1. Experience With Cardiology-Oriented Outcomes in Critically Ill Patients With Coronavirus Disease 2019
- Author
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Randi Connor-Schuler, MD, A. Ian Wong, MD, Anand Shah, MD, Babar Fiza, MD, Melissa Lyle, MD, Richard Ramonell, MD, Maxwell Hockstein, MD, George Chang, MD, David Markham, MD, Charles Searles, MD, Michael McDaniel, MD, Jefferson Baer, MD, Cindy Powell, MD, Lisa Daniels, MD, the Emory COVID-19 Quality and Clinical Research Collaborative, Max W. Adelman, Scott Arno, Sara C. Auld, Theresa Barnes, William Bender, James M. Blum, Gaurav Budhrani, Stephanie Busby, Laurence Busse, Mark Caridi-Scheible, David Carpenter, Nikulkumar Chaudhari, Craig M. Coopersmith, Lisa Daniels, Johnathan A. Edwards, Jane Fazio, Babar Fiza, Eliana Gonzalez, Ria Gripaldo, Charles Grodzin, Robert Groff, Alfonso C. Hernandez-Romieu, Max Hockstein, Dan Hunt, Craig S. Jabaley, Jesse T. Jacob, Colleen Kraft, Greg S. Martin, Samer Melham, Nirja Mehta, Chelsea Modlin, David J. Murphy, Jung Park, Deepa Patel, Cindy Powell, Amit Prabhakar, Jeeyon Rim, Ramzy Rimawi, Chad Robichaux, Nicholas Scanlon, Milad Sharifpour, Bashar Staitieh, Michael Sterling, Jonathan Suarez, Colin Swenson, Nancy Thakkar, Alexander Truong, Hima Veeramachaneni, Alvaro Velasquez, Michael Waldmann, Max Weinmann, Thanushi Wynn, and Joel Zivot
- Subjects
medicine.medical_specialty ,Myocarditis ,Coronavirus disease 2019 (COVID-19) ,Psychological intervention ,shock ,Critical Care and Intensive Care Medicine ,arrhythmia ,Continuous variable ,coronavirus disease 2019 ,cor pulmonale ,Internal medicine ,Medicine ,Myocardial infarction ,Original Clinical Report ,biology ,business.industry ,Critically ill ,RC86-88.9 ,Retrospective cohort study ,Medical emergencies. Critical care. Intensive care. First aid ,medicine.disease ,Troponin ,myocardial ischemia ,biology.protein ,Cardiology ,ComputingMethodologies_DOCUMENTANDTEXTPROCESSING ,myocarditis ,business - Abstract
Supplemental Digital Content is available in the text., Objectives: Coronavirus disease 2019 is associated with high mortality rates and multiple organ damage. There is increasing evidence that these patients are at risk for various cardiovascular insults; however, there are currently no guidelines for the diagnosis and management of such cardiovascular complications in patients with coronavirus disease 2019. We share data and recommendations from a multidisciplinary team to highlight our institution’s clinical experiences and guidelines for managing cardiovascular complications of coronavirus disease 2019. Design, Setting, and Patients: This was a retrospective cohort study of patients admitted to one of six ICUs dedicated to the care of patients with coronavirus disease 2019 located in three hospitals within one academic medical center in Atlanta, Georgia. Measurements/Interventions: Chart review was conducted for sociodemographic, laboratory, and clinical data. Rates of specific cardiovascular complications were assessed, and data were analyzed using a chi-square or Wilcoxon rank-sum test for categorical and continuous variables. Additionally, certain cases are presented to demonstrate the sub committee’s recommendations. Main Results: Two-hundred eighty-eight patients were admitted to the ICU with coronavirus disease 2019. Of these, 86 died (29.9%), 242 (84.03%) had troponin elevation, 70 (24.31%) had dysrhythmias, four (1.39%) had ST-elevation myocardial infarction, eight (2.78%) developed cor pulmonale, and 190 (65.97%) with shock. There was increased mortality risk in patients with greater degrees of troponin elevation (p < 0.001) and with the development of arrhythmias (p < 0.001), cor pulmonale (p < 0.001), and shock (p < 0.001). Conclusions: While there are guidelines for the diagnosis and management of pulmonary complications of coronavirus disease 2019, there needs to be more information regarding the management of cardiovascular complications as well. These recommendations garnered from the coronavirus disease 2019 cardiology subcommittee from our institution will add to the existing knowledge of these potential cardiovascular insults as well as highlight suggestions for the diagnosis and management of the range of cardiovascular complications of coronavirus disease 2019. Additionally, with the spread of coronavirus disease 2019, our case-based recommendations provide a bedside resource for providers newly caring for patients with coronavirus disease 2019.
- Published
- 2020
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