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Purpose of study The COVID-19 pandemic led to an unprecedented rapid transmission of healthcare information. This information was critical to enact frequently changing patient care protocols and to inform staff about redistribution of hospital resources at New York University Langone Hospital- Long Island. In this investigation, we analyze our hospital clinicians' methods of mass communication to front-line health care workers, with particular interest in assessing how communication was informed by real-time clinical findings. At the height of the pandemic (March 25th- April 15th), a mass broadcast email disseminated daily from the Director of Pulmonary and Critical Care was effective in informing treatment protocols that were clinically observed to improve patient outcomes. We analyzed over thirty broadcast emails and identified three major categories of information that were routinely addressed and/or updated: (i) reallocation of resources, (ii) clinical protocol changes, (iii) recommended lab tests for monitoring patient clinical course. We also interviewed key hospital clinicians and administrators on their experience working during the height of the pandemic. We found treatment protocols in these emails included information regarding the use of steroids and monoclonal antibody therapy, ventilators, and patient repositioning. In addition, the hospital's first autopsy results on COVID related deaths gave further insight into the disease process and manner of death for many patients (diffuse alveolar damage and evidence of hypercoagulability). So, too, did clinical findings around this time support what was seen grossly on autopsy-patients with more severe disease often presented with serial d-dimer levels >6x the normal limit. The information through these different conduits was synthesized and subsequently communicated in the aforementioned mass emails as an anticoagulation treatment protocol. Through continuous input of data, this protocol was updated and adjusted over the course of three weeks. We found that real-time communication amongst hospital staff regarding patient treatment protocols was a dynamic process that required synthesis of lab values, autopsy findings, and observed response to treatments. Successful treatment of patients depended on continuous review and communication of this information. Methods used The COVID-19 pandemic led to an unprecedented rapid transmission of healthcare information. This information was critical to enact frequently changing patient care protocols and to inform staff about redistribution of hospital resources at New York University Langone Hospital-- Long Island. In this investigation, we analyze our hospital clinicians' methods of mass communication to front-line health care workers, with particular interest in assessing how communication was informed by real-time clinical findings. At the height of the pandemic (March 25th- April 15th), a mass broadcast email disseminated daily from the Director of Pulmonary and Critical Care was effective in informing treatment protocols that were clinically observed to improve patient outcomes. Summary of results We analyzed over thirty broadcast emails and identified three major categories of information that were routinely addressed and/or updated: (i) reallocation of resources, (ii) clinical protocol changes, (iii) recommended lab tests for monitoring patient clinical course. We also interviewed key hospital clinicians and administrators on their experience working during the height of the pandemic. We found treatment protocols in these emails included information regarding the use of steroids and monoclonal antibody therapy, ventilators, and patient repositioning. In addition, the hospital's first autopsy results on COVID related deaths gave further insight into the disease process and manner of death for many patients (diffuse alveolar damage and evidence of hypercoagulability). So, too, did clinical findings around this time support what was seen grossly on autopsy- patients with more severe disease often presented with seri l d-dimer levels >6x the normal limit. The information through these different conduits was synthesized and subsequently communicated in the aforementioned mass emails as an anticoagulation treatment protocol. Through continuous input of data, this protocol was updated and adjusted over the course of three weeks. Conclusions We found that real-time communication amongst hospital staff regarding patient treatment protocols was a dynamic process that required synthesis of lab values, autopsy findings, and observed response to treatments. Successful treatment of patients depended on continuous review and communication of this information.
RESUMEN
Introduction: Extracorporeal membrane oxygenation (ECMO) therapy is indicated for acute respiratory distress syndromes (ARDS) with refractory hypoxia1. ARDS associated with Severe Acute Respiratory Syndrome-Coronavirus-2 infection has been shown to have 45% mortality, secondary to elevated inflammatory cytokines2. Prolonged duration of ECMO leads to poor short term neurological function 3. However there is lack of data regarding long term quality of life among patients who undergo ECMO for ARDS. We plan to conduct a retrospective study among patients undergoing ECMO to assess their quality of life. Methods: Retrospectives chart review and phone interviews conducted approximately 6 months after receiving ECMO at New York University-Long Island Hospital. 22 patients have received veno-venous or veno-arterial ECMO since March 2020. Phone interviews of 10 patients have been conducted. Welch two sample t test will be used to detect differences between activities of daily living (ADL) between prolonged ECMO (more than 20 days) and routine ECMO (less than 20 days) groups. Association between ECMO parameters, laboratory values and ADL will be evaluated by using a multivariable logistic regression analysis. Result will be considered statistically significant if p<0.05 Results:11 out of 22 patients have been discharged from hospital, 1 patient continues to receive ECMO. Initial analysis of our data shows that patients undergoing prolonged ECMO have a low mean score of 14 for activities of daily living (bathing, independent use of toilet, cooking and eating meals, shopping, driving, and use of supplemental oxygen) when compared to a mean score of 30 among routine ECMO. Mean Interleukin-6 (IL-6) and D Dimer levels 24 hours prior to undergoing cannulation for ECMO among prolonged ECMO group was higher when compared to routine ECMO group. (table 1) Conclusion:Patients undergoing prolonged ECMO have reduced activities of daily living 6 months post hospital discharge. Immune and coagulation markers prior to receiving ECMO were elevated among prolonged ECMO group suggesting severe cytokine storm and immunothrombosis resulting in poor prognosis.