scholarly journals Efficacy of Multidisciplinary Team Approach with Extracorporeal Membrane Oxygenation for COVID‐19 in Low Volume ECMO center

2021 ◽  
Author(s):  
Eiki Nagaoka ◽  
Hirokuni Arai ◽  
Toyomu Ugawa ◽  
Takahiro Masuda ◽  
Kanae Ochiai ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Multidisciplinary Team ◽  
Team Approach ◽  
Multidisciplinary Team Approach ◽  
Membrane Oxygenation ◽  
Low Volume

P1711The association of multidisciplinary team approach with clinical outcomes in patients with acute myocardial infarction underwent veno-arterial extracorporeal membrane oxygenation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Hong ◽  
K H Choi ◽  
T Youn ◽  
S Y Lee ◽  
M Bak ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Clinical Outcomes ◽  
Intensive Care Unit Mortality ◽  
Team Approach ◽  
Cardiac Intensive Care Unit ◽  
Multidisciplinary Team Approach ◽  
Membrane Oxygenation ◽  
Cardiac Intensive Care

Abstract Background Multidisciplinary team approach is necessary for the management of critically-ill patients. However, limited data are available on the impact of specialized extracorporeal membrane oxygenation (ECMO) team on clinical outcomes in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock. Objectives This study aimed to identify whether specialized ECMO team is associated with improved in-hospital mortality in AMI patients underwent venoarterial ECMO. Methods A total of 255 AMI patients underwent venoarterial ECMO from May 2004 to July 2018 were enrolled. In January 2014, multidisciplinary ECMO team was founded at our institution. Eligible patients were classified into pre-ECMO team group (n=131) and post-ECMO team group (n=124). The primary outcome was in-hospital mortality. Results In-hospital mortality (54.2% vs. 33.9%, p=0.002) and cardiac intensive care unit mortality (45.0% vs. 25.0%, p=0.001) were significantly lower after the implantation of multidisciplinary ECMO team (pre ECMO team vs. post-ECMO team). On binary logistic regression model, the multidisciplinary ECMO team approach was associated with lower risk of in-hospital mortality (odds ratio 0.36, 95% confidence interval 0.19–0.67, p=0.001). Incidence of all-cause mortality (58.3% vs. 35.2%, p<0.001) and rehospitalization due to heart failure (28.2% vs. 6.4%, p=0.001) at 6-months follow-up were also significantly lower in the post-ECMO team group than in the pre-ECMO team group. Clinical outcomes Variables Total (N=255) Pre-ECMO team (N=131) Post-ECMO team (N=124) P value In-hospital mortality 113 (44.3) 71 (54.2) 42 (33.9) 0.002 Cardiovascular death 90 (35.3) 59 (45.0) 31 (25.0) 0.001 Noncardiovascular death 23 (9.0) 12 (9.2) 11 (8.9) >0.99 Cardiac intensive care unit mortality 106 (41.6) 68 (51.9) 38 (30.6) 0.001 Successful weaning of ECMO 169 (66.3) 75 (57.3) 94 (75.8) 0.002 Data are presented as n (%). Abbreviations: ECMO, extracorporeal membrane oxygenation. Incidence of death, readmission for HF Conclusions The multidisciplinary ECMO team approach was associated with improved clinical outcomes in AMI patients complicated by cardiogenic shock. Our data support that specialized ECMO team is indispensable to improve outcomes in patients with AMI with refractory cardiogenic shock.

scholarly journals Using a multidisciplinary approach to reveal decision-making capacity within acute care for an individual with aphasia

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110270
Author(s):  
Ruth Maxwell ◽  
Michelle O’Brien ◽  
Deirdre O’Donnell ◽  
Lauren Christophers ◽  
Thilo Kroll
Keyword(s):  
Decision Making ◽  
Multidisciplinary Team ◽  
Team Approach ◽  
Term Care ◽  
Multidisciplinary Team Approach ◽  
Decision Making Capacity ◽  
Health And Social Care ◽  
Functional Assessments ◽  
Health Nursing ◽  
Communication Approach

Formal assessments of cognition that rely on language may conceal the non-linguistic cognitive function of people with aphasia. This may have detrimental consequences for how people with aphasia are supported to reveal communicative and decision-making competence. This case report demonstrates a multidisciplinary team approach to supporting the health and social care decision-making of people with aphasia. The case is a 67-year-old woman with Wernicke’s type aphasia. As the issue of long-term care arose, the speech and language therapist used a supported communication approach with the patient who expressed her wish to go home. A multidisciplinary team functional assessment of capacity was undertaken which involved functional assessments and observations of everyday tasks by allied health, nursing, catering and medical staff. In this way, the patient’s decision-making capacity was revealed and she was discharged home. A collaborative multidisciplinary team approach using supported communication and functional capacity assessments may be essential for scaffolding the decision-making capacity of people with aphasia.

scholarly journals Feasibility of extracorporeal membrane oxygenation cardiopulmonary resuscitation by low volume centers in Belgium

2021 ◽  
Vol 2 (3) ◽  
Author(s):  
Paul B. Massion ◽  
Sabrina Joachim ◽  
Philippe Morimont ◽  
Guy‐Loup Dulière ◽  
Romain Betz ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Extracorporeal Membrane Oxygenation ◽  
Membrane Oxygenation ◽  
Low Volume

scholarly journals Implementing a Massive Personal Protective Equipment Education—A Multidisciplinary Team Approach

2020 ◽  
Vol 41 (S1) ◽  
pp. s280-s281
Author(s):  
Mayar Al Mohajer ◽  
Megan Fischer ◽  
Melissa Rouse ◽  
Takei Pipkins ◽  
John Byrne
Keyword(s):  
Nursing Education ◽  
Personal Protective Equipment ◽  
Multidisciplinary Team ◽  
Infection Prevention ◽  
Just In Time ◽  
Protective Equipment ◽  
Team Approach ◽  
Online Video ◽  
Staff Members ◽  
Multidisciplinary Team Approach

Background: Personal protective equipment (PPE) is defined by the Occupational Safety and Health Administration as specialized clothing or equipment worn by an employee for protection against infectious materials. They include gloves, gowns, masks, respirators, googles and face shields. The CDC has issued guidelines on appropriateness of when, what, and how to use PPE. Despite these guidelines, compliance with PPE remains challenging. Methods: We implemented a massive hospital-wide rapid education program on PPE donning and doffing of all employees and staff. This program included an online video, return demonstration and just-in-time training. To develop the program, we recorded PPE training video, reviewed PPE validation checklist, developed new isolation precaution signage with quick response (QR) code to video, developed a nutrition tray removal video and a equipment cleaning video, developed family and visitor guidelines for isolation precautions, and created an audit tool for PPE donning and doffing practices. The program required interdisciplinary collaboration including administration, infection prevention, nursing education, central supply, environmental services, facility maintenance, and security. Results: The first phase of the program was implemented through 30 separate 4-hour PPE skills fair offered over 48 hours. In total, 500 staff members were trained in the first 48 hours; 6 additional 3-hour sessions were provided on site in the following 3 month. Additionally, training was provided in off-site clinics, physician leadership meetings, new-hire orientation for nursing staff, and monthly resident and fellow training through graduate medical education. As needed, training was provided by infection prevention, nursing education, and floor nurses. In total, 5,237 staff members were trained within 3 months after implementation. Actual audit results (50 audits per week) showed improved and sustained compliance to >94%. Conclusions: A massive hospital-wide educational program including online video, return demonstration, and just-in-time training is a feasible and very effective method to improve compliance with PPE donning and doffing. A multidisciplinary team approach, administration support, and continuous education and audits are key factors in successful implementation.Funding: NoneDisclosures: None

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