International Journal of Critical Care

A Brief Overview of the Use of Extracorporeal Membrane Oxygenation (ECMO) in COVID-19 Patients with Severe Acute Respiratory Distress Syndrome (ARDS)

Antony Macido — 2023-05-01

Background

A serious complication of coronavirus disease 2019 (COVID-19) is acute respiratory distress syndrome (ARDS). Hypoxemia refractory to traditional management, including invasive positive pressure ventilation, is not uncommon with COVID-19. It can lead to circulatory failure necessitating the use of mechanical circulatory support devices, specifically extracorporeal membrane oxygenation (ECMO).

Aim

This paper provides a brief update on the use and indications of ECMO for adult patients with COVID-19 around the world.

Methods

We conducted a rapid umbrella review on the use of ECMO in treating COVID-19-related ARDS (CARDS), as well as current indications and contraindications for the initiation of ECMO. We reviewed the use of venovenous (V-V) ECMO and veno-arterial (V-A) ECMO in CARDS.

Findings

V-V ECMO is the primary ECMO mode employed in the majority of the patients who required ECMO support for CARDS. Although the duration of V-V ECMO in COVID-19 was longer than the V-V ECMO in non-COVID-19 patients with ARDS, the mortality rate appears similar. Meta-analyses reviewed reported an in-hospital mortality rate ranging from 37% to 49% for COVID-19 patients who required V-V ECMO.

Conclusion

The survival benefit of ECMO in COVID-19 patients with severe cardiopulmonary failure is not clearly established, but V-V ECMO may be considered in adults with COVID-19 and severe cardiopulmonary compromise when resources are available. V-A ECMO may be considered in COVID-19 patients with severe cardiac failure, but limited data are available on survival benefits.

Recognizing Professor Louise Rose

Ged Williams — 2023-05-01

This is an acknowledgment of Professor Louise Rose, Guest Editor IJCC for this issue, who was recently awarded the honour of Member of the British Empire (MBE) for services to the United Kingdom (UK) National Health Service (NHS) during the COVID-19 pandemic.

The Story of Life Lines

Louise Rose — 2023-05-01

In this editorial, the author highlights the development and implementation of Life Lines, a virtual visiting solution, that was developed in England during the COVID-19 pandemic. Life Lines aims to identify new communication solutions for critically ill patients and their family members through virtual visiting.

Reinvigorating Critical Care Nurses Post-Pandemic Through a Critical Care Certification Pilot Program

Stacy Hull — 2023-05-01

Background

In 2022, after two and a half long years of caring for COVID-19 patients on the frontlines, critical care nurses were burnt out and leaving the bedside. Aim To reinvigorate critical care nurses, a large multisystem healthcare organization’s Nurse Scholars Academy partnered with Springer Publishing to offer a dynamic self-paced online review course for the critical care certification exam.

Methods

Recruitment strategies for all regional critical care departments were implemented through education departments at each facility. Springer Publishing would provide participating nurses with access to the self-paced study program on ExamPrepConnect. The Nurse Scholars Academy would provide a prepaid certification exam voucher at no cost. In exchange, participants would commit to take the certification exam within 3 months of Pilot kick-off.

Results/Findings By month 4, 70 nurses took the Adult CCRN^®certification exam. Of those 70 who took the exam, 58 passed. The pass rate was 82.8%, 11.3% above the national pass rate of 71.5% (AACN, 2021). Nurses spent more than 1,500 hours studying in ExamPrepConnect and successful ExamPrepConnect users studied for an average of 19 hours. Conclusions. The pass rate was a successful outcome. The overwhelming response from local critical care nurses who wanted to obtain their critical care certification was encouraging. The need was apparent, and the resources were there. Of note, only 30% of those participants took the certification exam, future implications for this study involve further brainstorming on effective promotion to improve awareness and support frontline staff to take full advantage of these unique programs.

Survey for Insertion and Management of Peripheral Arterial Catheter in the Acute Care Unit

Masako Shirasaka — 2023-05-01

Background: Arterial catheters are commonly used in acute care units for hemodynamic monitoring in conjunction with blood pressure and blood gas analysis. Complications arising from the use of arterial catheters have been reported; however, few studies have focused on standard practice of arterial catheters.

Aim: To clarify the management, particularly the insertion frequency and timing, of peripheral radial arterial catheters in acute care units in Japan.

Methods: We developed 34 questions through an interactive process based on guidelines and clinical experience to create a digital survey. This survey was conducted over a month. Participants were nurses working in acute care units in Japan who received electronically distributed surveys through nursing-specific mailing lists and social network services.

Results: A total of 451 responses were collected; 224 were used for analysis. Respondents reported 35% implemented routine insertion of arterial catheters for all newly admitted patients, while 58% would insert the arterial catheter within 24 hours of admission. Only 7% of respondents did not add heparin to the pressurized bag. Of the respondents, 51% had a rule to change the pressurized bag of fluids every 3 days. Splinting of the wrist was a routine procedure for 41% of respondents.

Conclusions: Arterial catheters were commonly used in all acute care units. Based on the results of the survey, we recommend the use of heparin as a flush fluid should be reconsidered. The high rate of unnecessary arterial catheter insertions and the routine use of splinting need to be reassessed.

The Positive Effects of Manual Pronation in a United States Community Based Hospital Intensive Care Unit During the COVID-19 Surge Crisis

Mollie Hoerr — 2023-05-01

Background

Patients in acute respiratory distress syndrome suffer a high mortality rate; however, manual pronation has a survival advantage up to 17% (Gattinoni, 2013). March 2020 marked the initial COVID-19 surge in the US, characterized by government lock-downs, inundation of healthcare systems, and high patient fatality levels. Initially, COVID-19 patients who might benefit from manual pronation were transferred to other local facilities until our interdisciplinary team implemented a manual pronation policy within 27 days of receiving our first COVID-19 positive patient.

Aim

The aim of this study was to describe the impact of a community hospital partaking in manual pronation for the first time, quality care metrics—specifically Central Line-Associated Bloodstream Infections (CLABSIs), Catheter-Associated Urinary Tract Infections (CAUTIs), and Ventilator-Associated Pneumonia/Events (VAP/VAEs)—associated with the COVID-19 surge, and the barriers overcome during this process.

Methods

This retrospective data collection study included hypoxemia, intubation, discharge and quality safety data from March 13 to June 1, 2020 for patients who underwent manual pronation.

Results/Findings

Pronation occurred a total of twenty-seven times in 13 patients (seven (53.8%) survived and six (46.2%) died during hospital admission). Four (57.1%) of the patients who survived were discharged home, two (28.6%) went to a rehabilitation facility, and one (14.3%) was transferred to an outside hospital. Zero CAUTIs (458 catheter days), CLABSIs (371 central line days), and VAEs (384 ventilator days) occurred during the study.

Conclusions

With the newly acquired proning policy in place and creative COVID-19 care, data were consistent with an overall improvement in patient outcomes. Manual pronation was shown to improve P/F ratios. There were no upticks in hospital acquired infections, notably CAUTIs, CLABSIs, and VAP/VAEs at our facility.