ABSTRACT
Objectives: Besides in-centre ECMO care, the certificated ECMO centre of the University Hospital Regensburg (UKR) offers out-of-centre ECMO initiation with mobile equipment. During the pandemic situation, this treatment was especially meant for patients with critical cardiopulmonary failure in remote hospitals who present themselves as too unstable for interhospital transfer. We evaluated if treatment with outof-centre ECMO initiation could benefit patients;outcome, by comparing this group with a group of COVID-19 patients who received ECMO therapy at the UKR by in-hospital initiation. Method(s): Retrospective single-centre study including 169 patients who received ECMO due to COVID-19- induced cardiopulmonary failure between March 2020 till March 2022. Patients;population was separated into two groups according to the location of ECMO initiation, out-of-centre or in-centre, and into two subgroups by the used ECMO mode, venovenous (VV) or venoarterial (VA). We compared demographics, treatment duration, adverse events and patient;s outcome. The primary endpoint of the investigation was patients;survival to hospital discharge rate or death on ECMO or after ECMO explant. Result(s): Regarding the total study population, 98 (58.0%) of the 169 patients could be discharged from the UKR. Before initiation of ECMO therapy and with regard to complications during the course of intensive care, such as renal failure requiring dialysis or bleeding, there were no relevant differences between the two groups and subgroups. The out-of-centre group showed a significantly higher survival rate with 70 (63.6%) survivors out of 110 externally cannulated patients. Conclusion(s): In the study population, external ECMO cannulation was beneficial in terms of survival, although the reasons did not show significant differences between the groups. A possible approach for the good overall survival of the study groups in international comparison could be the existing centre expertise. (Figure Presented).
ABSTRACT
Background: Since the beginning of the COVID-19 pandemic in April 2020 the supply with blood products was largely stable and the demand for red blood cell concentrates (RBCC) could be covered. From June 2021, a blatant undersupply of RBCC occurred and rescheduling elective interventions depending on the patient's blood group was required. A well-considered restrictive blood bank management approach for RBCC provision became imperative and the analysis of its effects is presented here. Method(s): Data was analyzed to show the influence of the COVID-19 pandemic on the RBCC distribution management in the blood bank. Therefore, RBCC cross-matches, delivery, return and transfusions of RBCC were analyzed, so the crossmatch-to-transfusion ratio (CTR: ratio of cross-matched to transfused RBCC) as an efficiency marker could be calculated. In consideration of the CTR the consequences of minimizing the number of RBCC provided for elective surgeries in direct consultation with clinical decision makers on blood bank management efficiency were statistically described in the context of inpatient admissions and operations. Result(s): The availability on demand and consumption of RBCC were stable from April 2020 to May 2021 (mean value per month, fig. 1). However, the significant drop in RBCC supply from June 2021 was intercepted by a change of the RBCC management strategy as the number of transfusions remained unchanged (fig. 1): for elective operations the amount of RBCC provided was drastically reduced (from 48% to 23%). As a result, the overall CTR decreased from 3.0 on annual average (January 2019 to June 2021) to 1.7 from July 2021 to December 2021 (fig. 2). The number of operations was stable on a monthly average, as well as the inpatient admissions per month from 2019 to 2021 (2512) were only interrupted temporarily in April 2020 (1689). Conclusion(s): Regarding constant inpatient admissions and performed surgeries, the amount of transfused RBCC was stable. With drastically decreasing the number of RBCC provided for elective interventions a more efficient blood bank management led to a uncompromised patient care and even the target CTR of 1.7 in the surgical field (Gombotz, Patient Blood Management, Anesthesiologist 2013, 62:519-527) could be reached. Therefore, we consider this proceeding worth maintaining for the future. (Figure Presented).
ABSTRACT
BACKGROUND: Due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, sufficient distance between people is absolutely necessary, especially in waiting rooms of medical care institutions. This is frequently difficult to realize due to restricted spatial capacities. OBJECTIVE: This study investigated the possibility of enabling patients to spend the waiting period outside of the waiting room of the ENT outpatient department, in order to reduce the number of patients in the waiting rooms and therefore observe distancing rules. This was realized by the use of a pager system. MATERIALS AND METHODS: During the timeframe of 12.5 weeks (04.06.2020-31.08.2020), ENT outpatients were issued with pagers. The patients could thus move freely within the hospital and grounds. The pager system was activated 10-15â¯min before the appointment, to call patients back to the outpatient ENT clinic. questionnaires were used to evaluate the system and examine patients' acceptance and satisfaction. RESULTS: The 137 questionnaires analyzed showed satisfaction with the system, not only regarding distancing rules but also with the more comfortable waiting time. CONCLUSION: Introduction of a pager system for patients could help to meet hygiene and distance rules, and also increase comfort during (often unavoidable) waiting times for patients in the university hospital ENT outpatient department. The long-term use of such a system seems promising.