ECMO Support and Operator Safety in the Context of COVID-19 Outbreak: A Regional Center Experience

Since the beginning of the COVID-19 emergency, the referral Intensive Care Unit for the Extracorporeal Membrane Oxygenation (ECMO) support of Piedmont Region (Italy), in cooperation with infectious disease specialists, perfusionists and cardiac surgeons, developed a protocol to guarantee operator safety during invasive procedures, among which the ECMO positioning or inter-hospital transport. The use of powered air-purifying respirators, filtering facepiece particles (FFP) 2–3 masks, protective suits, disposable sterile surgical gowns, and two pairs of sterile gloves as a part of a protocol seemed effective and feasible for trained healthcare workers and allow all the complex activities connected with the positioning of the ECMO support to be completed effectively. The simulation training on donning and doffing procedures and the presence of a dedicated team member to verify the compliance with the safety procedure effectively reassured operators and likely reduced the risk of self-contamination. From 1 March to 31 December 2020, we used the procedure in 35 severe acute respiratory distress syndrome (ARDS) patients and one acute respiratory failure caused by neoplastic total tracheal obstruction, all positive to COVID-19, to be connected to veno-venous ECMO in peripheral hospitals and centralized for ECMO management. This preliminary experience seems to confirm that the use of ECMO during COVID-19 outbreaks is feasible and the risks associated with its positioning and management are sustainable for the health-care workers and safe for patients.

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Clinical Management of Heart Transplant Recipients

Mayo Clinic Critical and Neurocritical Care Board Review ◽

10.1093/med/9780190862923.003.0070 ◽

2019 ◽

pp. 443-445

Author(s):

Arzoo Sadiqi ◽

Jama Jahanyar

Keyword(s):

Infectious Disease ◽

Heart Transplant ◽

Clinical Management ◽

Right Ventricular Failure ◽

Team Approach ◽

Transplant Recipients ◽

Multidisciplinary Team Approach ◽

Infectious Disease Specialists ◽

Heart Transplant Recipients ◽

Cardiac Surgeons

The challenges of managing heart transplant recipients postoperatively relate to right ventricular failure, immunosuppression, and the unique physiology of the donor heart. Clinical management of heart transplant recipients requires a multidisciplinary team approach with a coordinated effort between intensivists, cardiac surgeons, heart transplant cardiologists, and infectious disease specialists.

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Medical Textiles That Suit the User: Predicting Health Care Workers' Preference for Disposable Versus Reusable Surgical Gowns

Health Marketing Quarterly ◽

10.1080/07359683.2013.787892 ◽

2013 ◽

Vol 30 (2) ◽

pp. 162-176 ◽

Cited By ~ 2

Author(s):

Joanne Brasch ◽

Margaret Rucker ◽

Carrie Haise

Keyword(s):

Health Care ◽

Health Care Workers ◽

Medical Textiles ◽

Care Workers ◽

Surgical Gowns

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Pass On What You Have Learned: A Structured Mentor-Mentee Concept for the Implementation of a Minimally Invasive Mitral Valve Surgery Program

European Surgical Research ◽

10.1159/000520431 ◽

2021 ◽

pp. 1-7

Author(s):

Christian Heim ◽

Philipp P. Müller ◽

Parwis Massoudy ◽

Frank Harig ◽

Ehab Nooh ◽

...

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Low Cost ◽

Mitral Valve Surgery ◽

Ring Annuloplasty ◽

Cardiac Surgeon ◽

Heart Center ◽

Cardiac Surgeons ◽

Dedicated Team

Introduction: Starting a minimally invasive cardiac surgery (MICS) for mitral valve repair (MVR) program is challenging as it requires a new learning curve, but compromising surgical results at the same time is not acceptable. Here, we describe our surgical educational experience of starting a new MICS program at a university heart center in Germany. Methods: A dedicated team for the new MICS program including 2 cardiac surgeons, 1 cardiac anesthetist, 1 perfusionist, and 1 scrub nurse was chosen. The use of long shafted instruments was trained in a low-cost self-assembled MICS simulator, and the EACTS endoscopic dry lab course was visited. Thereafter, 1 MICS center was visited for direct observation and peer-to-peer education for 6 weeks. The mentor observed the first 10 cases performed by the mentee. The surgical mitral valve expertise of 1 single cardiac surgeon was retrospectively analyzed between April 2016 and April 2021. Results: Before the implementation of the MICS-MVR program, 18 mitral valve operations have been performed through sternotomy between April 2016 and October 2018 including 12 replacements and 6 ring annuloplasties. After starting the MICS-MVR program, 73 mitral operations have been performed by the same surgeon of which 53 video-assisted through minithoracotomy (72.6%). 83.1% of the MICS procedures included complex repair (n = 38) and ring annuloplasty (n = 6). Open heart MV surgery was necessary in 20 patients due to concomitant procedures (n = 8), redo procedures (n = 2), severe endocarditis (n = 4), or contraindication for MICS such as PAD (n = 6). There have been no deaths, 1 stroke, and 1 cardiac vascular (RCX) complication. Two patients required conversion to sternotomy and one pericardiocentesis in the long term. Conclusion: Typically, excellent exposure and high repair rates of the MV has led us offer MICS approach to a majority of patients with isolated MV disease. Careful planning and a strict mentor-mentee concept facilitated a safe startup of an MICS program in a busy university heart center.

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Early and long-term outcomes of extracorporeal membrane oxygenation support in refractory cardiogenic shock for non-surgical patients: nine years experience at our Institute

European Heart Journal ◽

10.1093/ehjci/ehaa946.1846 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

G St-Pierre ◽

L Laflamme ◽

E Charbonneau ◽

Y.T Sia

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Hospital Mortality ◽

Cardiogenic Shock ◽

Patient Selection ◽

Ecmo Support ◽

Long Term Outcomes ◽

Refractory Cardiogenic Shock ◽

Va Ecmo ◽

Cardiac Surgeons

Abstract Purpose Venoarterial extracorporeal membrane oxygenation (VA-ECMO) support is ultimately applied in refractory cardiogenic shock and is associated with high in-hospital mortality. We sought to describe the characteristics and analyze early and long-term outcomes of patients with refractory cardiogenic shock at our institution as well as our approach to patient selection. Methods This single-center retrospective study used the ECMO database from the cardiac surgery department to identify all patients with refractory cardiogenic shock at our Institute. VA-ECMO for patients with postcardiotomy shock, on-going cardiopulmonary resuscitation and venovenous ECMO were excluded. Primary endpoint was in-hospital mortality after VA-ECMO. Secondary outcomes were early complications on VA-ECMO and long-term survival after hospital discharge. Refractory cardiogenic shock was defined by either hypotension or end-organ failure despite adequate inotropic support. Results All patients with refractory cardiogenic shock were admitted to our cardiological ICU and our Heart team was systematically consulted. This team was mainly composed of transplant and LVAD cardiologists and cardiac surgeons specialized in ECMO. After case discussion, the decision for VA-ECMO implantation as a bridge therapy was made if the patient was deemed candidate to advance heart failure treatment. VA-ECMO was rapidly implanted by cardiac surgeons at bedside or in operating room with a median time from decision to implantation of 150 minutes (IQR: 100–233). Fifty-nine patients underwent VA-ECMO for refractory cardiogenic shock between 2010–2019. Patients were 52.1±14.5 years old, 75% were male and more than 90% were not known for any prior cardiac history. The indication for VA-ECMO support was acute myocardial infarction in 34 patients (58%) with reduced LVEF, mitral regurgitation, arrhythmia storm or ventricular septal defect. Myocarditis occurred in 19% of patients. The median LVEF was 13% (IQR: 10–31). Peripheral cannulation was most frequently implanted (92%). During VA-ECMO support, 43 patients survived and 16 patients died. Figure 1 shows weaning strategies for patients who survived VA-ECMO support. Of these, 37 patients survived up to discharge (86%). After a median follow-up of 2.9 years (IQR: 1.8–4.8), 92% were alive. The median time on VA-ECMO support was 4.9 days (IQR 3.5–7.6). Complications were bleeding needing reoperation (41%), pneumonia (41%), renal failure requiring dialysis (39%) and limb ischemia (17%). Conclusion In our experience, venoarterial ECMO is a feasible and acceptable alternative to support patients with refractory cardiogenic shock despite inotropic agents. Interestingly, the survival rate was particularly high as compared to the literature. This could be explained by patient selection and early VA-ECMO implantation. Evolution of patients after ECMO Funding Acknowledgement Type of funding source: None

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Tele-Medicine Provides an Effective Tool for the Management of COVID-19 in Children

10.21203/rs.3.rs-191998/v1 ◽

2021 ◽

Author(s):

Marco Poeta ◽

Luca Pierri ◽

Eugenia Bruzzese ◽

Francesco Nunziata ◽

Edoardo Vassallo ◽

...

Keyword(s):

Health Care Workers ◽

Hospital Admissions ◽

Medical Visit ◽

Referral Centre ◽

Campania Region ◽

At Risk Children ◽

Care Workers ◽

Rapid Spread ◽

Infectious Disease Specialists ◽

Management Advice

Abstract Overcrowding, the unavailability of personal protective equipment, and transmission between health care workers are the main causes of the rapid spread of coronavirus disease 2019 (COVID-19) in hospital settings. Because children have less severe symptoms than adults, we used tele-medicine (TM) as the main approach to managing subjects younger than 14 years who contacted their primary care paediatrician (PCP). A TM program for suspected paediatric COVID-19 cases was developed by the COVID-19 paediatric referral centre and PCPs in the Campania Region, Italy. A total of 269 cases of suspected COVID-19 were discussed through tele-consultation between PCPs and paediatric infectious disease specialists. The main reason for the initiation of tele-consultation by PCPs was the need for case management advice (n=206, 77%). A total of 203 children were tested for COVID-19, and 139 were positive (73 males, aged 5 years [IQR 1-10]), of whom 103 were managed at home with phone/video monitoring, 17 received a direct medical visit and discharged to home, and 19 were admitted to the COVID-19 unit. The main symptoms were fever (45%) and cough (25%). Thirty-five percent were asymptomatic and detected in family clusters. None had severe clinical outcomes.ConclusionTM is a reliable tool to limit the spread of COVID-19 and might reduce the number of unnecessary visits and hospital admissions. Through tele-consultation with an expert, PCPs can identify at-risk children who need testing and manage most cases remotely. However, standardization of the TM approach and criteria for hospital admission are needed.

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ASSESSMENT OF MEASURES ON SOCIAL SUPPORT OF MEDICAL WORKERS IN THE IRKUTSK REGION STATED IN OFFICIAL EMPLOYMENT PROPOSALS

Social Aspects of Population Health ◽

10.21045/2071-5021-2021-67-1-5 ◽

2021 ◽

Vol 67 (1) ◽

pp. 5-5

Author(s):

S.V. Makarov ◽

◽

G.M. Gajdarov ◽

Keyword(s):

Social Support ◽

Russian Federation ◽

Nursing Staff ◽

Professional Education ◽

Ministry Of Health ◽

Support Measures ◽

Irkutsk Region ◽

Care Workers ◽

Infectious Disease Specialists ◽

The Russian Federation

Significance. Social support measures for healthcare workers are one of the key mechanisms for retaining specialists. Meanwhile, according to the Ministry of Health of the Russian Federation, the current indicators of their implementation remain unsatisfactory. The purpose of the study was to assess frequency and structure of social support measures for medical workers based on the data of the official employment proposals posted by state medical organizations on the website of the Ministry of Health of the Irkutsk Region. Material and methods. Statistical charts have been developed, they included information from the employment proposals posted on the official website of the Ministry of Health of the Irkutsk Region, the total number of proposals added up to 429. Statistical methods to process the material included calculation of the extensive and intensive indexes without determining confidence intervals because the general aggregate was used in all cases. Results. The most wanted out of all doctors are district therapists (7.0% in the structure of doctors’ vacancies), followed by obstetricians-gynecologists (6.7%) and infectious disease specialists (6.1%). As for nursing staff, the highest number of employment proposals were looking for feldshers (22.4%), ward nurses (12.9%) and district nurses (11.2%). Of the total number of job proposals, social support measures were stated in 76.2 proposals out of 100, while the frequency of these measures added up to 77.4 out of 100 for doctors and 63.8 for nurses. The stated social support measures for doctors in the ascending order include as follows: issues related to housing (79.2 per 100 employment proposals); direct financial support (72.2 per 100); provision of a place in a preschool facility without waiting (35.1); additional vacation and travel expense reimbursement (27.2); reimbursement of expenses related to relocation and travel to the place of employment (14.4); payment for postgraduate and additional professional education (9.3). The rank structure of social support measures for nursing staff differs in the order, starting from the third. Conclusion. In both absolute and relative terms, the measures of social support stated by the employment proposals for doctors prevail. While primary health care workers are in highest demand, the need for such specialists is not directly reflected by the corresponding frequency of the stated social support measures. The results obtained are relevant to the development and implementation of the evidence-based personnel policy in healthcare at the level of an individual region of the Russian Federation.

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