Background
Recombinant, monoclonal antibody therapies have been utilized under emergency use authorization (EUA) for the prevention of clinical decompensation in high-risk COVID-19 positive patients for up to 10 days from symptom onset. The purpose of this study was to determine the impact of the timing of the monoclonal antibody, bamlanivimab, on clinical outcomes in high-risk COVID-19 positive patients.
Methods
This was an IRB-approved, retrospective evaluation of adult patients who received bamlanivimab per EUA criteria in the emergency department (ED). Patients were dichotomized into two groups– 3 days of symptoms or less (
early
) versus 4 to 10 days (
late
). The primary outcome was hospitalization for COVID-related illness at 28 days (or treatment failure). Secondary outcomes were COVID-related ED visits at 28 days, hospital and intensive care unit (ICU) length of stay (LOS), and in-hospital mortality at 28 days.
Results
A total of 839 patients were included in the analysis. There was no difference observed in COVID-related hospitalization rates within 28 days between the early and late bamlanivimab administration groups (7.5% vs. 8.2%,
p
= 0.71). There was no difference in COVID-related ED visits within 28 days with 13% of patients returning to the ED.
Conclusions
In conclusion, there were no differences in the rates of hospitalization at 28 days when bamlanivimab was administered in the first 3 days of illness versus days 4 to 10. Future prospective studies are warranted to expand upon the characteristics of patients that may or may not benefit from monoclonal antibody therapy.
The use of pulse oximetry as an adjunct to clinical evaluation of oxygenation during aeromedical transport by helicopter and fixed-wing aircraft was evaluated. As evidenced by an oxygen saturation of 90% or less, 29 of 150 patients (29%) were hypoxemic in the presence of the flight team. Airway interventions were carried out by the flight team in 17 of these 29 hypoxemic patients. In 11 of these 17 instances, desaturation noted by pulse oximeter was the first evidence that airway interventions were indicated. In the other 12 cases of hypoxemia, no new airway interventions were carried out despite oximeter evidence of desaturation. Three of these patients subsequently required aggressive airway interventions following their arrival at the receiving emergency department. Of the 32 patients transported by fixed-wing aircraft, 27% had evidence of unsuspected hypoxemia detected only by the pulse oximeter. The hypoxemia seemed related to increasing altitude in eight of this latter group. Pulse oximetry is a valuable and feasible technique for monitoring patients during aeromedical transport. Its use may allow detection of physiologic hypoxemia before such becomes apparent clinically.
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