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MeSH Disease

Human Phenotype

Transmission

Seroprevalence
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    Clinical Investigations External Validation of Multimodal Termination of Resuscitation Rules for Out-of-hospital Cardiac Arrest MESHD Cardiac Arrest HP Patients in the Covid-19 Era

    Authors: Haewon Jung; Mijin Lee; Jae Wan Cho; Sang Hun Lee; Suk Hee Lee; You Ho Mun; Han-sol Chung; Yang Hun Kim; Gyun Moo Kim; Sin-youl Park; Jae Cheon Jeon; Changho Kim

    doi:10.21203/rs.3.rs-32324/v1 Date: 2020-05-29 Source: ResearchSquare

    Background:Futile resuscitation for out-of-hospital cardiac arrest MESHD cardiac arrest HP (OHCA) patients in the COVID-19 era can lead to risk of disease MESHD transmission TRANS and unnecessary transport. Various existing basic or advanced life support (BLS or ALS) rules for termination of resuscitation (TOR)have been derived and validated in North America and Asian countries. This study aimed to evaluate the external validation of these rules in predicting the survival outcomes of OHCA patients in the COVID-19 era.Methods: A multicenter observational study was performed using the WinCOVID-19 Daegu registry data collected from 18 February to 31March 2020. The outcomes of each rule were compared to the actual patient survival outcomes. The sensitivity SERO, specificity, false positive ratio (FPR), and positive predictive value SERO (PPV) of each TOR rule were evaluated. Results: Of the 184 OHCA patients, 170 patients,who showed cardiac arrest HP of presumed cardiac etiology, were enrolled. TOR was recommended for 122 patientsbased on the international BLS-TOR rule, which showed 85% specificity, 74% sensitivity SERO, 0.8% FPR, and 99% PPV for predicting unfavorable survival outcomes. When the traditional BLS-TOR rules and KoCARC TOR rule II were applied to our registry, one patient met the TOR criteria but survived at hospital discharge. With regard to the FPR (upper limit of 95% confidence interval<5%) and PPV (>99%) criteria, only the KoCARCTOR rule I, which included a combination ofthree factors including not being witnessed by emergency MESHD medical technicians, presenting with an asystole at the scene, and not experiencing prehospital shock MESHD shock HP delivery or ROSC, was found to be superiorto all other TOR rules. Conclusion: Among the previous nine BLS and ALS TOR rules, KoCARCTOR rule I was most suitable for predicting poor survival outcomes and showed improved diagnostic performance SERO. Further research on variations in resources and treatment protocols among facilities, regions, and cultures will be useful in determining the feasibility of TOR rules for COVID-19 patients worldwide.Trial registration: Not applicable

    Excess Out-Of-Hospital Mortality and Declining Oxygen Saturation Documented by EMS During the COVID-19 Crisis in Tijuana, Mexico

    Authors: Joseph Friedman; Alheli Calderon-Villarreal; Ietza Bojorquez; Carlos Vera Hernandez; David Schriger; Eva Tovar Hirashima

    doi:10.1101/2020.05.13.20098186 Date: 2020-05-18 Source: medRxiv

    Objective: Emergency MESHD medical services (EMS) may serve as a key source of rapid data about the evolving health of COVID-19 affected populations. A study in Italy reported that EMS-documented out-of-hospital cardiac arrest MESHD cardiac arrest HP rose by 58% during the peak-epidemic. EMS and hospital reports from several countries have suggested that silent hypoxemia HP-low oxygen saturation (SpO2) in the absence of dyspnea MESHD dyspnea HP-is associated with COVID-19 outbreaks. It is unclear, however, how these phenomena can be generalized to low-and-middle-income countries (LMICs). Tijuana is a city on the Mexico-United States border that may serve as a bellwether for cities in other LMICs. Using EMS data, we assess changes in out-of-hospital mortality and the SpO2 of respiratory patients during the COVID-19 period. Methods: We calculated numbers of weekly out-of-hospital deaths MESHD and respiratory cases seen by EMS in Tijuana, and estimate the difference between peak-epidemic rates and forecasted 2014-2019 trends. Results were compared with official COVID-19 statistics, stratified by neighborhood socioeconomic status (SES), and examined for changing demographic or clinical features, including mean (SpO2). Results: An estimated 194.7 (95%CI: 135.5-253.9) excess out-of-hospital deaths MESHD events occurred during April 14th-May 11th, representing an increase of 145% (70%-338%) compared to forecasted trends. During the same window, only 8 COVID-19-positive, out-of-hospital deaths MESHD were reported in official statistics. This corresponded with a rise in respiratory cases of 274% (119%-1142%), and a drop in mean SpO2 to 77.7%, from 90.2% at baseline. Peak respiratory cases were concentrated in high-SES neighborhoods, while the highest out-of-hospital death MESHD rates were observed in low-SES areas. Conclusions: EMS systems may play an important sentinel role in monitoring excess out-of-hospital mortality and other trends during the COVID-19 crisis in LMICs. Using EMS data, we observed increases in out-of-hospital deaths MESHD in Tijuana that were nearly threefold greater magnitude than increases reported in Italy. Furthermore, these deaths MESHD may be missing from official records describing COVID-19 patients. We also found evidence of worsening hypoxemia HP among respiratory patients seen by EMS, suggesting a rise in silent hypoxemia HP, which should be met with increased detection and clinical management efforts. Finally, we observed that social disparities in out-of-hospital death MESHD that warrant monitoring and amelioration.

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MeSH Disease
Human Phenotype
Transmission
Seroprevalence


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