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Purpose To test the primary hypothesis that a CPR video will reduce ICU patients' surrogates' anxiety when deciding code status, as measured by the Hamilton Anxiety Rating (HAM-A) Scale, as compared to the no video group. Materials and methods This is a prospective randomized control trial. Twenty-seven ICU patients' surrogates were enrolled in the study after receiving an ICU team-led code status discussion. After the enrollment, twelve surrogates were randomized to the video group and fifteen to the no video group. The primary outcome of anxiety was quantified using the HAM-A Scale. Demographic information, clinical data, and patients' provenance information (Home vs. Not Home) were collected. The patients' severity of illness was calculated using the Sequential Organ Failure Assessment (SOFA) Score. Results The HAM-A score in the video group was 5.65 points lower than in the no video group ([β = −5.65, 95% CI −11.12 −0.18] P = 0.04). The statistically significant difference was maintained when adjusting for patients' SOFA Score and patients' provenance (P = 0.03). Conclusion CPR video used to supplement ICU team-led code status discussions reduced surrogates' anxiety, as compared to no video. Trial Registration: ClinicalTrials.gov Identifier NCT03630965 .

The full impact of the coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus (SARS-CoV-2), on the field of hematopoietic cell transplantation (HCT) is unknown. This perspective paper reviews the following: current COVID-19 epidemiology, diagnosis, and potential therapies; care considerations unique to HCT recipients; and the concept of a learning network to assimilate emerging guidelines and best practices and to optimize patient outcomes through facilitating shared learning and experience across transplantation centers.

Engraftment syndrome (ES) is an increasingly diagnosed complication after hematopoietic cell transplantation (HCT). Clinical presentation most commonly includes, but is not limited to fever, diarrhea, and skin rash developing at the time of absolute neutrophil count (ANC) recovery. Due to the broad and pleiotropic clinical presentation, ES can be a challenging diagnosis. Furthermore, despite many reports about the presentation of ES, the syndrome is still not completely understood. While most presentations of ES are mild and can either resolve spontaneously or with a brief course of systemic corticosteroids, mortality rates ranging from 8%-18% have been described. We present a case of ES in a critical care setting. A male patient who had an allogeneic HCT and developed fevers, diffuse skin rash, acute kidney injury and hypoxemic respiratory failure after his absolute neutrophilic count started recovering from nadir. He was subsequently transferred to the medical intensive care unit (MICU) for further management, where he was initially managed with mechanical ventilation, vasopressors and antibiotics. An extensive workup that included bronchoscopy with bronchoalveolar lavage was performed and failed to show an infectious etiology. Due to concern for ES, patient was started on steroids and his clinical status dramatically improved. The patient was eventually extubated and transferred back to the floor in stable condition. It is important for internists and critical care physicians in the MICU to be aware of post-HCT complications and be cognizant of the clinical signs of ES to better understand the syndrome and its management.