Thread by @WhistlingDixie4

⭐️Learning points from the @ESICM second webinar on #COVID19 and intensive care, today⭐️
Thanks to Prof Yaseen Arabi for presenting the information and Dr Lennie Derde for leading.

It's a long one!

(thread)

In the Chinese cohort, 87% of cases occurred in the 30-79 year age group

<2% were in <19 year olds

We learned in the last webinar that Dr Bin Du (China) had noted possible myocardial virulence...

Ruan ICM 2020 report causes of death (Chinese cohort) as:
- Respiratory failure - 53%
- Myocardial damage/heart failure - 7%
- Both together 33%

Guan et al NEJM 2020 reported that almost 21% of patients with COVID-19 in the Chinese cohort had *NO* abnormalities on chest x-ray OR CT thorax.

56% had ground glass opacities on CT

The exact sensitivity and specificity of RT-PCR (upper or lower respiratory samples) is not clear

*They advocated repeated sampling where tests are negative but strong suspicion persists....*

Also - the virus (SARS-CoV-2) has been isolated in stool and blood

In treating those admitted to ICU, and considering inotropes, we need to consider a predisposition to arrhythmia

... Dawei Wang et al JAMA 2020 reported 44% of 36 pts admitted to ICU developed arrhythmia as a complication

Hospital transmission was thought to be responsible for 41% of transmission in one study (Want JAMA 2020)

12% of these cases were to patients

...and **29%** was to healthcare workers 👩‍⚕️👨‍⚕️⚕️

3.8% of 44672 Chinese cases were healthcare personal and almost *15%* were severe/critical

.... this is higher than for the general population

(Zunyou Wu et al JAMA 2020)

What about treatment?

Can we learn from research looking at treatment for other viral illnesses - ie. MERS, SARS or Flu?

Note, the following studies are on other viruses, not this coronavirus specifically (ie SARS-COV-2)

NIV was used in 35% of critically ill patients with MERS in one study. NINTY TWO PERCENT of these pts then required invasive ventilation

...but using NIV wasn't independently associated with 90-day mortality
(Alradaddi BM et al)

but is felt that up to 85% of those with MERS infection in ICU will need invasive ventilation anyway (more than reported for #COVID19)

Current advice-selected pts, early & milder hypoxia

...if pt doesn't show signs of early recovery, NIV unlikely to avoid invasive ventilation

There was re-iteration that clincal evidence doesn't support corticosteroid treatment in #COVID19

- Evidence suggests it delays clearance of viral RNA for both MERS-CoV and SARS-CoV

ECMO? - unclear

In **MERS infections** Alshahrani MS et all (Annals Int Care, 2018) looked at a small cohort (n=35)...

- In hospital mortality was 100% in the conventional group and 65% in the ECMO group
-ECMO was used as rescue therapy in this study

That's all!

Thanks to @ESICM for the webinar and again to the critical care community for working so hard to sharing and publish their experiences #COVID19