40.6%, p < 0.001, comparing 2018 versus 2020 and 2019 and 2020, respectively). Pearson's correlation evidenced a significant inverse relationship between the number of COVID-19 cases and both ACS hospital admissions (r = −0.881, p = 0.005) and hospitalizations for acute CV conditions (r = −0.738, p = 0.01), respectively. Conclusions: The decrease in hospitalizations for ACS and other acute CV conditions will strongly affect future patients' management since undiagnosed nonfatal CV events represent a source of increased (and unknown) CV morbidity and mortality.

Takotsubo Syndrome during COVID-19 Pandemic in the Veneto Region, Italy.

Background: During the COVID-19 pandemic, the risk of SARS-CoV-2 infection, the public health measures of social distancing, the freedom limitations, quarantine, and the enforced homeworking under the lockdown period, as well as medical causes including COVID-19 infection per se, may have caused major emotional distress, especially in the most vulnerable patients. We aimed to evaluate the variations in the number of admissions due to Takotsubo syndrome (TTS) during the COVID-19 pandemic in the Veneto region. Methods: We retrospectively reviewed and analyzed the number of admissions because of TTS in 13 Divisions of Cardiology located in the Veneto region, the northeastern area of Italy, covering a population of more than 2.5 million inhabitants, during the two major pandemic waves of COVID-19 (the first between 15 March and 30 April 2020 and the second between 15 November and 30 December 2020) that occurred in 2020. Results: In total, 807 acute coronary syndromes were admitted in the 13 enrolling hospitals. Among these, 3.9% had TTS. Compared to the corresponding 2018 and 2019 time periods, we observed a significant increase in the number of TTS cases (+15.6%, p = 0.03 and +12.5%, p = 0.04, comparing 2018 to 2020 and 2019 to 2020, respectively). Geographical distribution of the TTS cases reflected the broad spread of the SARS-CoV-2 infection with a significant direct relationship between TTS incidence and the number of COVID-19 infections according to Pearson's correlation (r = 0.798, p < 0.001). Conclusions: The higher incidence of TTS during the 2020 COVID-19 pandemic waves, especially in the areas that were hit hardest in terms of morbidity and mortality by the SARS-CoV-2 infection, suggest a strong direct and/or indirect role of COVID-19 in the pathogenesis of TTS.

Three-dimensional rotational digital angiography in a complicated case of patent ductus arteriosus transcatheter closure.

There has been no report so far as to the usefulness of 3D rotational angiography in congenital heart disease interventions. We present a case of a difficult patent ductus arteriosus in which 3D rotational angiography was the key to successful closure. A 64-year-old woman who had been operated on many years previously for a patent ductus arteriosus came to our attention for a heart murmur on the left upper sternal border. Echocardiography revealed a still patent duct with moderate shunt. The patient underwent cardiac magnetic resonance imaging, which confirmed patency of the duct, but its diameter and length were difficult to measure due to the particular orientation and morphology of the previously legated duct. It was decided to attempt device closure. Three-dimensional rotational digital subtraction technique enabled us to find the most useful projection for measuring the duct and selecting the best implant device (coil or Amplatzer device). The exact oblique and cranio-caudal degree of the selected projection on rotational 3D reconstruction was replicated to obtain the best standard digital subtraction angiographic view of the duct. Thus, a 5/4-mm Amplatzer Duct Occluder was selected and successfully implanted with excellent results. This case suggests that 3D rotational angiography may be an important imaging tool to guide congenital heart disease interventions such as patent ductus arteriosus closure or aortic coarctation repair.

Are coronary artery anomalies an accelerating factor for coronary atherosclerosis development?

The relevance of benign congenital coronary anomalies (CAAs) in the atherosclerotic process is still confused despite the number of single reports of coronary artery disease in CAAs. The present study is aimed at assessing the role of CAAs on the progression of coronary artery disease (CAD). A review of the last 15,000 coronary angiographies was performed to select patients with CAAs, and they were divided into 2 groups on the basis of the presence (group I) or the absence (group II) of CAD. Clinical and instrumental records of the selected patients were reviewed and the numbers of cardiovascular events for each group (acute myocardial infarct, unstable angina, silent ischemia, bypass or percutaneous transluminal coronary angioplasty (PTCA) interventions, and cardiovascular death) were recorded from the date of diagnosis to July 2002. Group I (22 patients, mean age 64.1 +/- 9.1 years, F/M = 10/12) and group II (17 patients, mean age 66.5 +/- 10.6 years, F/M = 7/10) were similar for age and ejection fraction values. The presence of risk factors was statistically higher in group I. The number of patients with cardiovascular events was significantly higher in group I: 50% (11 patients) in group I vs 12% (2 patients) in group II, p<0.05). Repeated coronary angiography in 8/11 patients of group I and in the 2 patients of group II confirmed that the causes of the events were precedent atherosclerotic lesions in 7 patients and newly developed lesions in 3. At a mean follow-up of 60.4 +/- 12.3 months, mean actuarial survival was lower in group I than in group II (74.8% vs 100%, p=0.045), whereas mean event-free survival was 41.7% in group I and 88.7% in group II (p=0.02). Benign CAAs do not seem per se to be an accelerating factor for coronary atherosclerosis development in patients with no or few classical risk factors.