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A Dedicated Veno-Venous Extracorporeal Membrane Oxygenation Unit during a Respiratory Pandemic: Lessons Learned from COVID-19 Part I: System Planning and Care Teams

Background: The most critically ill patients with coronavirus disease 2019 (COVID-19) may require advanced support modalities, such as veno-venous extracorporeal membrane oxygenation (VV-ECMO). A systematic, methodical approach to a respiratory pandemic on a state and institutional level is critical...

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Autores principales: Dave, Sagar, Shah, Aakash, Galvagno, Samuel, George, Kristen, Menne, Ashley R., Haase, Daniel J., McCormick, Brian, Rector, Raymond, Dahi, Siamak, Madathil, Ronson J., Deatrick, Kristopher B., Ghoreishi, Mehrdad, Gammie, James S., Kaczorowski, David J., Scalea, Thomas M., Menaker, Jay, Herr, Daniel, Krause, Eric, Tabatabai, Ali
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8065909/
https://www.ncbi.nlm.nih.gov/pubmed/33918355
http://dx.doi.org/10.3390/membranes11040258
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author Dave, Sagar
Shah, Aakash
Galvagno, Samuel
George, Kristen
Menne, Ashley R.
Haase, Daniel J.
McCormick, Brian
Rector, Raymond
Dahi, Siamak
Madathil, Ronson J.
Deatrick, Kristopher B.
Ghoreishi, Mehrdad
Gammie, James S.
Kaczorowski, David J.
Scalea, Thomas M.
Menaker, Jay
Herr, Daniel
Krause, Eric
Tabatabai, Ali
author_facet Dave, Sagar
Shah, Aakash
Galvagno, Samuel
George, Kristen
Menne, Ashley R.
Haase, Daniel J.
McCormick, Brian
Rector, Raymond
Dahi, Siamak
Madathil, Ronson J.
Deatrick, Kristopher B.
Ghoreishi, Mehrdad
Gammie, James S.
Kaczorowski, David J.
Scalea, Thomas M.
Menaker, Jay
Herr, Daniel
Krause, Eric
Tabatabai, Ali
author_sort Dave, Sagar
collection PubMed
description Background: The most critically ill patients with coronavirus disease 2019 (COVID-19) may require advanced support modalities, such as veno-venous extracorporeal membrane oxygenation (VV-ECMO). A systematic, methodical approach to a respiratory pandemic on a state and institutional level is critical. Methods: We conducted retrospective review of our institutional response to the COVID-19 pandemic, focusing on the creation of a dedicated airlock biocontainment unit (BCU) to treat patients with refractory COVID-19 acute respiratory distress syndrome (CARDS). Data were collected through conversations with staff on varying levels in the BCU, those leading the effort to make the BCU and hospital incident command system, email communications regarding logistic changes being implemented, and a review of COVID-19 patient census at our institution from March through June 2020. Results: Over 2100 patients were successfully admitted to system hospitals; 29% of these patients required critical care. The response to this respiratory pandemic augmented intensive care physician staffing, created a 70-member nursing team, and increased the extracorporeal membrane oxygenation (ECMO) capability by nearly 200%. During this time period, 40 COVID-19 patients on VV-ECMO were managed in the BCU. Challenges in an airlock unit included communication, scarcity of resources, double-bunking, and maintaining routine care. Conclusions: Preparing for a surge of critically ill patients during a pandemic can be a daunting task. The implementation of a coordinated, system-level approach can help with the allocation of resources as needed. Focusing on established strengths of hospitals within the system can guide triage based on individual patient needs. The management of ECMO patients is still a specialty care, and a systematic and hospital based approach requiring an ECMO team composed of multiple experienced individuals is paramount during a respiratory viral pandemic.
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spelling pubmed-80659092021-04-25 A Dedicated Veno-Venous Extracorporeal Membrane Oxygenation Unit during a Respiratory Pandemic: Lessons Learned from COVID-19 Part I: System Planning and Care Teams Dave, Sagar Shah, Aakash Galvagno, Samuel George, Kristen Menne, Ashley R. Haase, Daniel J. McCormick, Brian Rector, Raymond Dahi, Siamak Madathil, Ronson J. Deatrick, Kristopher B. Ghoreishi, Mehrdad Gammie, James S. Kaczorowski, David J. Scalea, Thomas M. Menaker, Jay Herr, Daniel Krause, Eric Tabatabai, Ali Membranes (Basel) Article Background: The most critically ill patients with coronavirus disease 2019 (COVID-19) may require advanced support modalities, such as veno-venous extracorporeal membrane oxygenation (VV-ECMO). A systematic, methodical approach to a respiratory pandemic on a state and institutional level is critical. Methods: We conducted retrospective review of our institutional response to the COVID-19 pandemic, focusing on the creation of a dedicated airlock biocontainment unit (BCU) to treat patients with refractory COVID-19 acute respiratory distress syndrome (CARDS). Data were collected through conversations with staff on varying levels in the BCU, those leading the effort to make the BCU and hospital incident command system, email communications regarding logistic changes being implemented, and a review of COVID-19 patient census at our institution from March through June 2020. Results: Over 2100 patients were successfully admitted to system hospitals; 29% of these patients required critical care. The response to this respiratory pandemic augmented intensive care physician staffing, created a 70-member nursing team, and increased the extracorporeal membrane oxygenation (ECMO) capability by nearly 200%. During this time period, 40 COVID-19 patients on VV-ECMO were managed in the BCU. Challenges in an airlock unit included communication, scarcity of resources, double-bunking, and maintaining routine care. Conclusions: Preparing for a surge of critically ill patients during a pandemic can be a daunting task. The implementation of a coordinated, system-level approach can help with the allocation of resources as needed. Focusing on established strengths of hospitals within the system can guide triage based on individual patient needs. The management of ECMO patients is still a specialty care, and a systematic and hospital based approach requiring an ECMO team composed of multiple experienced individuals is paramount during a respiratory viral pandemic. MDPI 2021-04-02 /pmc/articles/PMC8065909/ /pubmed/33918355 http://dx.doi.org/10.3390/membranes11040258 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Dave, Sagar
Shah, Aakash
Galvagno, Samuel
George, Kristen
Menne, Ashley R.
Haase, Daniel J.
McCormick, Brian
Rector, Raymond
Dahi, Siamak
Madathil, Ronson J.
Deatrick, Kristopher B.
Ghoreishi, Mehrdad
Gammie, James S.
Kaczorowski, David J.
Scalea, Thomas M.
Menaker, Jay
Herr, Daniel
Krause, Eric
Tabatabai, Ali
A Dedicated Veno-Venous Extracorporeal Membrane Oxygenation Unit during a Respiratory Pandemic: Lessons Learned from COVID-19 Part I: System Planning and Care Teams
title A Dedicated Veno-Venous Extracorporeal Membrane Oxygenation Unit during a Respiratory Pandemic: Lessons Learned from COVID-19 Part I: System Planning and Care Teams
title_full A Dedicated Veno-Venous Extracorporeal Membrane Oxygenation Unit during a Respiratory Pandemic: Lessons Learned from COVID-19 Part I: System Planning and Care Teams
title_fullStr A Dedicated Veno-Venous Extracorporeal Membrane Oxygenation Unit during a Respiratory Pandemic: Lessons Learned from COVID-19 Part I: System Planning and Care Teams
title_full_unstemmed A Dedicated Veno-Venous Extracorporeal Membrane Oxygenation Unit during a Respiratory Pandemic: Lessons Learned from COVID-19 Part I: System Planning and Care Teams
title_short A Dedicated Veno-Venous Extracorporeal Membrane Oxygenation Unit during a Respiratory Pandemic: Lessons Learned from COVID-19 Part I: System Planning and Care Teams
title_sort dedicated veno-venous extracorporeal membrane oxygenation unit during a respiratory pandemic: lessons learned from covid-19 part i: system planning and care teams
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8065909/
https://www.ncbi.nlm.nih.gov/pubmed/33918355
http://dx.doi.org/10.3390/membranes11040258
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