Non-rebreather mask and low-flow nasal cannula vs high-flow nasal cannula in severe COVID-19 pneumonia in the emergency department.

BACKGROUND: To assess the effectiveness of non-rebreather mask combined with low-flow nasal cannula (NRB + NC) compared to high-flow nasal cannula (HFNC) in improving oxygenation in patients with COVID-19-related hypoxemic respiratory failure (HRF). METHODS: This retrospective study was conducted in emergency departments of two tertiary hospitals from June 1 to August 31, 2021. Consecutive patients aged >18 years admitted for COVID-19-related HRF (World Health Organization criteria: confirmed COVID-19 pneumonia with respiratory rate > 30 breaths/min, severe respiratory distress, or peripheral oxygen saturation < 90% on room air) requiring NRB + NC or HFNC were screened for enrollment. Primary outcome was improvement of partial pressure arterial oxygen (PaO2) at two hours. Secondary outcomes were intubation rate, ventilator-free days, hospital length of stay, and 28-day mortality. Data were analyzed using linear regression with inverse probability of treatment weighting (IPTW) based on propensity score. RESULTS: Among the 110 patients recruited, 52 (47.3%) were treated with NRB + NC, and 58 (52.7%) with HFNC. There were significant improvements in patients' PaO2, PaO2/FIO2 ratio, and respiratory rate two hours after the initiation of NRB + NC and HFNC. Comparing the two groups, after IPTW adjustment, there were no statistically significant differences in PaO2 improvement (adjusted mean ratio [MR] 2.81; 95% CI -5.82 to 11.43; p = .524), intubation rate (adjusted OR 1.76; 95% CI 0.44 to 6.92; p = .423), ventilator-free days (adjusted MR 0.00; 95% CI -8.84 to 8.85; p = .999), hospital length of stay (adjusted MR 3.04; 95% CI -2.62 to 8.69; p = .293), and 28-day mortality (adjusted OR 0.68; 95% CI 0.15 to 2.98; p = .608). CONCLUSION: HFNC may be beneficial in COVID-19 HRF. NRB + NC is a viable alternative, especially in resource-limited settings, given similar improvement in oxygenation at two hours, and no significant differences in long-term outcomes. The effectiveness of NRB + NC needs to be investigated by a powered randomized controlled trial.

A cross-sectional study of assessing knowledge, attitude, and practice of COVID-19 resuscitation among health care workers in a hybrid hospital for COVID-19 in Malaysia.

BACKGROUND: The COVID-19 pandemic is an international public health emergency. As hospitals receive more severe forms of COVID-19 that necessitate resuscitation, emergency health care workers (HCW) must follow interim COVID-19 resuscitation guidelines. OBJECTIVE: The aim is to evaluate the levels of knowledge, attitude, and practice among emergency HCW of the COVID-19 resuscitation protocol by the European Resuscitation Council (ERC). METHODS: A cross-sectional study using a validated questionnaire was conducted among HCW in the emergency department of University of Malaya Medical Centre (UMMC), Malaysia from April to June 2021. RESULTS: A total of 159 respondents were included in the analysis (89% response rate). Sixty-eight percent of respondents had adequate knowledge regarding COVID-19 resuscitation. Majority of the respondents had knowledge on airborne-precaution personal protective equipment (PPE) (99%) and infection control measures (98%). Nearly 73% were pessimistic about the COVID-19 prognosis. Seventy-three percent of respondents thought an arrested COVID-19 patient may benefit from cardiopulmonary resuscitation (CPR) and 94% were willing to administer CPR provided airborne-precaution PPE was available. Ninety percent of respondents reported adherence to resuscitation guidelines. There were significant differences in the mean knowledge scores between designation, education levels, and COVID-19 training. Overall, the respondents' level of practice was insufficient (27%), with a mean score of 53.7%(SD = 14.7). There was a lack of practicein the resuscitation oftheintubatedand patients who were beingprone. There was insufficient practice about ventilation technique, use ofsupraglotticdevices, and intubation barriers. There was a positive correlation between adequate knowledge and good practice. CONCLUSION: Emergency HCW have adequate knowledge, but poor compliance to the ERC COVID-19 guidelines. Emergency HCW were willing and confident to resuscitate COVID-19 patients, despite fears of nosocomial infection and expectation of poor patients' prognosis. Ongoing education and trainingprogramsare recommended to improve their knowledge, cultivate a positive attitude, andachievegood compliance with COVID-19 resuscitation guidelines.