ABSTRACT
INTRODUCTION: Determining a patient's candidacy for extracorporeal membrane oxygenation (ECMO) in severe COVID-19 pneumonia is a critical aspect of efficient healthcare delivery. A body mass index (BMI) ≥40 is considered a relative contraindication for ECMO by the Extracorporeal Life Support Organization (ELSO). We sought to determine the impact of obesity on the survival of patients with COVID-19 on ECMO. METHODS: This project was a retrospective review of a multicenter US database from January 2020 to December 2021. The primary outcome was in-hospital mortality after ECMO initiation, with a comparison between patients classified into body mass index categories (<30, 30-39.9, and ≥40). Secondary outcomes included ventilator days, intensive care days, and complications. RESULTS: We completed records review on 359 patients, with 90 patients excluded because of missing data. The overall mortality for the 269 patients was 37.5%. Patients with a BMI <30 had higher odds of mortality compared to all patients with BMI >30 (OR 1.98; p = 0.013), those with BMI 30-39.9 (OR 1.84; p = 0.036), and BMI ≥40 (OR 2.33; p = 0.024). There were no differences between BMI groups for ECMO duration; length of stay (LOS); or rate of bloodstream infection, stroke, or blood transfusion. Age, ECMO duration, and modified-Elixhauser index were not independent risk factors for mortality. CONCLUSIONS: In patients receiving ECMO for severe COVID-19, neither obesity (BMI >30) nor morbid obesity (BMI >40) were associated with in-hospital mortality. These results are consistent with previous reports and held true after adjusting for age and comorbidities. Our data suggest further examination of the recommendations to withhold ECMO in patients who are obese.
ABSTRACT
Introduction: After being removed from patient care due to equipment shortages, medical students and new residents around the United States are returning to clinical medicine/acute care settings as the SARS-CoV-2 (COVID-19) pandemic continues. We hypothesize that trainees returned with increased preparedness and had better access to and knowledge of personal protective equipment (PPE). Methods: Anonymous online surveys were distributed via snowball sampling to medical students and residents performing clinical duties in the United States. Respondents completed self-assessments for preparedness regarding PPE use, access to PPE and COVID-19 testing, and access to COVID-19 positive patients. Group comparisons were conducted using chi-square analysis and the Kruskal Wallis rank sum test. Multivariate ordinary least squares regression analysis was used to estimate the relationship between feeling prepared and other variables. Results: A total of 194 trainees (63 year 3 [MS3] medical students, 95 year 4 [MS4] medical students, and 36 year 1 [PGY1] postgraduates]) completed the survey. Collectively, 27% provided their own PPE on ≥ 1 rotation, 27% did not know how/where to obtain PPE, 36% did not know how/where to get tested, and 57% were never asked to demonstrate proficiency with PPE. In-person training was reported at 31.3% prior to 2020, which decreased to 21% during 2020. Mask-fit testing decreased from 83.1% to 56.9%. Online video lectures on PPE training increased from 52% to 80%. The mean (±SD) preparedness for return to clinical duty for MS3 students was 3.4/5 (±1.0), for MS4 students was 3.8/5 (±.90), and for PGY1 residents was 4.1/5(± .89) (P = .002). PPE training in 2020 was not associated with feeling prepared (P = .81). Conclusion: Survey respondents felt prepared by their institutions to return to clinical duties during the COVID-19 pandemic. There was some apprehension about knowledge of or access to PPE and COVID-19 testing. The confidence in the ability to don/doff PPE was the main factor associated with increased feelings of preparedness. While in-person training decreased from pre-2020 to during 2020, an increase of in-person training with supervised donning and doffing provides one potential avenue of further increasing the preparedness of trainees.
ABSTRACT
OBJECTIVE: Salivary gland tumors account for 6%-8% of head and neck neoplasms with the parotid gland as the most common primary site. Pleomorphic adenomas (PA) are considered the most common benign parotid gland neoplasms, followed by Warthin tumors (WT). The goal of this study was to investigate the distribution of parotid gland neoplasms among a United States veteran population. DESIGN: Retrospective chart review. SETTING: Washington DC Veterans Affairs Medical Center. PARTICIPANTS: Veterans who underwent fine needle aspiration (FNA) for a parotid gland mass from 2000 to 2018 were included. Medical records were reviewed for gender, age, tobacco use, surgery date, and pathology results. MAIN OUTCOME MEASURES: Changes in the distribution of parotid neoplasms and tobacco use over an 18-year period. RESULTS: Of 141 patients with parotid gland masses, 86.5% (n = 122) were benign, 9.9% (n = 14) were malignant, and 3.5% (n = 5) were indeterminate. Of benign tumors, WT accounted for the majority at 51.6%, followed by PA at 40.2%. When stratified by decade (2000-2009 and 2010-2018), the proportion of WT compared to all other benign and malignant neoplasms increased from 31.6% to 53.6%, whereas the proportion of PA decreased from 36.8% to 33.3%. The rate of tobacco use was unchanged at approximately 32.0% among our cohort from 2000 to 2018. CONCLUSION: Among our cohort of veteran patients, WT was the most common benign parotid tumor and has increased in incidence over the last two decades despite an unchanged smoking rate.
