Risk factors associated with severe hospital burden of COVID-19 disease in Regione Lombardia: a cohort study.

BACKGROUND: Understanding the risk factors associated with hospital burden of COVID-19 is crucial for healthcare planning for any future waves of infection. METHODS: An observational cohort study is performed, using data on all PCR-confirmed cases of COVID-19 in Regione Lombardia, Italy, during the first wave of infection from February-June 2020. A multi-state modelling approach is used to simultaneously estimate risks of progression through hospital to final outcomes of either death or discharge, by pathway (via critical care or not) and the times to final events (lengths of stay). Logistic and time-to-event regressions are used to quantify the association of patient and population characteristics with the risks of hospital outcomes and lengths of stay respectively. RESULTS: Risks of severe outcomes such as ICU admission and mortality have decreased with month of admission (for example, the odds ratio of ICU admission in June vs March is 0.247 [0.120-0.508]) and increased with age (odds ratio of ICU admission in 45-65 vs 65 + age group is 0.286 [0.201-0.406]). Care home residents aged 65 + are associated with increased risk of hospital mortality and decreased risk of ICU admission. Being a healthcare worker appears to have a protective association with mortality risk (odds ratio of ICU mortality is 0.254 [0.143-0.453] relative to non-healthcare workers) and length of stay. Lengths of stay decrease with month of admission for survivors, but do not appear to vary with month for non-survivors. CONCLUSIONS: Improvements in clinical knowledge, treatment, patient and hospital management and public health surveillance, together with the waning of the first wave after the first lockdown, are hypothesised to have contributed to the reduced risks and lengths of stay over time.

Electrical features of eighteen automated external defibrillators: a systematic evaluation.

AIM: Assessment and comparison of the electrical parameters (energy, current, first and second phase waveform duration) among eighteen AEDs. METHOD: Engineering bench tests for a descriptive systematic evaluation in commercially available AEDs. AEDs were tested through an ECG simulator, an impedance simulator, an oscilloscope and a measuring device detecting energy delivered, peak and average current, and duration of first and second phase of the biphasic waveforms. All tests were performed at the engineering facility of the Lombardia Regional Emergency Service (AREU). RESULTS: Large variations in the energy delivered at the first shock were observed. The trend of current highlighted a progressive decline concurrent with the increases of impedance. First and second phase duration varied substantially among the AEDs using the exponential biphasic waveform, unlike rectilinear waveform AEDs in which phase duration remained relatively constant. CONCLUSIONS: There is a large variability in the electrical features of the AEDs tested. Energy is likely not to be the best indicator for strength dose selection. Current and shock duration should be both considered when approaching the technical features of AEDs. These findings may prompt further investigations to define the optimal current and duration of the shock waves to increase the success rate in the clinical setting.