Cargando…
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...
Autores principales: | , , , , , , , , , , , , , , , , , , |
---|---|
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 |
_version_ | 1783682450943115264 |
---|---|
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. |
format | Online Article Text |
id | pubmed-8065909 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
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 |
work_keys_str_mv | AT davesagar adedicatedvenovenousextracorporealmembraneoxygenationunitduringarespiratorypandemiclessonslearnedfromcovid19partisystemplanningandcareteams AT shahaakash adedicatedvenovenousextracorporealmembraneoxygenationunitduringarespiratorypandemiclessonslearnedfromcovid19partisystemplanningandcareteams AT galvagnosamuel adedicatedvenovenousextracorporealmembraneoxygenationunitduringarespiratorypandemiclessonslearnedfromcovid19partisystemplanningandcareteams AT georgekristen adedicatedvenovenousextracorporealmembraneoxygenationunitduringarespiratorypandemiclessonslearnedfromcovid19partisystemplanningandcareteams AT menneashleyr adedicatedvenovenousextracorporealmembraneoxygenationunitduringarespiratorypandemiclessonslearnedfromcovid19partisystemplanningandcareteams AT haasedanielj adedicatedvenovenousextracorporealmembraneoxygenationunitduringarespiratorypandemiclessonslearnedfromcovid19partisystemplanningandcareteams AT mccormickbrian adedicatedvenovenousextracorporealmembraneoxygenationunitduringarespiratorypandemiclessonslearnedfromcovid19partisystemplanningandcareteams AT rectorraymond adedicatedvenovenousextracorporealmembraneoxygenationunitduringarespiratorypandemiclessonslearnedfromcovid19partisystemplanningandcareteams AT dahisiamak adedicatedvenovenousextracorporealmembraneoxygenationunitduringarespiratorypandemiclessonslearnedfromcovid19partisystemplanningandcareteams AT madathilronsonj adedicatedvenovenousextracorporealmembraneoxygenationunitduringarespiratorypandemiclessonslearnedfromcovid19partisystemplanningandcareteams AT deatrickkristopherb adedicatedvenovenousextracorporealmembraneoxygenationunitduringarespiratorypandemiclessonslearnedfromcovid19partisystemplanningandcareteams AT ghoreishimehrdad adedicatedvenovenousextracorporealmembraneoxygenationunitduringarespiratorypandemiclessonslearnedfromcovid19partisystemplanningandcareteams AT gammiejamess adedicatedvenovenousextracorporealmembraneoxygenationunitduringarespiratorypandemiclessonslearnedfromcovid19partisystemplanningandcareteams AT kaczorowskidavidj adedicatedvenovenousextracorporealmembraneoxygenationunitduringarespiratorypandemiclessonslearnedfromcovid19partisystemplanningandcareteams AT scaleathomasm adedicatedvenovenousextracorporealmembraneoxygenationunitduringarespiratorypandemiclessonslearnedfromcovid19partisystemplanningandcareteams AT menakerjay adedicatedvenovenousextracorporealmembraneoxygenationunitduringarespiratorypandemiclessonslearnedfromcovid19partisystemplanningandcareteams AT herrdaniel adedicatedvenovenousextracorporealmembraneoxygenationunitduringarespiratorypandemiclessonslearnedfromcovid19partisystemplanningandcareteams AT krauseeric adedicatedvenovenousextracorporealmembraneoxygenationunitduringarespiratorypandemiclessonslearnedfromcovid19partisystemplanningandcareteams AT tabatabaiali adedicatedvenovenousextracorporealmembraneoxygenationunitduringarespiratorypandemiclessonslearnedfromcovid19partisystemplanningandcareteams AT davesagar dedicatedvenovenousextracorporealmembraneoxygenationunitduringarespiratorypandemiclessonslearnedfromcovid19partisystemplanningandcareteams AT shahaakash dedicatedvenovenousextracorporealmembraneoxygenationunitduringarespiratorypandemiclessonslearnedfromcovid19partisystemplanningandcareteams AT galvagnosamuel dedicatedvenovenousextracorporealmembraneoxygenationunitduringarespiratorypandemiclessonslearnedfromcovid19partisystemplanningandcareteams AT georgekristen dedicatedvenovenousextracorporealmembraneoxygenationunitduringarespiratorypandemiclessonslearnedfromcovid19partisystemplanningandcareteams AT menneashleyr dedicatedvenovenousextracorporealmembraneoxygenationunitduringarespiratorypandemiclessonslearnedfromcovid19partisystemplanningandcareteams AT haasedanielj dedicatedvenovenousextracorporealmembraneoxygenationunitduringarespiratorypandemiclessonslearnedfromcovid19partisystemplanningandcareteams AT mccormickbrian dedicatedvenovenousextracorporealmembraneoxygenationunitduringarespiratorypandemiclessonslearnedfromcovid19partisystemplanningandcareteams AT rectorraymond dedicatedvenovenousextracorporealmembraneoxygenationunitduringarespiratorypandemiclessonslearnedfromcovid19partisystemplanningandcareteams AT dahisiamak dedicatedvenovenousextracorporealmembraneoxygenationunitduringarespiratorypandemiclessonslearnedfromcovid19partisystemplanningandcareteams AT madathilronsonj dedicatedvenovenousextracorporealmembraneoxygenationunitduringarespiratorypandemiclessonslearnedfromcovid19partisystemplanningandcareteams AT deatrickkristopherb dedicatedvenovenousextracorporealmembraneoxygenationunitduringarespiratorypandemiclessonslearnedfromcovid19partisystemplanningandcareteams AT ghoreishimehrdad dedicatedvenovenousextracorporealmembraneoxygenationunitduringarespiratorypandemiclessonslearnedfromcovid19partisystemplanningandcareteams AT gammiejamess dedicatedvenovenousextracorporealmembraneoxygenationunitduringarespiratorypandemiclessonslearnedfromcovid19partisystemplanningandcareteams AT kaczorowskidavidj dedicatedvenovenousextracorporealmembraneoxygenationunitduringarespiratorypandemiclessonslearnedfromcovid19partisystemplanningandcareteams AT scaleathomasm dedicatedvenovenousextracorporealmembraneoxygenationunitduringarespiratorypandemiclessonslearnedfromcovid19partisystemplanningandcareteams AT menakerjay dedicatedvenovenousextracorporealmembraneoxygenationunitduringarespiratorypandemiclessonslearnedfromcovid19partisystemplanningandcareteams AT herrdaniel dedicatedvenovenousextracorporealmembraneoxygenationunitduringarespiratorypandemiclessonslearnedfromcovid19partisystemplanningandcareteams AT krauseeric dedicatedvenovenousextracorporealmembraneoxygenationunitduringarespiratorypandemiclessonslearnedfromcovid19partisystemplanningandcareteams AT tabatabaiali dedicatedvenovenousextracorporealmembraneoxygenationunitduringarespiratorypandemiclessonslearnedfromcovid19partisystemplanningandcareteams |