Life support physicians offer guidance in the context of resource-scarce COVID-19 treatment

Rapidly escalating numbers of COVID-19 patients suffering from respiratory failure threaten to overwhelm hospital capacity and force healthcare providers into making challenging decisions about the care they provide.

Of particular interest is the role of ECMO – extracorporeal membrane oxygenation, a form of life support for patients with advanced lung disease – to support critically ill patients during the coronavirus pandemic.

In "ECMO Resource Planning in the Setting of a Pandemic Respiratory Illness," an open-access paper published in the Annals of the American Thoracic Society, ECMO physicians outline their approach for care.

WHAT'S THE IMPACT?

Currently, there's no vaccine or treatment for COVID-19 beyond supportive care such as mechanical ventilation or, in severe cases, ECMO to maintain patients and provide a window for potential recovery. But when demand far outpaces a hospital's ability to provide highly specialized, resource-intensive therapies such as ECMO, physicians should be prepared to determine when and if to offer such support.

Optimizing resource utilization is the key challenge in such a scenario, since patients need to be appropriately triaged and cared for within the larger health system. That requires a level of planning and coordination that's not typical within the current system, and it means a limited window for planning, often without the requisite resources.

Yet this coordination is vitally important in ensuring those who would most benefit from EMCO are able to receive that level of support, which can greatly increase chances for survival. Such patients include those who are younger and have severe respiratory failure, but lack comorbidities or evidence of multi-organ failure.

The authors suggest several guidelines to help medical centers respond to patients' needs as resources contract during the coronavirus pandemic. For mild surges, hospitals should focus on increasing capacity, colocating or regionalizing ECMO patients, implementing staffing protocols that allow specialists and RNs to care for more patients based on acuity, and collaborating with other local or regional ECMO centers.

For moderate surges, hospitals should transition their focus to determine the allocation of scarce resources. For major surges, they should limit or defer the use of scarce resources.

THE LARGER TREND

Patient care is a challenge for healthcare personnel in all walks of the industry, but during the COVID-19 pandemic, equipment shortages have exacerbated the problem, with shortages of ventilators and ventilator medications posing a threat to those suffering from the coronavirus or indeed any other respiratory ailment.

Data recently released by Vizient shows that there are potential shortages of 13 drugs found in three distinct drug classes that are crucial to the use of ventilators. Sedatives and anesthetics, for example, saw a 51% increase in demand during March, while the fill rate has dropped to 63%.

Meanwhile, there's been a 67% increase in demand for analgesics, with the fill rate dropping to 73%, Neuromuscular blockers saw a 39% increase in demand, with fill rates dropping to 70%.

Twitter: @JELagasse

Email the writer: jeff.lagasse@himssmedia.com