ILCOR’s revised Covid-19 defibrillation recommendation requires a new approach to training

In-hospital resuscitation practices have changed by necessity in the Covid-19 era, principally due to precautions intended to protect caregivers from infection. This has resulted in serious delays in resuscitation response. ILCOR has recently modified its guidelines to separate defibrillation from other interventions, recognizing that shock success is extremely time-dependent and that defibrillation poses relatively little risk of Covid-19 transmission. The new recommendation calls for sending one caregiver into the isolation room in order to initiate bedside monitoring and defibrillate if indicated, while the code team is donning their personal protective equipment. Implementing this change requires focused training in that specific role. This can be accomplished by intensively training a subset of clinical staff to assume the responsibility and act without hesitation when a code occurs. Focused defibrillation training promises to avoid compromising the care of patients experiencing tachyarrhythmic arrests in the setting of Covid-19. Such a training program might even result in better survival than before the pandemic for this subset of patients.

The characteristics of echocardiography in ICU patients and its relationship with the outcomes

Background Echocardiography is widely used for bedside monitoring in ICU. We aimed to describe the characteristics of echocardiography manifestations in different groups of ICU patients, and the association with the outcomes.Methods This is a prospective multiple-center cohort study took place in 17 ICUs in China. A total of 1682 continuous adult patients admitted between August 31, 2017 to February 16, 2019 who had echocardiography performed within 24 hours in ICU were included. The echocardiography was performed and the echocardiography scores were calculated. Data was analyzed and compared between different outcome and primary indication groups.Results The overall 28-day mortality was 15.76%. Left ventricle enlargement and other echocardiogram abnormalities were more common in the non-survivors than the survivors. The EF value was lower, and the decrease in EF value was more frequent in the non-survivors than the survivors. The echocardiography score was significantly higher in the non-survivors than the survivors. The incidence of right ventricle enlargement and EF decrease was high in ICU patients (26.52% and 26.93% respectively). The independent risk factors for 28-day mortality was APACHE II, the length of MV, the length of ICU stay, oxygenation index, right ventricle wall thickening, IVC diameter, IVC variability, and the echocardiography score.Conclusions The incidence of cardiac dysfunction is high in ICU patients. The echocardiography score was significantly higher in the non-survivors than the survivors, and was an independent risk factor for 28-day mortality. Echocardiography is a convenient bedside monitoring method which deserves widely use in ICUs.Trial registration: Chinese Clinical Trial Registry (ChiCTR-DDD-17012391). Registered 2017.08.17. http://www.chictr.org.cn/showprojen.aspx?proj=21127.