Objective Coronavirus disease 2019 (COVID-19) generally causes milder illness in the pediatric population. However, infants represent a higher-risk population with evolving symptomatology and severity. There is a paucity of large population-based data on the impact of COVID-19 on hospitalized infants. Study Design In this large cohort study, the National Inpatient Sample database was queried for all infant hospital admissions between January and December 2020 in the United States, with and without a diagnosis of COVID-19 based on ICD-10-CM U07. The mortality and morbidity of infants with and without COVID-19 were evaluated. Parent-reported race and outcomes were also analyzed. Results A weighted total of 3,754,236 infants who were hospitalized were identified, of which 4,265 patients (0.11%) had a concomitant diagnosis of COVID-19. Infants with COVID-19 had similar mortality and extracorporeal membrane oxygenation utilization. Infants with concomitant COVID-19 had a higher rate of respiratory failure, congestive heart failure, acute kidney injury, and coagulopathy. Compared with Caucasian infants and Asian infants, Hispanic and African American infants were more likely to have COVID-19 hospital admissions than hospitalizations without COVID-19 diagnosis. Patients with lower median household income represented the majority of the COVID-19 hospitalization. The infants with COVID-19 were more likely to have Medicaid or Medicare insurance and less likely to have private insurance. Conclusion In this large cohort of hospitalized infants with COVID-19, the infection was associated with complications, including respiratory failure and endotracheal intubations but not associated with a higher risk for mortality. Infants from racial minorities and lower socioeconomic strata carry the highest burden of COVID-19 infection. Key Points
Background: The Organ Care System (OCS) (Transmedics, Andover, MA) for ex vivo organ perfusion of the heart has enabled significant extension of ex situ intervals. OCS can minimize cold ischemic time, allowing for an expansion of the limited donor pool to include extended distances. As the use of OCS for donor recovery after brain death (DBD) in the United States is lacking, we report our initial experience. Methods: We reviewed consecutive DBD heart transplant (HT) patients at our center from May 2022 (FDA approval) to January 2023. Patients were stratified into two groups: OCS (N=10) vs. Conventional cold storage (Control, N=16). The indication for OCS use was an expected ischemic time >4 hours. Results: Baseline characteristics were similar (Table 1). The OCS group displayed a significantly greater distance traveled for heart recovery (OCS, 764±352 vs Control, 207±176 miles, p <0.001), in addition to mean total preservation time (6.2±0.9 vs 2.6±0.6, p<0.001) (Figure 1). No patients in the OCS group required new veno-arterial extracorporeal membrane oxygenation support (0% vs 7.7%, p=0.32). Primary graft dysfunction was comparable in both groups (OCS 10% vs Control 18.7%, p=0.55). Mortality was lower in the OCS group, with 100% in-hospital survival compared to 93.7% in conventional group (p=0.21). Conclusion: Our short-term results of the use of OCS for DBD recovery were favorable. Given our mean preservation time of approximately 7 hours and distance traveled of >700 miles, OCS can safely augment the number and viability of available organs without compromising the outcome.Figure 1. Total preservation time and cold ischemic time in OCS and conventional procurement groups
The new heart allocation policy places veno-arterial extracorporeal membrane oxygenation (VA-ECMO)-supported heart transplant (HT) candidates at the highest priority status. Despite increasing evidence supporting left ventricular (LV) unloading during VA-ECMO, the effect of LV unloading on transplant outcomes following bridging to HT with VA-ECMO remains unknown.
Renal denervation is a relatively recent concept whose initial promising results suffered a setback following the SYMPLICITY 3 trial, which did not show a significant blood pressure-lowering effect in comparison to sham. In this review article, we begin with the history including the physiological basis behind the concept of renal denervation. Furthermore, we review the literature in support of renal denervation, including the recently published SPYRAL HTN-OFF MED, which demonstrated significant blood pressure reduction in the absence of antihypertensive medication. We further touch upon the potential pitfalls and possible future directions of renal denervation.
Background: SimpleSense (Nanowear, New York, NY) is an FDA-cleared artificial intelligence (AI) based wearable diagnostic platform with multiparametric monitoring including 2-leads of ECG, thoracic impedance, heart sounds, blood pressure, posture and activity (Fig. 1 A). We explored the correlation between SimpleSense-derived and invasive hemodynamics (HD) parameters during right heart catheterization (RHC). The SimpleSense parameters assessed included amplitudes and width of heart sounds S1 and S2, ECG amplitudes, R to S1 and S2 times (Fig. 1 B), and pulse ejection period (PEP). PEP is a surrogate measurement that combines the pre-ejection period and left ventricular ejection time (Fig. 1 C). Methods: A single-center prospective feasibility study was conducted after IRB approval. Adult patients >18 yrs undergoing RHC were screened and enrolled after informed consent (NCT05629533). SimpleSense recorded data on the patients throughout the RHC procedure. We performed an exploratory analysis to identify potential correlations between the SimpleSense data and HD parameters utilizing maching learning. Results: Data from 11 subjects (8 Males, age:64.3 ± 10.23 yrs.) included 39 thermodilution cardiac outputs (CO) and 11 pulmonary artery pressures (PAP). The mean ± SD values of CO, cardiac index (CI), Systolic PAP, Diastolic PAP, and mean PAP were 4.4±1.9 l/min, 2.19±0.96 L/min/m 2 , 37.27±17.32 mmHg, 12.09±5.03 mmHg, and 22.72±8.42 mmHg respectively. Multiple SimpleSense derived data show statistically significant correlations with HD parameters (Fig. 2). The PEP metric exhibited the highest correlation with mean PAP and systolic PAP. Conclusion: The results highlight SimpleSense’s potential as a non-invasive AI tool that could revolutionize management by offering a reliable alternative to traditional invasive RHC. With further validation, SimpleSense may provide continuous, real-time hemodynamic information, significantly enhancing patient care and outcomes.
