Introduction In response to the COVID-19 pandemic in Detroit, an earlier termination of resuscitation protocol was initiated in March 2020. To characterize pre-hospital cardiac arrest careduring COVID-19 in Detroit, we analyzed out-of-hospital cardiac arrest (OHCA) rate of ROSC (return of spontaneous circulation) and patient characteristics before and during the COVID-19 pandemic. Methods OHCA data was analyzed between March 10th, 2020 – April 30th,2020 and March 10th, 2019 – April 30th,2019. ROSC, patient demographics, arrest location, initial rhythms, bystander CPR and field termination were compared before and during the pandemic. Descriptive statistics were utilized to compare arrest characteristics between years, and the odds of achieving vs. not achieving ROSC. 2020 vs. 2019 as a predictor for ROSC was assessed with logistic regression. Results 471 patients were included. Arrests increased to 291 during the pandemic vs. 180 in 2019 (62% increase). Age (mean difference + 6; 95% CI: +2.4 to +9.5), arrest location (nursing home OR = 2.42; 95% CI: 1.42–4.31; public place OR = 0.47; 95% CI: 0.25–0.88), BLS response (OR = 0.68; 95% CI: 0.47–0.99), and field termination of resuscitation (OR = 2.36; 95% CI: 1.36–4.07) differed significantly in 2020 compared to 2019. No significant difference was found in the confounder-adjusted odds of ROSC in 2020 vs 2019 (OR = 0.61; 95% CI: 0.34–1.11). Conclusion OHCA increased by 62% during COVID-19 in Detroit, without a significant change in prehospital ROSC. The rate of ROSC remained similar despite the implementation of an early termination of resuscitation protocol in response to COVID-19.
Background: The Diamondback 360® Coronary Orbital Atherectomy System (Cardiovascular Systems Inc., St. Paul, MN) is the first and only orbital atherectomy system approved by the US FDA for the treatment of severely calcified lesions. While the device has proven to be safe in clinical trials, real-world data are minimal.Methods: The Manufacturer and User Facility Device Experience (MAUDE) database was queried for reports on the Diamondback 360® Coronary from January 2019 to January 2022.Results: A total of 566 events were reported during the study period. After the exclusion of duplicate reports, the final cohort included 547 reports. The most common mode of failure was break or separation of a device part (40.4%, n = 221) mainly due to breaking in the tip of the ViperWire (66.1%), driveshaft (22.7%), or crown (12.2%). The most common vessel associated with events was the left anterior descending artery (31.4%), followed by the right coronary artery (26.9%), left circumflex (21.6%), and left main coronary artery (6.4%). The most common clinical adverse outcome was perforation (33.0%, n = 181) with 23.7% resulting in cardiac tamponade. Most perforation cases were treated by covered stent (44.2%), surgery (30.5%), stent (98%), and balloon angioplasty (9%). There were 89 (16.3%) events of death with 67% due to perforation (p < 0.001). Conclusion:Our study provided a glimpse of real-world adverse outcomes and common modes of failure due to orbital atherectomy. The most common mode of failure was the break or separation of a device part and the most common complication was perforation according to the MAUDE database. It will help physicians to anticipate complications and escalate care appropriately.
Introduction: March 10 th , 2020 marked the first positive case of SARS-CoV-2 in Detroit. EMS protocol changes were implemented by March 25 th , 2020 in response to the virus. These modifications restricted intubation and allowed medical control to terminate resuscitation in cases of suspected COVID-19 after 10 minutes of CPR without ROSC. Due to global changes in pre-hospital cardiac arrest care caused by COVID-19, we conducted an analysis to determine OHCA characteristics of patients and fatality rates in the COVID-19 era. Methods: CARES data was analyzed between March 10 th , 2019 - April 30 th , 2019 and March 10 th , 2020 - April 30 th, 2020 for comparison before and during the pandemic. Patient demographics, location of arrest, initial rhythms, bystander CPR, EMS interventions and field termination were compared between the two time points. No major factors occurred in 2019 that would potentially skew that data. Descriptive statistics were utilized. Results: A total of 475 CARES patients were included during the study period. Total arrests surged in the COVID-19 era from 180 to 295. OHCA for individuals greater than 50 increased from 130 to 243. An initial rhythm of PEA tripled (10 to 30) during COVID-19, possibly due to hypoxia. The percentage of patients with a shockable rhythm declined (7.8 to 5.1). Bystander CPR decreased from 28.9% (52) to 18.3% (54), secondary to an increase of arrests being in non-public places and concern about disease transmission. Nursing home cardiac arrests increased during COVID from 19 to 73, from the previous year. Placement of an endotracheal tube or supraglottic airway by a basic or advanced unit decreased from 68.3% (123) in pre-COVID-19 era to 37.0% (109) in the current state of the pandemic. Termination of resuscitation in the field occurred over 3-fold from the previous year, an absolute increase from 64 to 204. Conclusion: There was a 61% increase in cardiac arrests during COVID-19 in Detroit. The pandemic and subsequent protocol changes greatly altered practice. COVID-19 has likely directly and indirectly, due to fear of going to the hospital, affected the number of out-of-hospital cardiac arrests. Additional review is being conducted to further delineate arrest etiologies.
Introduction: The aim of this study was to evaluate malperfusion in patients presenting with acute type A dissection (ATAD) and correlate with mortality based on organ system involved. Methods: A registry of all patients who underwent ATAD repair at our tertiary referral center between 2002 and 2018 was retrospectively queried. Patients with type B aortic dissection and chronic type A aortic dissections (time from presentation > 14 days) were excluded. Malperfusion syndromes at presentation including central nervous system (brain and spinal cord), visceral renal, and lower extremity (LE) were documented. Preoperative and intraoperative variables were analyzed, and post-operative outcomes were correlated with the malperfused organ system. Results: From 2002 to 2018, 378 patients underwent ATAD repair at our tertiary referral center. The average age was 57 years, 68% were male, and 51% were white. Approximately 70% of the cohort were transferred from an outside hospital. A total of 124 patients (33%) presented with malperfusion of at least one organ: 16% (N=62) LE, 8% (N=31) brain, 8% (N=30) renal, 3% (N=11) with visceral malperfusion, and 2% (N=8) with spinal cord malperfusion. On multivariate analysis, 30-day mortality was significantly increased in patients presenting with visceral ischemia (OR=3.7, P=0.04). The average follow-up was 2.3 years. Kaplan Meier survival curves showed a significant decrease in long term survival in patients presenting with brain (P=0.01), visceral (P=0.002), and renal ischemia (P<0.001). No difference in short or long-term survival was seen in patients presenting with LE ischemia (P=0.28). Conclusions: In this review, 33% of ATAD patients presented with malperfusion of at least one organ system. Visceral malperfusion was associated with poor short-term survival, whereas CNS, renal, and visceral malperfusion had decreased long term survival. LE malperfusion had no association with short or long-term mortality.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.