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TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Electronic cigarette or vaping product use-associated lung injury (EVALI) is potentially life-threatening disease that has become increasingly recognized over the last years. However, the extra-pulmonary manifestations of this disease are not as well described. We present a patient who simultaneously developed acute EVALI and stress induced cardiomyopathy. CASE PRESENTATION: A 35-year-old female with a recent heavy vaping history presented to hospital via EMS due to disorganized behavior. Her past medical history was notable for polysubstance abuse and an extensive neuropsychiatric history. Her vital signs were notable for sinus tachycardia, hypotension and hypoxia with an oxyhemoglobin saturation 65%. Her physical exam was notable for cyanosis, rales to pulmonary auscultation and use of accessory muscles. She was intubated and started on empiric antibiotics for community acquired pneumonia, and vasopressors. A computer tomography pulmonary angiography (CTPE) was negative for acute pulmonary embolism but showed scattered bilateral airspace opacities with dependent consolidations (fig 1.). Relevant laboratory on admission included procalcitonin 28.17, WBC count 12.9 and troponin 1.58. SARs-COV-2, serum blood cultures, legionella antigen, streptococci pneumoniae antigen and HIV were negative. Urine toxicology was positive for cannabinoids. Bronchoalveolar lavage later demonstrated 50,000 TNC with neutrophil predominance. EKG showed sinus tachycardia and nonspecific ST depression. Echocardiogram revealed severe diffuse hypokinesis with left ventricular ejection fraction (LVEF) of 13%. During her ICU course she continued on mechanical ventilation with lung protective strategy, systemic glucocorticoids and antibiotics. Vasopressors were subsequently weaned off. Repeated echocardiogram on ICU day five demonstrated a recovered LVEF at 55%. Patient's hypoxemia improved, and she was successfully extubated on ICU day eight. DISCUSSION: Pulmonary injury is the most well described clinical manifestation of EVALI, however a large majority of these patients also present with gastrointestinal symptoms and malaise, suggesting a systemic disease process. Our patient had newly reduced LVEF suggestive of stress induced cardiomyopathy which consequently improved with standard and supportive care. CONCLUSIONS: It is important to maintain a high index of suspicion of secondary organ damage, as prompt diagnosis and treatment of EVALI associated cardiac dysfunction can have an impact in short- and long-term prognosis. REFERENCE #1: Kligerman S, Raptis C, Larsen B, Henry TS, Caporale A, Tazelaar H, Schiebler ML, Wehrli FW, Klein JS, Kanne J. Radiologic, Pathologic, Clinical, and Physiologic Findings of Electronic Cigarette or Vaping Product Use-associated Lung Injury (EVALI): Evolving Knowledge and Remaining Questions. Radiology. 2020 Mar;294(3):491-505. doi: 10.1148/radiol.2020192585. Epub 2020 Jan 28. PMID: 31990264. DISCLOSURES: No relevant relationships by David barounis, source=Web Response No relevant relationships by Xavier Fonseca, source=Web Response No relevant relationships by Dana Mueller, source=Web Response

Introduction: In the US, 1 in 4 heart failure (HF) patients is readmitted to the hospital within 30-days of discharge and the cost to Medicare is billions of dollars annually. This has made reducing readmissions a top priority for Medicare. In July 2012, we implemented the TransitionAdvantage (TA) service at 3 hospitals in central North Carolina. The service is designed to reduce readmissions for HF patients by: 1) assigning patients to transition liaisons (TLs) who have been trained in motivational interviewing to facilitate compliance with discharge instructions and 2) using home telemonitoring to closely follow patients’ medical condition after discharge. A focal point of the service is a technology platform that facilitates information flow during care transitions (Figure). Patients’ discharge instructions are uploaded from each hospital’s electronic medical record and stored on the platform which is used by TLs to help with medication adherence and timely follow-up with doctor visits. Post discharge, patients perform daily health checks of their weights, blood pressures and symptoms. This information is uploaded to the platform via interactive voice response (IVR), web or phone call from TLs, and used by TLs to transfer patients to the nurse phone service if patients show early signs of worsening HF. TLs also facilitate the transfer of discharge summaries to patients’ primary care doctors.Methods:We conducted an interim analysis of the impact the TA service has on 30-day readmission using matched historical controls from the 3 hospitals. We used multivariate logistic regression and adjusted the effect of the TA service for differences between the 2 study groups. We also analyzed surveys of patients and their caregivers regarding satisfaction with the service. We anticipate enrolling a total of 320 patients by study’s end (May 31, 2013). This interim analysis describes results for the first 125 patients enrolled in the TA service. Results: The average patient age was 65 years, 53% were women, and 58% were Caucasian. In multivariate analyses, patients in the TA service were 29% less likely to be readmitted within 30-days of hospital discharge (OR50.71, p50.36). It should be noted that the interim analysis was not powered to demonstrate statistical significance. Patient and caregiver satisfaction with the service was high (95% and 90%; respectively). Conclusion: An interim analysis of the TA service suggests a trend towards lower 30 day hospital readmission and high patient and caregiver satisfaction with the services provided. Final results are expected in late2013.