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AWAreness during REsuscitation - II: A Multi-Center Study of Consciousness and Awareness in Cardiac Arrest

Parnia, Sam; Keshavarz Shirazi, Tara; Patel, Jignesh; Tran, Linh; Sinha, Niraj; O'Neill, Caitlin; Roellke, Emma; Mengotto, Amanda; Findlay, Shannon; McBrine, Michael; Spiegel, Rebecca; Tarpey, Thaddeus; Huppert, Elise; Jaffe, Ian; Gonzales, Anelly M; Xu, Jing; Koopman, Emmeline; Perkins, Gavin D; Vuylsteke, Alain; Bloom, Benjamin M; Jarman, Heather; Nam Tong, Hiu; Chan, Louisa; Lyaker, Michael; Thomas, Matthew; Velchev, Veselin; Cairns, Charles B; Sharm, Rahul; Kulstad, Erik; Scherer, Elizabeth; O'Keeffe, Terence; Foroozesh, Mahtab; Abe, Olumayowa; Ogedegbe, Chinwe; Girgis, Amira; Pradhan, Deepak; Deakin, Charles D
INTRODUCTION/BACKGROUND:Cognitive activity and awareness during cardiac arrest (CA) are reported but ill understood. This first of a kind study examined consciousness and its underlying electrocortical biomarkers during cardiopulmonary resuscitation (CPR). METHODS:) monitoring into CPR during in-hospital CA (IHCA). Survivors underwent interviews to examine for recall of awareness and cognitive experiences. A complementary cross-sectional community CA study provided added insights regarding survivors' experiences. RESULTS:=43%) normal EEG activity (delta, theta and alpha) consistent with consciousness emerged as long as 35-60 minutes into CPR. CONCLUSIONS:Consciousness. awareness and cognitive processes may occur during CA. The emergence of normal EEG may reflect a resumption of a network-level of cognitive activity, and a biomarker of consciousness, lucidity and RED (authentic "near-death" experiences).
PMID: 37423492
ISSN: 1873-1570
CID: 5537312

The Importance of Incorporating Patient Throughput in Crisis Standards of Care Simulations

Walsh, B Corbett; Pradhan, Deepak
PMID: 37165793
ISSN: 1938-744x
CID: 5503352

Local and Systemic Antibody Response to SARS-CoV-2 Infection in Critically Ill COVID-19 Patients

Barnett, C.R.; Krolikowski, K.; Tsay, J.J.; Wu, B.G.; Li, Y.; Chang, M.; Kyeremateng, Y.; Brosnahan, S.; Singh, S.; Kocak, I.; Collazo, D.E.; Mukherjee, V.; Lubinsky, A.S.; Postelnicu, R.; Ghedin, E.; Chung, M.; Angel, L.F.; Sulaiman, I.; Duerr, R.; Schluger, R.; Rafeq, S.; Carpenito, J.; Bakker, J.; Amoroso, N.E.; Kaufman, D.A.; Pradhan, D.; Li, H.; Wang, C.; Silverman, G.; Segal, L.N.
ISSN: 1535-4970
CID: 5651662

Critical Care Ultrasound Competency of Fellows and Faculty in Pulmonary and Critical Care Medicine: A Nationwide Survey

Adelman, Mark H; Deshwal, Himanshu; Pradhan, Deepak
PMID: 38099164
ISSN: 2369-8543
CID: 5588942

Measurement of Cardiac Output by Point-of-Care Transthoracic Echocardiography

Talan, Jordan W; Mangalick, Keshav; Pradhan, Deepak; Sauthoff, Harald
Traditionally measured with invasive methods or specialized equipment, stroke volume and cardiac output can be determined reliably with transthoracic echocardiography. This video guides the viewer in a step-by-step fashion through the technical aspects of Doppler echocardiographic assessment of cardiac output.
PMID: 36726703
ISSN: 2690-7097
CID: 5599392

How Common SOFA and Ventilator Time Trial Criteria would have Performed during the COVID-19 Pandemic: An Observational Simulated Cohort Study

Walsh, B Corbett; Pradhan, Deepak; Mukherjee, Vikramjit; Uppal, Amit; Nunnally, Mark E; Berkowitz, Kenneth A
OBJECTIVES/OBJECTIVE:To evaluate how key aspects of New York State Ventilator Allocation Guidelines (NYSVAG)-Sequential Organ Failure Assessment score criteria and ventilator time trials -might perform with respect to the frequency of ventilator reallocation and survival to hospital discharge in a simulated cohort of COVID-19 patients. METHODS:Single center retrospective observational and simulation cohort study of 884 critically-ill COVID-19 patients undergoing ventilator allocation per NYSVAG. RESULTS:742 patients (83.9%) would have had their ventilator reallocated during the 11-day observation period, 280 (37.7%) of whom would have otherwise survived to hospital discharge if provided a ventilator. Only 65 (18.1%) of the observed surviving patients would have survived by NYSVAG. Extending ventilator time trials from 2 to 5 days resulted in a 49.2% increase in simulated survival to discharge. CONCLUSIONS:In the setting of a protracted respiratory pandemic, implementation of NYSVAG or similar protocols could lead to a high degree of ventilator reallocation, including withdrawal from patients who might otherwise survive. Longer ventilator time trials might lead to improved survival for COVID-19 patients given their protracted respiratory failure. Further studies are needed to understand the survival of patients receiving reallocated ventilators to determine whether implementation of NYSVAG would improve overall survival.
PMID: 35678391
ISSN: 1938-744x
CID: 5248482


Alviar, Carlos L.; Postelnicu, Radu; Pradhan, Deepak R.; Hena, Kerry M.; Chitkara, Nishay; Milland, Thor; Mukherjee, Vikramjit; Uppal, Amit; Goldberg, Randal I.; Divita, Michael; Asef, Fariha; Wan, Kah Loon; Vlahakis, Susan; Patel, Mansi; Mertola, Ma-Rosario; Stasolla, Vito; Bianco, Lauren; Nunemacher, Kayla M.; Yunaev, Victoria; Howe, William B.; Cruz, Jennifer; Bernard, Samuel; Bangalore, Sripal; Keller, Norma M.
ISSN: 0012-3692
CID: 5523002

Microbial signatures in the lower airways of mechanically ventilated COVID-19 patients associated with poor clinical outcome

Sulaiman, Imran; Chung, Matthew; Angel, Luis; Tsay, Jun-Chieh J; Wu, Benjamin G; Yeung, Stephen T; Krolikowski, Kelsey; Li, Yonghua; Duerr, Ralf; Schluger, Rosemary; Thannickal, Sara A; Koide, Akiko; Rafeq, Samaan; Barnett, Clea; Postelnicu, Radu; Wang, Chang; Banakis, Stephanie; Pérez-Pérez, Lizzette; Shen, Guomiao; Jour, George; Meyn, Peter; Carpenito, Joseph; Liu, Xiuxiu; Ji, Kun; Collazo, Destiny; Labarbiera, Anthony; Amoroso, Nancy; Brosnahan, Shari; Mukherjee, Vikramjit; Kaufman, David; Bakker, Jan; Lubinsky, Anthony; Pradhan, Deepak; Sterman, Daniel H; Weiden, Michael; Heguy, Adriana; Evans, Laura; Uyeki, Timothy M; Clemente, Jose C; de Wit, Emmie; Schmidt, Ann Marie; Shopsin, Bo; Desvignes, Ludovic; Wang, Chan; Li, Huilin; Zhang, Bin; Forst, Christian V; Koide, Shohei; Stapleford, Kenneth A; Khanna, Kamal M; Ghedin, Elodie; Segal, Leopoldo N
Respiratory failure is associated with increased mortality in COVID-19 patients. There are no validated lower airway biomarkers to predict clinical outcome. We investigated whether bacterial respiratory infections were associated with poor clinical outcome of COVID-19 in a prospective, observational cohort of 589 critically ill adults, all of whom required mechanical ventilation. For a subset of 142 patients who underwent bronchoscopy, we quantified SARS-CoV-2 viral load, analysed the lower respiratory tract microbiome using metagenomics and metatranscriptomics and profiled the host immune response. Acquisition of a hospital-acquired respiratory pathogen was not associated with fatal outcome. Poor clinical outcome was associated with lower airway enrichment with an oral commensal (Mycoplasma salivarium). Increased SARS-CoV-2 abundance, low anti-SARS-CoV-2 antibody response and a distinct host transcriptome profile of the lower airways were most predictive of mortality. Our data provide evidence that secondary respiratory infections do not drive mortality in COVID-19 and clinical management strategies should prioritize reducing viral replication and maximizing host responses to SARS-CoV-2.
PMID: 34465900
ISSN: 2058-5276
CID: 4998422

Point-of-care ultrasound in a pandemic: Practical guidance in COVID-19 units

Deshwal, Himanshu; Pradhan, Deepak; Mukherjee, Vikramjit
The coronavirus disease 2019 (COVID-19) pandemic has stretched our healthcare system to the brink, highlighting the importance of efficient resource utilization without compromising healthcare provider safety. While advanced imaging is a great resource for diagnostic purposes, the risk of contamination and infection transmission is high and requires extensive logistical planning for intrahospital patient transport, healthcare provider safety, and post-imaging decontamination. This dilemma has necessitated the transition to more bedside imaging. More so than ever, during the current pandemic, the clinical utility and importance of point-of-care ultrasound (POCUS) cannot be overstressed. It allows for safe and efficient beside procedural guidance and provides front line providers with valuable diagnostic information that can be acted upon in real-time for immediate clinical decision-making. The authors have been routinely using POCUS for the management of COVID-19 patients both in the emergency department and in intensive care units turned into "COVID-units." In this article, we review the nuances of using POCUS in a pandemic situation and maximizing diagnostic output from this bedside technology. Additionally, we review various methods and diagnostic uses of POCUS which can replace conventional imaging and bridge current literature and common clinical practices in critically ill patients. We discuss practical guidance and pertinent review of the literature for the most relevant procedural and diagnostic guidance of respiratory illness, hemodynamic decompensation, renal failure, and gastrointestinal disorders experienced by many patients admitted to COVID-units.
PMID: 34616657
ISSN: 2220-3141
CID: 5085192

How would new york ventilator reallocation policies perform during a COVID-19 surge? An observational cohort study [Meeting Abstract]

Walsh, B C; Pradhan, D
COVID-19 has created significant strain on the supply of healthcare resources and, during the spring surge in New York City, many hospitals prepared resource allocation policies should the demand for ventilators exceed supply. In such circumstances, resources should remain allocated to patients most likely to survive. Understanding how these guidelines perform is an important consideration in disaster planning. Numerous allocation guidelines exist however nearly all utilize a Sequential Organ Failure Assessment (SOFA) score. We sought to evaluate the performance of ventilator reallocation by applying the New York State Ventilator Allocation Guidelines (NYVAG) to a large cohort of COVID-19 patients. Our retrospective cohort included 895 intubated COVID-19 patients admitted to an academic system in New York City. SOFA scores were calculated for every day of mechanical ventilation. Per NYVAG, patients would have their ventilator reallocated at 48 hours if their interval SOFA score increased, did not change from an initial SOFA of 8-11, or was greater than 11. At 120 hours it would be reallocated if their SOFA score worsened or was greater than 7. At 168 hours and every subsequent 48 hours it would be reallocated if their SOFA score worsened. Ventilator reallocation was simulated and no reallocation was made for any patient. The average SOFA (n=895) at the time of intubation was 7.1 +/- 3.6. At the 48-hour reassessment (average SOFA 8.2 +/- 3.6, n=759), 436 (57%) patients would have their ventilator reallocated, 145 (33%) of whom would later survive to discharge. At the 120-hour reassessment (average SOFA 7.8 +/- 3.6, n=264) 173 (66%) of the 264 remaining simulated ventilated patients would have their ventilators reallocated, 83 (48%) of whom would later survive to discharge. At the 168-hour reassessment (average SOFA 7.8 +/- 3.6, n=80) 66 (83%) of the 80 simulated remaining ventilated patients would have their ventilators reallocated. Overall, 685 patients (77%) of the starting cohort would have had their ventilator reallocated at some time during the first 168 hours of mechanical ventilation, 268 (40%) of whom survived to discharge. Our simulated study found that the application of NYVAG to the COVID-19 surge at one academic system would have resulted in a significant portion of ventilated patients having had their ventilators reallocated. This may be deeply concerning as a significant portion of patients ultimately survived to discharge. These results call for further confirmatory studies and have implications for optimal resource allocation strategies during pandemics
ISSN: 1535-4970
CID: 4915662