Journal of the American College of Emergency Physicians open
-
J Am Coll Emerg Physicians Open · Aug 2020
Extracorporeal cardiopulmonary resuscitation for in- and out-of-hospital cardiac arrest: systematic review and meta-analysis of propensity score-matched cohort studies.
In this systematic review and meta-analysis of propensity score-matched cohort studies, we quantitatively summarize whether venoarterial extracorporeal membrane oxygenation (VA-ECMO) used as extracorporeal cardiopulmonary resuscitation (ECPR), compared with conventional cardiopulmonary resuscitation (CCPR), is associated with improved rates of 30-day and long-term favorable neurological outcomes and survival in patients resuscitated from in- and out-of-hospital cardiac arrest. ⋯ Our analysis suggests that VA-ECMO used as ECPR may improve long-term favorable neurological outcomes and survival when compared to the best standard of care in a selected patient population. Therefore, it is imperative for well-designed randomized clinical trials to obtain a higher level of scientific evidence to ensure optimal outcomes for cardiac arrest patients.
-
J Am Coll Emerg Physicians Open · Aug 2020
Boarding of critically Ill patients in the emergency department.
Emergency department boarding is the practice of caring for admitted patients in the emergency department after hospital admission, and boarding has been a growing problem in the United States. Boarding of the critically ill has achieved specific attention because of its association with poor clinical outcomes. Accordingly, the Society of Critical Care Medicine and the American College of Emergency Physicians convened a Task Force to understand the implications of emergency department boarding of the critically ill. The objective of this article is to review the U.S. literature on (1) the frequency of emergency department boarding among the critically ill, (2) the outcomes associated with critical care patient boarding, and (3) local strategies developed to mitigate the impact of emergency department critical care boarding on patient outcomes. ⋯ Emergency department boarding of critically ill patients was common and was associated with worse clinical outcomes. Health systems have generated a number of strategies to mitigate these effects. A definition for emergency department boarding is proposed. Future work should establish formal criteria for analysis and benchmarking of emergency department-based boarding overall, with subsequent efforts focused on developing and reporting innovative strategies that improve clinical outcomes of critically ill patients boarded in the emergency department.
-
J Am Coll Emerg Physicians Open · Jul 2020
Case ReportsDizziness can be an early sole clinical manifestation for COVID-19 infection: A case report.
SARS-CoV-2 is a novel strain of coronavirus that was first identified in Wuhan, China; it has since spread rapidly throughout the world. Most of the patients with COVID-19 present with respiratory symptoms, including cough, nasal symptoms, fever, and shortness of breath. However, several groups have reported that SARS-CoV-2 can infect the central nervous system via the olfactory bulb followed by spread throughout the brain and peripheral nervous system. ⋯ The neurological symptoms associated with COVID-19 are frequently non-specific and may emerge several days before the respiratory symptoms; as such, identification of patients presenting with these subtle and seemingly unremarkable COVID-19 symptoms will be quite difficult. Added to this, numerous countries still limit testing for SARS-COV-2 to patients presenting with fever or respiratory symptoms. Frontline physicians should be aware of early, non-specific symptoms associated with SARS-CoV-2 infection.
-
J Am Coll Emerg Physicians Open · Jul 2020
The role of lung ultrasonography in COVID-19 disease management.
Coronavirus disease 2019 (COVID-19) has created unprecedented disruption for global healthcare systems. Offices and emergency departments (EDs) were the first responders to the pandemic, followed by medical wards and intensive care unit (ICUs). Worldwide efforts sprouted to coordinate proper response by increasing surge capacity and optimizing diagnosis and containment. ⋯ We propose 11 lung ultrasound roles for different medical settings during the pandemic, starting from the out-of-hospital setting, where lung ultrasound has ergonomic and infection control advantages. Then we describe how medical wards and ICUs can safely integrate lung ultrasound into COVID-19 care pathways. Finally, we present outpatient use of lung ultrasound to aid follow-up of positive case contacts and of those discharged from the hospital.
-
J Am Coll Emerg Physicians Open · Jul 2020
Deep-learning artificial intelligence analysis of clinical variables predicts mortality in COVID-19 patients.
The large number of clinical variables associated with coronavirus disease 2019 (COVID-19) infection makes it challenging for frontline physicians to effectively triage COVID-19 patients during the pandemic. This study aimed to develop an efficient deep-learning artificial intelligence algorithm to identify top clinical variable predictors and derive a risk stratification score system to help clinicians triage COVID-19 patients. ⋯ Deep-learning prediction model and the resultant risk stratification score may prove useful in clinical decision-making under time-sensitive and resource-constrained environment.This article is protected by copyright. All rights reserved.