The impact of COVID-19 critical illness on new disability, functional outcomes and return to work at 6 months: a prospective cohort study

Background: There are few reports of new functional impairment following critical illness from COVID-19. We aimed to describe the incidence of death or new disability, functional impairment and changes in health-related quality of life of patients after COVID-19 critical illness at 6 months. Methods: In a nationally representative, multicenter, prospective cohort study of COVID-19 critical illness, we determined the prevalence of death or new disability at 6 months, the primary outcome. We measured mortality, new disability and return to work with changes in the World Health Organization Disability Assessment Schedule 2.0 12L (WHODAS) and health status with the EQ5D-5LTM. Results: Of 274 eligible patients, 212 were enrolled from 30 hospitals. The median age was 61 (51–70) years, and 124 (58.5%) patients were male. At 6 months, 43/160 (26.9%) patients died and 42/108 (38.9%) responding survivors reported new disability. Compared to pre-illness, the WHODAS percentage score worsened (mean difference (MD), 10.40% [95% CI 7.06–13.77]; p < 0.001). Thirteen (11.4%) survivors had not returned to work due to poor health. There was a decrease in the EQ-5D-5LTM utility score (MD, − 0.19 [− 0.28 to − 0.10]; p < 0.001). At 6 months, 82 of 115 (71.3%) patients reported persistent symptoms. The independent predictors of death or new disability were higher severity of illness and increased frailty. Conclusions: At six months after COVID-19 critical illness, death and new disability was substantial. Over a third of survivors had new disability, which was widespread across all areas of functioning.Carol L. Hodgson, Alisa M. Higgins, Michael J. Bailey, Anne M. Mather, Lisa Beach, Rinaldo Bellomo, Bernie Bissett, Ianthe J. Boden, Scott Bradley, Aidan Burrell, D. James Cooper, Bentley J. Fulcher, Kimberley J. Haines, Jack Hopkins, Alice Y. M. Jones, Stuart Lane, Drew Lawrence, Lisa van der Lee, Jennifer Liacos, Natalie J. Linke, Lonni Marques Gomes, Marc Nickels, George Ntoumenopoulos, Paul S. Myles, Shane Patman, Michelle Paton, Gemma Pound, Sumeet Rai, Alana Rix, Thomas C. Rollinson, Janani Sivasuthan, Claire J. Tipping, Peter Thomas, Tony Trapani, Andrew A. Udy, Christina Whitehead, Isabelle T. Hodgson, Shannah Anderson, Ary Serpa Neto, and The COVID-Recovery Study Investigators and the ANZICS Clinical Trials Grou

Cardiopulmonary resuscitation and back injury in ambulance officers

Objective: Cardiopulmonary resuscitation (CPR) is frequently performed by allied health professionals, and, if undertaken in compromised positions, it may induce injury to the rescuer's spine. Back pain as an occupational symptom in manual workers has received considerable attention in the medical literature, but there is no report on the effect of CPR on back discomfort. This article reports a survey that explored the difficulties encountered by ambulance officers during the CPR procedure. Methods: A questionnaire was sent to ambulance officers who had CPR experience through the Director and station officers-in-charge of the Fire Services Department in Hong Kong. Results: Analysis of 318 completed questionnaires showed that the duration of the CPR procedure could last up to 32 min. Two hundred and ninety ambulance officers had experience in delivering CPR on a bed, and 60% of them often had to climb onto the bed with their legs overhanging to perform CPR. Eighty-nine percent were often required to turn their head or twist their back to look at the monitor during CPR. Almost 60% complained of always, and 36% sometimes, experiencing back discomfort during CPR. Only 4.5% had no experience of back discomfort during CPR. Seventy-six (24%) respondents suffered back injury, and as many as 62% of these 76 officers considered the cause of their back injury was related to CPR delivery. Nearly 50% of respondents reported that it was difficult to maintain balance and concurrently deliver CPR while travelling in the ambulance or when the patient was being transported from one location to another. Conclusions: Results of this survey suggest that there is a need to review the support given to ambulance officers to ensure safe administration of CPR, particularly during ambulance transport.Department of Rehabilitation Science