COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Techniques for Inflow Cannula Placement

An adequate surgical technique is paramount for the outcome of any surgical procedure. Implantation of left ventricular assist devices (LVADs) presents a series of technical challenges for the appropriate placement and long-term function of the device. The proper positioning of the inflow cannula is possibly the most important technical aspect of LVAD implantation. This chapter is intended to highlight pitfalls related to placement of the inflow cannula during implantation of LVAD

Preservation of aortic leaflets during rapid deployment valve implantation in patients with aortic insufficiency

Development of a new surgical technique for aortic valve replacement with the use of rapid deployment/sutureless valve: a leaflet preservation technique applying imbrication methods to pliable aortic leaflets. We aim to decrease the incidence of paravalvular leak by preserving aortic leaflets in patients with aortic insufficiency and large aortic annulus

Treatment of Refractory Intraoperative Hypoxemia After Trauma With Venovenous Extracorporeal Membrane Oxygenation: A Case Report

Extracorporeal membrane oxygenation has emerged as a treatment of choice for refractory hypoxemia in the intensive care unit. Severe hypoxemia unresponsive to conventional lung-protective mechanical ventilation could also occur in the operating room from severe bronchospasm, pulmonary contusions, or acute respiratory distress syndrome. We report a case of acute hypoxic respiratory failure in an adolescent with blunt chest trauma that was successfully managed with the intraoperative initiation of venovenous extracorporeal membrane oxygenation during the initial damage control surgery

Heart and kidney transplant from donor with recent veno‐arterial extracorporeal cardiopulmonary resuscitation

Objetives ECMO is progressively being adopted as a last resort to stabilize patients receiving cardiopulmonary resuscitation (ECMO CPR). A significant number of these patients will present recovery of end‐organ function, but evolve with brain death, accounting for only 30% of patients discharged from the hospital alive. Harvesting organs from donors on VA ECMO has recently been proposed as a strategy to expand the pool of available organs for transplantation. Methods We present a case of combined heart and kidney transplantation from a brain death donor with recent out of hospital cardiac arrest rescued with eCPR. Results A 31 year old male patient was admitted to local hospital with diagnosis of drowning after seizure episode. Patient received two rounds of CPR for 8 and 30 minutes respectively, and required emergency insertion of VA ECMO. Patient developed compartment syndrome of right lower extremity (RLE) with CPK = 30,720, prompting discontinuation of ECMO support within 48 hours as cardiac function had recovered, reflected on echocardiographic and enzymatic parameters. Patient was declared brain death and became organ donor. Multiple organ procurement was performed. Combined heart and right kidney transplant was then performed on a 61‐year‐old male with uneventful course, and with normal function of all implanted allografts at 3 months follow up. Conclusion Our experience supports the concept that VA ECMO is not a contraindication for solid organ donation. Individual evaluation of organ function can lead to successful transplantation of multiple organs from donors with recent history of VA ECMO support

Horner's syndrome following single lung transplantation

Lung transplantation have significantly improved quality of life in patients with end stage respiratory failure, however use of lifelong immunosuppressive therapy and development of bronchiolitis obliterans reflects in a 5‐year survival is less the 60%. Ophthalmic complications following lung transplantation are uncommon. Some cases of infectious and malignant ophthalmic complications have been described previously. Here we describe a case of Horner's syndrome following single lung transplantation

Long-term outcomes of elderly patients receiving continuous flow left ventricular support

Heart failure is an epidemic affecting over 6 million people in the United States. Eighty percent of all heart failure patients are older than 65 years of age. Heart transplant is the gold standard treatment for patients suffering advanced heart failure, but only 18.5% of patients receiving heart transplant in the United States are 65 years of age or older. Continuous-flow left ventricular assist devices are a safe and effective therapy for patients with advanced heart failure, and can be used to bridge patients to a heart transplant or to support patients long-term as destination therapy. We sought to characterize long-term outcomes of elderly patients receiving continuous-flow left ventricular support in our program. Elderly patients with advanced heart failure presented comparable operative results to those of younger patients. The rate of complications up to 6 years of support was low, and comparable to those of younger patients. An effective and safe alternative for patients whom are less likely to receive heart transplantation