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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| Format: | Article |
| Language: | English |
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MDPI AG
2021-04-01
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| Series: | Membranes |
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| Online Access: | https://www.mdpi.com/2077-0375/11/4/258 |
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Article |
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DOAJ |
| language |
English |
| format |
Article |
| sources |
DOAJ |
| author |
Sagar Dave Aakash Shah Samuel Galvagno Kristen George Ashley R. Menne Daniel J. Haase Brian McCormick Raymond Rector Siamak Dahi Ronson J. Madathil Kristopher B. Deatrick Mehrdad Ghoreishi James S. Gammie David J. Kaczorowski Thomas M. Scalea Jay Menaker Daniel Herr Eric Krause Ali Tabatabai |
| spellingShingle |
Sagar Dave Aakash Shah Samuel Galvagno Kristen George Ashley R. Menne Daniel J. Haase Brian McCormick Raymond Rector Siamak Dahi Ronson J. Madathil Kristopher B. Deatrick Mehrdad Ghoreishi James S. Gammie David J. Kaczorowski Thomas M. Scalea Jay Menaker Daniel Herr Eric Krause Ali Tabatabai A Dedicated Veno-Venous Extracorporeal Membrane Oxygenation Unit during a Respiratory Pandemic: Lessons Learned from COVID-19 Part I: System Planning and Care Teams Membranes extracorporeal membrane oxygenation COVID-19 acute respiratory distress syndrome biocontainment unit |
| author_facet |
Sagar Dave Aakash Shah Samuel Galvagno Kristen George Ashley R. Menne Daniel J. Haase Brian McCormick Raymond Rector Siamak Dahi Ronson J. Madathil Kristopher B. Deatrick Mehrdad Ghoreishi James S. Gammie David J. Kaczorowski Thomas M. Scalea Jay Menaker Daniel Herr Eric Krause Ali Tabatabai |
| author_sort |
Sagar Dave |
| 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_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_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_sort |
dedicated veno-venous extracorporeal membrane oxygenation unit during a respiratory pandemic: lessons learned from covid-19 part i: system planning and care teams |
| publisher |
MDPI AG |
| series |
Membranes |
| issn |
2077-0375 |
| publishDate |
2021-04-01 |
| 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. |
| topic |
extracorporeal membrane oxygenation COVID-19 acute respiratory distress syndrome biocontainment unit |
| url |
https://www.mdpi.com/2077-0375/11/4/258 |
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doaj-014bee7a3a924327ae14373ab16bcc202021-04-02T23:04:20ZengMDPI AGMembranes2077-03752021-04-011125825810.3390/membranes11040258A Dedicated Veno-Venous Extracorporeal Membrane Oxygenation Unit during a Respiratory Pandemic: Lessons Learned from COVID-19 Part I: System Planning and Care TeamsSagar Dave0Aakash Shah1Samuel Galvagno2Kristen George3Ashley R. Menne4Daniel J. Haase5Brian McCormick6Raymond Rector7Siamak Dahi8Ronson J. Madathil9Kristopher B. Deatrick10Mehrdad Ghoreishi11James S. Gammie12David J. Kaczorowski13Thomas M. Scalea14Jay Menaker15Daniel Herr16Eric Krause17Ali Tabatabai18Department of Surgery, Program in Trauma, University of Maryland School of Medicine, Baltimore, MD 21201, USADepartment of Surgery, Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USADepartment of Anesthesiology, Program in Trauma, University of Maryland School of Medicine, Baltimore, MD 21201, USADepartment of Surgery, Program in Trauma, University of Maryland School of Medicine, Baltimore, MD 21201, USADepartment of Emergency Medicine, Program in Trauma, University of Maryland School of Medicine, Baltimore, MD 21201, USADepartment of Emergency Medicine, Program in Trauma, University of Maryland School of Medicine, Baltimore, MD 21201, USAPerfusion Services, University of Maryland Medical Center, Baltimore, MD 21201, USAPerfusion Services, University of Maryland Medical Center, Baltimore, MD 21201, USADepartment of Surgery, Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USADepartment of Surgery, Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USADepartment of Surgery, Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USADepartment of Surgery, Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USADepartment of Surgery, Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USADepartment of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USADepartment of Surgery, Program in Trauma, University of Maryland School of Medicine, Baltimore, MD 21201, USADepartment of Surgery, University of California San Francisco Medical Center, San Francisco, CA 94143, USADepartment of Surgery, Program in Trauma, University of Maryland School of Medicine, Baltimore, MD 21201, USADepartment of Surgery, Division of Thoracic Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USADepartment of Medicine, Division of Pulmonary and Critical Care, Program in Trauma, University of Maryland School of Medicine, Baltimore, MD 21201, USA.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.https://www.mdpi.com/2077-0375/11/4/258extracorporeal membrane oxygenationCOVID-19acute respiratory distress syndromebiocontainment unit |