ABSTRACT
Introduction: Baystate Medical Center is the only Level I Trauma Center in Western, MA. The COVID-19 pandemic has had varying effects on Trauma Centers in regards to volume. Initial studies showed an increase in volume during the lockdown phase, but there has been no evidence of trends after lockdown. Method(s): Retrospective, review of trauma registry data pre- COVID (1/2016-2/2020) and during COVID-19 pandemic (3/2020-12/2021). Comparisons between time periods performed using T-Test. Result(s): Mean total traumas per month were significantly increased during the pandemic (191.3 v. 110.3 patients per month, p <0.001). Both blunt (174.2 v. 100.4, p <0.001) and penetrating (17.1 v 9.9, p <0.001) traumas increased during the COVID pandemic. There was a significant increase in both scene calls (105.0 v 73.8, p<0.001) and interfacility transfers (IFT) (42.7 v 36.0 P = 0.004) during the pandemic. There was no change in injury severity score (11.0 v 11.2, p = 0.498) during the pandemic. Ground interfacility transport times (34.13 min v 28.60 min, p = 0.036) increased significantly during COVID. Other transport times were not changed. Conclusion(s): During the COVID-19 pandemic, Baystate Medical Center saw a statistically significant increase in trauma volume across multiple dimensions that continued even after the end of the lockdown period. In addition, IFT ground transport times increased suggesting that patients were being transported from facilities farther away likely due to the strain on the regional health system from the pandemic.
ABSTRACT
Purpose: Describe outcomes of patients (pt) with pre-tx COVID-19. Method(s): Multicenter study of SOT/HCT candidates who had a positive (pos) SARS-CoV-2 PCR pre-tx. Result(s): Pre-tx: Of 208 pt, median age was 56 (range 3-76). 87.8% were SOT candidates (40.5% kidney, 40.5% liver, 9.8% lung, 6.9% heart, 2.3% pancreas) and 13.9% were HCT candidates (54.2% allo, 45.8% auto). Pt underwent a median of 2 tests (range 1 - 14). In 41% of pt, > 1 neg PCR was required by the tx center before reactivation. Neg PCR was documented in 67.4% of pt at a median of 41 days (18-68) after pos PCR. Waitlist mortality was 11.0%;deaths were due to COVID-19 in 60% (12/20). Post-tx (all pt): 78 pt underwent tx at a median of 65.5 days (range 17-324) from COVID-19;71/78 have completed 4-weeks of follow-up. 24/78 (30.7%) pt were still PCR pos at time of tx (details below). 54/78 (69.2%) pt underwent routine PCR testing post-tx;62% were tested regularly for 8 weeks. Only 1 pt, who remained asymptomatic, developed recurrent pos PCR on surveillance testing 18 days post-tx. 1 pt had graft loss. There were no deaths at 4 weeks post-tx. Pt transplanted without a negative PCR: 24 pt with COVID-19 did not have neg PCR at time of tx: 9 (37.5%) kidney, 9 (37.5%) liver, 2 (8.3%) SLK, 1 (4.2%) lung, 1 heart (4.2%), 2 auto-HSCT (8.3%), 2 allo-HSCT (8.3%). Of 24 pt who were reactivated at a median of 21 days (range 8 - 38) from COVID-19 diagnosis, 7 underwent tx emergently (5 liver, 1 lung, 1 heart). 20/24 completed 4-weeks of follow-up;all were alive. PCR Cycle thresholds (Ct) increased over time, suggesting a reduction in SARS-CoV-2 viral loads with time elapsed since COVID-19 diagnosis. Conclusion(s): Short-term outcomes of transplantation in SOT/HCT candidates with prior COVID-19 were promising in this small cohort, even with a positive PCR going into transplant. Whether documentation of a negative PCR should be required for all tx candidates with a history of COVID-19 prior to transplantation should be investigated further, particularly among lung tx candidates. For certain tx candidates with COVID-19, relying time-based strategy instead of a test-based strategy may be safe.
ABSTRACT
INTRODUCTION: The COVID-19 pandemic presents a unique challenge to critical care teams during disaster surge scenarios due to the large number of highly trained personnel required to care for a potentially overwhelming number of critical ill patients. Our hypothesis is that CRNAs possess a valuable skill set that can be effectively integrated into disaster ICU teams. METHODS: Detailed medical planning factors were applied to specific personnel, equipment, and supply resources available at a Level 1 trauma center during the first surge period of the COVID-19 pandemic. Regional modeling of COVID-19 cases was utilized to prepare a tiered staffing response. Model included a variety of qualified specialties designed to complement each other on critical care teams. Study team included anesthesiologists, CRNAs, and anesthesiology residents supervised by a surgical intensivist. All CRNAs had recent exposure to critically ill patients in the perioperative period. Clinical and didactic training program specific to COVID critical care was completed by all team members. COVID specific web-based guidelines were developed by intensivists and practiced by all teams. The State Governor expanded the disaster role for CRNAs. RESULTS: The medical center is the major regional treatment center for the COVID-19 response. The total number of COVID patients admitted to ICUs during the 10 weeks of peak surge -161: intubated-134, managed with NIV/HFNC-27. Number of intubated COVID patients in ICUs at peak of the surge (requiring CRNA utilization) was 41. COVID critical care patient-days provided by CRNA teams - 83. The CRNA pool trained to provide COVID critical care included 20 providers (27 CRNAs continued anesthesia/OR support). COVID ICU mortality was 38% (61/161, including CMO/DNR). Observed morbidity and mortality rates for CRNA teams was similar to other COVID ICU teams. CONCLUSIONS: The COVID-19 pandemic requires an ?all hands-on deck? approach to maximize high quality, safe care for a high volume of critically ill patients. The utilization of CRNAs has been demonstrated to provide effective, highly skilled critical care team augmentation during a disaster surge scenario. Appropriate critical care team preparation and coordination, communication and training guidelines are essential during a disaster scenario.