Catastrophic Adult Respiratory Distress Syndrome in a patient coinfected with Pulmonary Tuberculosis and SARS-Cov2: Utility of ECMO-NovalungR AV

This clinical case shows a patient who was admitted to the Hospital Regional Antofagasta (HRA) due to pneumonia associated with COVID-19, coinfected with Mycobacterium tuberculosis, and who consequently developed Acute Respiratory Distress Syndrome (ARDS) in a Catastrophic condition, which warranted Sequential management that began with airway rescue at the hospital of origin (Barros Luco Trudeau (HBLT)) with mechanical ventilation support, in prone condition with poor results. Upon arrival of the transfer team, Extracorporeal Membrane Cannulation (ECMO) was decided. After his favorable response, he was weaned to the artificial respirator (RA) and supported with Arteriovenous CO2 remover (NovalungR ), a maneuver that lasted 192 hours, achieving improvement from Mechanical Ventilation support, until his final weaning. This is an unprecedented clinical case, due to the combination of catastrophic ARDS, associated with the COVID 19 and TB coinfection, and for this reason it is necessary to document cases, guide behaviors and management, which can be adapted according to the technological and professional development with which count each hospital.

Upper respiratory tract viral load quantification in COV ID-19 patients at hospital admission and its association with disease severity

Introduction: There are aspects of COVID-19 pathogenesis that are still unknown. Objective: To determine the relationship between severity, mortality and viral replication in patients with COVID-19. Methods: Clinical characteristics, severity and mortality of 203 patients hospitalized for COVID-19 were analyzed and correlated with viral load (VL) and threshold cycle (TC) at admission;nasopharyngeal swab was obtained. Results: Mean VLs in surviving patients with mild to moderate, moderate to severe and severe disease were the following: 6.8 x 10(6), 7.6 x 10(7) and 1.0 x 10(9), respectively;and in patients with critical disease who died, VL was 1.70 x 10(9). TCs were 26.06, 24.07, 22.66 and 21.78 for the same groups. In those who died, a higher mean VL was observed at admission in comparison with those who survived (1.7 x 10(9) vs 9.84 x 10(6);p < 0.001). A significant correlation was observed between VL, severity and death (r = 0.254, p < 0.045 and r = 0.21, p < 0.015). High VL was associated with increased in-hospital mortality in comparison with low VL (OR = 2.926, p < 0.017). Conclusion: SARS-CoV-2 VL determined at hospital admission might classify risk simultaneously with other factors described in COVID-19.

Ischemic stroke in consecutive patients with COVID-19: A case-control study of clinical features, mechanisms and outcome in the swiss stroke registry

Background and Aims: Most case series of patients with ischemic stroke (IS) and COVID-19 are limited to random centers or lack 3-month outcome. The aim of this study is to describe prevalence, clinical, radiological and pathophysiological features and long-term outcome of COVID-19-related IS in a nationwide stroke registry. Methods: From the Swiss Stroke Registry (SSR), we included all consecutive IS patients aged ≥18 years who were admitted to stroke units during the first wave of COVID-19 (25.02.-08.06.2020). We compared baseline features, stroke etiology and 3-month outcome (modified Rankin shift) of COVID PCR+ IS patients with COVID PCR-and/or asymptomatic non-tested IS patients. Results: Of the 2376 IS patients entered in the SSR during the study period, 36 (1.5%) had confirmed COVID-19 infection (details in Figure 1). In multivariate analysis, COVID+ patients had lower admission blood pressure (p=0.004) and more frequently lesions in multiple vascular territories (p=0.09). Stroke seemed more often related to several defined etiologies (p=0.07), and less often to large artery atherosclerotic (p=0.07) and cryptogenic mechanisms (p=0.03). There was a strong trend towards worse outcome in COVID+ patients across the entire Rankin-spectrum (Figure 2) despite adjustment for age, stroke severity and revascularization treatments (OR 1.97, 95%CI 0.92-4.21, p=0.08). Conclusions: In this nationwide analysis of consecutive ischemic strokes, concomitant COVID-19 was relatively rare. COVID+ patients more often had multiple territory involvement and multiple stroke mechanisms, and their 3-month outcome was worse across the entire Rankin spectrum. (Table Presented).