evere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 , now characterized as a pandemic by the World Health Organization. 1 Infection rates and deaths worldwide increased exponentially. About 35 000 confirmed cases and more than 1600 deaths were reported in Canada as of Apr. 21, 2020. 2 In British Columbia, as of May 20, 2020, there were 2467 confirmed cases and 149 deaths. 3 However, the number of new cases has been decreasing since the beginning of April 2020. More than 85% of the cases of COVID-19 in BC have been located in the Metro Vancouver area. 3 Initial studies from China 4 and Italy 5 showed mortality ranging from 26% to 62% in critically ill patients with COVID-19. Studies from Seattle 6 and New York 7 reported overall mortality ranging from 23% to 50%. In these case series, between 13% and 71% of patients remained in the intensive care units (ICUs) at the time of publication, so actual mortality may be greater than reported.Canadian data describing critically ill patients with COVID-19 are lacking, and better characterization is crucial to direct critical care resource allocation and to understand the disease in our local context. The aim of our multicentre case series was to describe the demographic characteristics, management patterns and outcomes among critically ill patients with COVID-19 in Metro Vancouver. MethodsWe conducted a case series of all patients with COVID-19 admitted to an ICU in the Metro Vancouver area from Feb. 21 to Apr. 14, 2020, with outcomes followed until May 5, 2020. This area serves about 3 million residents of BC (population 4.9 million). The hospitals included were Vancouver General Hospital (46 ICU beds, quaternary hospital), Surrey Memorial Hospital (46 ICU beds, tertiary hospital), Lions Gate Hospital (11 ICU beds, community hospital),

Studies on severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1) suggest a protective effect of anti-A antibodies against viral cell entry that may hold relevance for SARS-CoV-2 infection. Therefore, we aimed to determine whether ABO blood groups are associated with different severities of COVID-19. We conducted a multicenter retrospective analysis and nested prospective observational substudy of critically ill patients with COVID-19. We collected data pertaining to age, sex, comorbidities, dates of symptom onset, hospital admission, intensive care unit (ICU) admission, mechanical ventilation, continuous renal replacement therapy (CRRT), standard laboratory parameters, and serum inflammatory cytokines. National (N = 398 671; P = .38) and provincial (n = 62 246; P = .60) ABO blood group distributions did not differ from our cohort (n = 95). A higher proportion of COVID-19 patients with blood group A or AB required mechanical ventilation (P = .02) and CRRT (P = .004) and had a longer ICU stay (P = .03) compared with patients with blood group O or B. Blood group A or AB also had an increased probability of requiring mechanical ventilation and CRRT after adjusting for age, sex, and presence of ≥1 comorbidity. Inflammatory cytokines did not differ between patients with blood group A or AB (n = 11) vs O or B (n = 14; P > .10 for all cytokines). Collectively, our data indicate that critically ill COVID-19 patients with blood group A or AB are at increased risk for requiring mechanical ventilation, CRRT, and prolonged ICU admission compared with patients with blood group O or B. Further work is needed to understand the underlying mechanisms.

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Background: Janus kinase (JAK) inhibitors represent a novel therapeutic class for treatment of inflammatory bowel disease. Aims:To determine the efficacy and safety of JAK inhibitors compared to placebo for the treatment of Crohn's disease (CD) and ulcerative colitis (UC). Methods:PubMed, Embase and CENTRAL were systematically searched to November 1, 2018. Randomised placebo-controlled trials (RCTs) of JAK inhibitors in adult patients with CD or UC were eligible. Open-label extension studies without a placebo comparator arm were excluded. Clinical, endoscopic, and safety outcomes were extracted and rates relative to placebo were pooled using a random-effects model. Results:A total of 12 RCTs (5 CD, 7 UC) were included. Patients were randomised to placebo (n = 844), tofacitinib (n = 1882), filgotinib (n = 130), peficitinib (n = 176), upadacitinib (n = 387) or TD-1473 (n = 31). JAK inhibitor treatment was associated with induction of clinical remission in CD (RR, relative risk 1.38 [95% confidence interval CI 1.04-1.83], P = 0.025, I 2 = 14%) and UC (RR 3.07 [95% CI 2.03-4.63], P < 0.001, I 2 = 0%). In UC, JAK inhibitor treatment was associated with induction of endoscopic remission (endoscopic Mayo subscore MCSe = 0/1) (RR 2.43 [95% CI 1.64-3.59], P < 0.001, I 2 = 27%) and mucosal healing (MCSe = 0) (RR 5.50 [95% CI 2.46-12.32], P < 0.001, I 2 = 0%). JAK inhibitor treatment increased the risk of infection compared to placebo (RR 1.40 [95% CI 1.18-1.67], P < 0.001, I 2 = 0%), particularly for herpes zoster. Conclusions: JAK inhibitors are effective for inducing clinical remission in CD and induction of clinical and endoscopic remission in UC, although are associated with an increased risk of infectious complications. R-Biopharm and Takeda and consulting fees from Janssen, Pfizer, Progenity, Prometheus, Takeda, and UCB. Reena Khanna has re-

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OBJECTIVES: The objective of this systematic review was to evaluate the impact of intraarrest corticosteroids on neurologic outcomes and mortality in patients with cardiac arrest. DATA SOURCES: We conducted a systematic search using the Cochrane Central Register of Controlled Trials, EMBASE, and MEDLINE databases. STUDY SELECTION: We included all randomized controlled trials and comparative observational studies. We excluded single arm studies, case reports/series, narrative reviews, and studies irrelevant to the focus of this article. DATA EXTRACTION: Two reviewers independently assessed trial eligibility. Data were collected for the following outcomes: primary outcomes included good neurologic outcome, survival to hospital discharge, and survival at greater than or equal to 1 year. Secondary outcomes included incidence of return of spontaneous circulation, ICU and hospital length of stay, duration of vasopressor and inotropic treatment, and blood pressure during cardiopulmonary resuscitation and after return of spontaneous circulation. DATA SYNTHESIS: The pooled estimates from randomized controlled trials for the following subgroups were analyzed using random-effects models: 1) patients with in-hospital cardiac arrest who received vasopressin, steroids, and epinephrine; 2) patients with in-hospital cardiac arrest who used corticosteroids only (i.e., no vasopressin); and 3) patients with out-of-hospital cardiac arrest who used corticosteroids only. Results included an increase in good neurologic outcomes (relative risk, 2.84; 95% CI, 1.36–5.94) and survival to hospital discharge (relative risk, 2.58; 95% CI, 1.36–4.91) in in-hospital cardiac arrest patients receiving vasopressin, steroids, and epinephrine followed by corticosteroids for postresuscitation shock. This was further supported by an increase in return of spontaneous circulation (relative risk, 1.35; 95% CI, 1.12–1.64) and hemodynamics in this population. There was no benefit observed in in-hospital cardiac arrest or out-of-hospital cardiac arrest patients receiving corticosteroids alone. CONCLUSIONS: Our study found that there are limited high-quality data to analyze the association between corticosteroids and reducing mortality in cardiac arrest, but the available data do support future randomized controlled trials. We did find that corticosteroids given as part of a vasopressin, steroids, and epinephrine regimen in in-hospital cardiac arrest patients and for postresuscitation shock did improve neurologic outcomes, survival to hospital discharge, and surrogate outcomes that include return of spontaneous circulation and hemodynamics. We found no benefit in in-hospital cardiac arrest or out-of-hospital cardiac arrest patients receiving corticosteroids only; however, a difference cannot be ruled out due to imprecision and lack of available data.

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