Regional extracorporeal membrane oxygenation retrieval service during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic: an interdisciplinary team approach to maintain service provision despite increased demand

Abstract

OBJECTIVES Coronavirus disease 2019 is a new contagious disease that has spread rapidly across the world. It is associated with high mortality in those who develop respiratory complications and require admission to intensive care. Extracorporeal membrane oxygenation (ECMO) is a supportive therapy option for selected severely ill patients who deteriorate despite the best supportive care. During the coronavirus disease 2019 pandemic, extra demand led to staff reorganization; hence, cardiac surgery consultants joined the ECMO retrieval team. This article describes how we increased service provisions to adapt to the changes in activity and staffing. METHODS The data were collected from 16 March 2020 to 8 May 2020. The patients were referred through a dedicated Web-based referral portal to cope with increasing demand. The retrieval team attended the referring hospital, reviewed the patients and made the final decision to proceed with ECMO. RESULTS We reported 41 ECMO retrieval runs during this study period. Apart from staffing changes, other retrieval protocols were maintained. The preferred cannulation method for veno-venous ECMO was drainage via the femoral vein and return to the right internal jugular vein. There were no complications reported during cannulation or transport. CONCLUSIONS Staff reorganization in a crisis is of paramount importance. For those with precise transferrable skills, experience can be gained quickly with appropriate supervision. Therefore, the team members were selected based on skill mix rather than on roles that are more traditional. We have demonstrated that an ECMO retrieval service can be reorganized swiftly and successfully to cope with the sudden increase in demand by spending cardiac surgeons services to supplement the anaesthetic-intensivist roles.

Efficacy of multidisciplinary team approach with extracorporeal membrane oxygenation for COVID‐19 in a low volume ECMO center

“…One of the pertinent factors to achieve good outcomes requires implementing and maintaining ECMO without major complications. Appropriate treatment of pneumonia by pulmonologists, high‐quality intensive care by acute critical care physicians, intensivists, and nurses, and safe ECMO initiation and management by cardiac surgeons and perfusionists are necessary for the most critically ill patients with COVID‐19 9 . Moreover, minimizing complications during extracorporeal circulation is routine work for cardiac surgeons.…”

The Use of Extracorporeal Membrane Oxygenation for COVID-19

“…Mobile ECMO or ECMO transport with cannulation at the originating hospital and transfer to another institution appears to be safe from a healthcare exposure standpoint when accompanied by protocols incorporating adequate protective measures. 29 , 30 However, it is important to note that the coordination and feasibility of ECMO transport varies across regions and, consequently, rates of transport do as well. This may be due in part to differences in practice, training, certification and regulation.…”

Efficacy of a single‐day task trainer–based extracorporeal membrane oxygenation training course

“…[1][2][3][4] Several authors have indicated the importance of ECMO use and properly trained ECMO clinicians on rescuing patients from cardiopulmonary complications, including COVID-19 patients. [5][6][7][8] Of further relevance to emergency physicians is the use of VA ECMO for management of out-of-hospital cardiac arrest. [9][10][11][12] Recently, a study was prematurely terminated by reviewers given that survival in the ECMO arm was greater compared to therapy (33% vs. 7%) and thus, enrollment of patients into the control arm was considered unethical.…”

“…Studies have demonstrated the efficacy of VV ECMO for management of severe Acute Respiratory Distress Syndrome (ARDS) 1–4 . Several authors have indicated the importance of ECMO use and properly trained ECMO clinicians on rescuing patients from cardiopulmonary complications, including COVID‐19 patients 5–8 . Of further relevance to emergency physicians is the use of VA ECMO for management of out‐of‐hospital cardiac arrest 9–12 .…”