The coronavirus disease 2019 (COVID-19) pandemic has placed extraordinary strain on global healthcare systems. Use of extracorporeal membrane oxygenation (ECMO) for patients with severe respiratory or cardiac failure attributed to COVID-19 has been debated due to uncertain survival benefit and the resources required to safely deliver ECMO support. We retrospectively investigated adult patients supported with ECMO for COVID-19 at our institution during the first 80 days following New York City’s declaration of a state of emergency. The primary objective was to evaluate survival outcomes in patients supported with ECMO for COVID-19 and describe the programmatic adaptations made in response to pandemic-related crisis conditions. Twenty-two patients with COVID-19 were placed on ECMO during the study period. Median age was 52 years and 18 (81.8%) were male. Twenty-one patients (95.4%) had severe ARDS and seven (31.8%) had cardiac failure. Fifteen patients (68.1%) were managed with venovenous ECMO while 7 (31.8%) required arterial support. Twelve patients (54.5%) were transported on ECMO from external institutions. Twelve patients were discharged alive from the hospital (54.5%). Extracorporeal membrane oxygenation was used successfully in patients with respiratory and cardiac failure due to COVID-19. The continued use of ECMO, including ECMO transport, during crisis conditions was possible even at the height of the COVID-19 pandemic.

Using in-house-designed phantoms, the authors evaluated radiation exposure rates in the vicinity of a newly acquired intraoperative radiation therapy (IORT) system: Axxent Electronic Brachytherapy System. The authors also investigated the perimeter radiation levels during three different clinical intraoperative treatments (breast, floor of the mouth and bilateral neck cancer patients). Radiation surveys during treatment delivery indicated that IORT using the surface applicator and IORT using balloons inserted into patient body give rise to exposure rates of 200 mR h(-1), 30 cm from a treated area. To reduce the exposure levels, movable lead shields should be used as they reduce the exposure rates by >95%. The authors' measurements suggest that intraoperative treatment using the 50-kVp X-ray source can be administered in any regular operating room without the need for radiation shielding modification as long as the operators utilise lead aprons and/or stand behind lead shields.

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The rapid spread of coronavirus disease 2019 (COVID-19) has exceeded the standard capacity of many hospital systems and led to an unprecedented scarcity of resources, including the already limited resource of extracorporeal membrane oxygenation (ECMO). With the large amount of critically ill patients and the highly contagious nature of the virus, significant consideration of ECMO candidacy is crucial for both appropriate allocation of resources as well as ensuring protection of health care personnel. As a leading pediatric ECMO program in the epicenter of the pandemic, we established new protocols and guidelines in order to continue caring for our pediatric patients while accepting adult patients to lessen the burden of our hospital system which was above capacity. This article describes our changes in consultation, cannulation, and daily care of COVID-19 positive patients requiring ECMO as well as discusses strategies for ensuring safety of our ECMO healthcare personnel and optimal allocation of resources.

Purpose: The main objective was to evaluate and commission the Xoft Electronic Brachytherapy System for intraoperative treatments. Method and Materials: Using the manufacturer supplied phantom, we evaluated and commissioned the Xoft Electronic Brachytherapy system. We tested well‐chamber constancy and intercomparison, beam output stability with time, start/end effects, and performed radiation surveys. Other checks recommended by the AAPM TG152 were evaluated. Results The Ir‐192 calibrated well chamber is 3.7 times more sensitive when irradiated with the Xoft source than the Xoft calibrated well chamber. Expectation was that both chambers would give approximately the same reading because the Xoft integrated well chamber is cross calibrated in I‐125 source. It takes about 28s for the doserate from the Xoft Unit to ramp up to the treatment doserate. The unit delivers 9s worth of treatment during the ramp up phase. For treatment times less than 100s, this would introduce a dosimetry error of about 10% which will be repeated if there is a treatment interruption. Xoft Unit output may vary by up to 5% between 0.25 and 30 minutes. This variation is source dependent. So the minimum time used to collect charges for the AAPM‐TG61 calibration should be 1 minute, not 0.25 minute. Radiation surveys during treatment indicate that surface and intraoperative treatments give rise to exposure rates of 200mR/hr, 30cm from treatment area. Conclusions: Well chamber calibration inconsistency for Xoft Unit needs further investigation. Ramp up time accounts for 9s equivalent treatment time. Correction needed for treatment time less than 150 seconds. Charges for TG61 calibration should be collected for at least 1 minute, not 0.25 minute. Intraoperative and surface treatment produces exposure rate of 200mR/hr at distances of 30 cm. Exercise extreme caution by standing behind lead shield or wearing a lead apron.