ABSTRACT
Introduction: Use of extracorporeal membrane oxygenation (ECMO) has been a transport standard of care for cardiovascular and pulmonary compromised patients. However, implementation and associated outcomes for unstable patients diagnosed with SARS-COV-2 infection has not been documented. Method(s): A retrospective chart review was performed examining ECMO transports of patients with SARS-COV-2 infection from April 2020- October 2021 involving one healthcare transport program. Variables of interest included: pH pre-post cannulation, BMI, pre-existing health conditions, medications utilized, and health outcomes. Descriptive statistics was used to analyze the data. Result(s): 21 transports were completed involving North Carolina and South Carolina referral facilities: 15 ground ambulance and 6 EC-145 rotor wing aircraft. All patients were cannulated at outside hospitals, with 2 performed by the transport team. While there were no complications during transport, trends illustrated those patients persistently acidotic (pH< 7.35) after ECMO cannulation were more likely to die.8 of the 10 patients who died had persistently low pH, versus the survivors where only 3 of 11 had persistently low pH after cannulation. This was a statistically significant difference in survival outcomes for those with sustained normal pH after cannulation, p=0.03. BMI had no statistically significant influence on outcomes, p=0.08. Conclusion(s): Transportof patients on ECMO with SARS-COV-2 virus infection is safe and effective with a specialty transport team. The significance between post-ECMO cannulation pH and patient outcomes requires further examination which may aid in patient management.Copyright © 2022
ABSTRACT
Background: Screening for communicable diseases at entry to any healthcare setting due to a patient's travel or exposure history is an important tenet of reducing transmission of pathogens among patients and healthcare providers. We identified multiple screening tools across our enterprise leading to inconsistent documentation by staff and inability to rapidly change screening questions. We aimed to develop a customized screening tool within our electronic health record to address these challenges and provide real-time screening data to our Department of Infection Prevention. Methods: Stakeholders from all clinical areas as well as family consultants and registration staff provided input on needs for an optimized screening tool. Process mapping across clinical areas of prior screening tools identified variation in decision support and screening questions for both countries and diseases, and demonstrated lack of clear communication between registration staff and clinical teams. Questions and decision support needed to identify communicable diseases in a waiting room setting were identified with stakeholders. Our informatics team reviewed multiple tool options available in the EHR including a built-in travel module with print groups and best practice alerts, a smartform, and flowsheets. Results: Our informatics team designed a universal flowsheet with cascading rows that included clinical decision support with travel, exposure, and symptom screening. During the period of peak COVID-19 transmission in our region, an average of 1644 patients were screened daily. Of those, 2.8% screened positive for travel to an area of increased transmission with 14.9% of those who traveled reporting respiratory symptoms. An additional 4.1% of total patients screened positive for exposure to COVID-19, while 7.7% reported respiratory symptoms. Nine real-time updates to locations of increased disease transmission and symptoms have been made. Conclusion: Utilizing a custom-built flowsheet model in our EHR permitted real time changes to screening to support appropriate use of infection prevention measures. Customizable travel and exposure screening is critical for identification of patients with concern for COVID-19 and other emerging pathogens.
ABSTRACT
COVID-19 has unfortunately halted lab work, conferences, and in-person networking, which is especially detrimental to researchers just starting their labs. Through social media and our reviewer networks, we met some early-career stem cell investigators impacted by the closures. Here, they introduce themselves and their research to our readers.