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

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

doi:10.3390/membranes11040258

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 (Basel). 2021 Apr 2;11(4):258. doi: 10.3390/membranes11040258.

Authors

Sagar Dave¹, Aakash Shah², Samuel Galvagno³, Kristen George¹, Ashley R Menne⁴, Daniel J Haase⁴, Brian McCormick⁵, Raymond Rector⁵, Siamak Dahi², Ronson J Madathil², Kristopher B Deatrick², Mehrdad Ghoreishi², James S Gammie², David J Kaczorowski⁶, Thomas M Scalea¹, Jay Menaker⁷, Daniel Herr¹, Eric Krause⁸, Ali Tabatabai⁹

Affiliations

¹ Department of Surgery, Program in Trauma, School of Medicine, University of Maryland, Baltimore, MD 21201, USA.
² Department of Surgery, Division of Cardiac Surgery, School of Medicine, University of Maryland, Baltimore, MD 21201, USA.
³ Department of Anesthesiology, Program in Trauma, School of Medicine, University of Maryland, Baltimore, MD 21201, USA.
⁴ Department of Emergency Medicine, Program in Trauma, School of Medicine, University of Maryland, Baltimore, MD 21201, USA.
⁵ Perfusion Services, University of Maryland Medical Center, Baltimore, MD 21201, USA.
⁶ Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
⁷ Department of Surgery, University of California San Francisco Medical Center, San Francisco, CA 94143, USA.
⁸ Department of Surgery, Division of Thoracic Surgery, School of Medicine, University of Maryland, Baltimore, MD 21201, USA.
⁹ Department of Medicine, Division of Pulmonary and Critical Care, Program in Trauma, School of Medicine, University of Maryland, Baltimore, MD 21201, USA.

Abstract

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.

Keywords: COVID-19; acute respiratory distress syndrome; biocontainment unit; extracorporeal membrane oxygenation.

Grants and funding

TL1 TR003100/TR/NCATS NIH HHS/United States