Accuracy of peak VO2 assessments in career firefighters

Abstract Background Sudden cardiac death is the leading cause of on-duty death in United States firefighters. Accurately assessing cardiopulmonary capacity is critical to preventing, or reducing, cardiovascular events in this population. Methods A total of 83 male firefighters performed Wellness-Fitness Initiative (WFI) maximal exercise treadmill tests and direct peak VO2 assessments to volitional fatigue. Of the 83, 63 completed WFI sub-maximal exercise treadmill tests for comparison to directly measured peak VO2 and historical estimations. Results Maximal heart rates were overestimated by the traditional 220-age equation by about 5 beats per minute (p < .001). Peak VO2 was overestimated by the WFI maximal exercise treadmill and the historical WFI sub-maximal estimation by ~ 1MET and ~ 2 METs, respectively (p < 0.001). The revised 2008 WFI sub-maximal treadmill estimation was found to accurately estimate peak VO2 when compared to directly measured peak VO2. Conclusion Accurate assessment of cardiopulmonary capacity is critical in determining appropriate duty assignments, and identification of potential cardiovascular problems, for firefighters. Estimation of cardiopulmonary fitness improves using the revised 2008 WFI sub-maximal equation

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Cardiovascular Risk Factors in Career Firefighters

CARDIOVASCULAR RISK FACTORS IN CAREER FIREFIGHTERSBackground: Sudden cardiac death is the leading cause of on-duty death among career firefighters. Limited literature as to the etiology of on-duty sudden cardiac death in firefighters is available. Cardiovascular risk profiles of firefighters are similar to those of the general population. Firefighters seem not to be protected from the national obesity epidemic; and hypertension and/or hypercholesteremia are often not diagnosed, or are under treated. Methods: Accurately assessing cardiopulmonary capacity in career firefighters is critical to duty assignment and prevention of sudden cardiac death. Eighty-three male career firefighters performed maximal exercise treadmills (per the revised 2008 Wellness-Fitness Initiative (WFI)) and direct VO2max assessments to determine the accuracy of WFI estimates of VO2max and maximal heart rate.VO2 and heart rate at ventilatory threshold and at maximal exercise were measured. They then wore Holter monitors and were asked to record their activities for 24 hours on duty. Subsequently, 63 career firefighters completed a sub-maximal exercise treadmill for comparison to the direct measure VO2max and historical estimates. Results: The WFI maximal exercise treadmill test overestimated ~ 1.16 METs; the initial WFI sub-maximal estimation over-estimated ~ 2.23 METs; and the revised WFI sub-maximal estimation was found to accurately estimate VO2max when compared to directly measured VO2max. Maximum heart rates on duty were analyzed to determine if measured maximal heart rate, or heart rate at ventilatory threshold, were reached. About 18% exceeded their measured maximal heart rate, 51% exceeded their measured heart rate at ventilatory threshold, and 20.5% had an episode of tachycardia while on duty. The most common activity at peak 24-hour heart rate was exercising (32.5%), followed by performance drills (28.9%), pack tests (14.5%), fire suppression and overhaul (10.8%), responding to other calls (9.6%), and other (3.7%). About 90% of the participants experienced elevated heart rates while being monitored. The range of maximum METs demonstrated on duty was 4.8 to 17.0. Implications: Excessive heart rates and work demands may contribute to cardiac compromise if there is underlying cardiovascular disease. Occupational health practitioners should advocate for accurate cardiopulmonary testing and treatment of underlying cardiovascular risk factors in career firefighters

Characteristics and Predictors of Occupational Injury Among Career Firefighters.

The purpose of this study was to assess occupational injury characteristics and predictors among career firefighters. A total of 249 firefighters from central Texas and northern California participated in this Internet-based survey. Approximately 27% of firefighters had reported an occupational injury within the previous 12 months. The majority of injuries occurred on the scene of a non-fire call while performing an activity that required lifting, pushing, or pulling. Firefighters' backs were most frequently injured. Of the reported injuries, approximately 18% returned to work on modified duty, but 46% were not allowed to work due to their occupational injuries. Firefighters who reported occupational injuries were more likely to be older and experiencing occupational stress compared with their coworkers who did not report occupational injuries. Injured firefighters were also more likely to report fewer job rewards (money/salary), overcommitment, less esteem (respect and support), and fewer promotional prospects. These injury factors should be incorporated into interventions to reduce or prevent workplace injuries