A percutaneous method via the brachial artery for left heart catheterization and selective coronary angiography is described. The technique uses the sheath intended for the femoral artery, continuously infused and introduced following a particular technique. The procedure was performed with minimal complications over 18 months, with multipurpose "Schoonmaker" or preshaped catheters, in all the patients (37) in whom the femoral approach was contraindicated or failed. When a catheterization must be performed from the arm, this method, without cutdown and arteriotomy and allowing a good distal flow during the procedure, appears to have some advantages over the classical Sones technique or the percutaneous arterial axillary approach.

The Philippines has the highest COVID-19 mortality rate by country (per million) in South East Asia. We aim to explore predictors of mortality among critically ill COVID-19 patients. METHODSThis single-centered, retrospective cohort study included consecutive patients with confirmed COVID-19 infection and acute respiratory distress syndrome requiring mechanical ventilation and intensive care unit (ICU) admission at The Medical City hospital from March 6 to March 31, 2020. Clinical data were obtained from medical records review and compared between survivors and non-survivors. RESULTSAmong 30 patients (mean age 65±3 years, interquartile range 32-86; 63% male), hypertension (67%), diabetes mellitus (45%), hyperlipidemia (40%) and smoking history (30%) were common. Those with echocardiogram showed no left ventricular dysfunction except 1 (preexisting heart failure), despite elevated troponin and NT-pro BNP. All had sepsis; 87% had septic shock. Twenty two (73%) died, 6 (20%) discharged improved, 1 (3%) transferred to another hospital (outcome unknown), and 1 (3%) still admitted. Mean duration from ICU admission to death was 13 days for non-survivors. Use of norepinephrine plus vasopressin and unfractionated heparin (UFH) for thromboprophylaxis were significantly higher among non-survivors versus survivors. There was a nonsignificant trend towards a higher mean troponin and NT-proBNP among non-survivors versus survivors. CONCLUSIONWe report that use of norepinephrine plus vasopressin and UFH for thromboprophylaxis were predictors of mortality among critically ill COVID-19 patients. Mean survival time of non-survivors is likely to be 13 days after ICU admission. Elevated troponin and NT-proBNP were not associated with increased mortality.

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