RESUMEN
Objectives: To present an unusual complication related to prolonged ECMO support in a patient with COVID19 induced acute respiratory syndrome (ARDS). Method(s): Clinical chart review of the care process after obtaining the informed consent from the patient. Result(s): A 48-year-old female with COVID-19 infection during second wave of pandemic in August 2021 progressed to severe ARDS. She was put on VV-ECMO support after failing conventional therapy for refractory hypoxemia. Her cannulation configuration included a 25 F venous drainage cannula in the right femoral vein and a 21 F venous return cannula in the right Internal Jugular (IJ) vein. Cannulations were performed using the ;Seldinger technique;under USG guidance, and no difficulties or complications were reported. Her hospital course was notable for delirium, and intermittent bleeding from the cannula sites. After 80 days of support, she showed adequate respiratory improvement which allowed ECMO decannulation. She continued to show improvement, and was eventually discharged after 102 days of total hospital stay. During her 6 weeks follow-up clinic visit a palpable thrill was noted at the jugular ECMO cannula site. A CT angiogram of the neck demonstrated a large venous varix connecting the right IJ and the left common carotid artery with filling from the left common carotid artery. ECMO cannulation site complications such as aneurysm, clots, infections and stenosis are well known. What was unusual in this case is the nature of the aneurysm given that there were no arterial procedures performed on the left side of the neck. She was managed by an ;Amplatzer plug;to the carotid artery at the level of the connection to the varix without any complications. Conclusion(s): Longer duration of ECMO support needs careful follow-up for timely recognition and management of vascular complications. (Figure Presented).
RESUMEN
Objectives: Extracorporeal membrane oxygenation (ECMO) is well established in cardiorespiratory failure. Here we report the use of ECMO in an airway emergency to provide respiratory support. Method(s): Informed consent was obtained from patient at the time of admission. Result(s): A 48-year-old with COVID-19 requiring venovenous ECMO (VVECMO) for 32 days and tracheostomy for 47 days had developed tracheal stenosis three months after tracheostomy removal, and undergone tracheal resection and reconstruction. He presented two weeks later with acute dyspnea, bloody drainage and a bulge in his neck with coughing. A computerized tomography (CT) of the cervical spine and chest showed dehiscence of the tracheal wound and a gap in the trachea. He was managed with High Flow Nasal Canula and supported on VVECMO support using 25 Fr. right femoral drainage cannula and 23 Fr. left IJ return cannula. A covered stent was placed, neck wound was irrigated and debrided. Patient was decannulated after 10 days on ECMO. Future therapeutic considerations include mediastinal tracheostomy, aortic homograft interposition of the disrupted segment of trachea with stent placement and permanent self-expandable stent with internal silicone stent. Conclusion(s): ECMO is increasingly used in complex thoracic surgery as well as in the perioperative period as salvage support. One of the areas where it has shown promising results is traumatic main bronchial rupture, airway tumor leading to severe airway stenosis, and other complex airway problems. The ease of cannulation, the technological advances and growing confidence in the management of ECMO patients are the main reasons for the expansion of ECMO use beyond conventional indications. The case described above is an example of the use of ECMO in the perioperative management of impending respiratory failure due to airway obstruction or disconnection. (Figure Presented).
RESUMEN
Background: Prior to the COVID-19 pandemic, oncology patients attended in-person educational sessions to understand the practicalities and side-effects of their planned systemic anti-cancer treatments (SACT). These were halted during the pandemic to minimise hospital attendances. Moreover, patients were unable to bring family or friends for support at consultations. Providing this key treatment information in a digital format using videos was proposed with these aims: 1. Improve accessibility of information. 2. Improve patient experience. 3. Improve staff experience and efficiency. Method(s): A network collaboration with the Royal Free London and North East London Cancer Alliance enabled consistency of information and increased exposure of the videos. A patient-centred approach was taken in developing the videos: 1. A baseline patient survey assessed current and proposed methods of communicating: patients received written and verbal information, but some felt they had been given 'too much' or 'not enough' information and 33% of patients reported a video would be helpful. 2. A patient focus group guided content: cannulation, real patient experiences and images of staff/facilities were identified as important. 3. The videos were translated into four languages to meet the needs of the local patient population. A multiprofessional team of doctors, nurses, managers and communications staff were involved in the development and production of the videos. Between November 2020 and September 2021, several Plan Do Study ACT (PDSA) cycles were undertaken to create, edit and review content in the production process, with patient and production team feedback throughout. Intervention(s): Three videos were produced covering an overview of treatment and the side-effects of chemotherapy and immunotherapy. These were disseminated via trust websites, YouTube and QR codes on posters. Learning outcomes of the videos were assessed by separate patient and staff feedback surveys. Result(s): 15 patients were approached prior to starting SACT to complete a questionnaire prior to and after watching the videos. Prior to watching the videos, 60% of patients felt they had not received enough SACT information, 73% were anxious about treatment. After watching the videos, 100% reported understanding of the common side-effects of treatment and how to contact the hospital for advice. 87% would recommend the videos to others, 73% would watch them again. 100% of staff surveyed agreed that the videos improved accessibility to key patient information. The videos answered common questions patients asked staff prior to starting treatment. Over six months, there have been >300 YouTube views. [Formula presented] Conclusion(s): Multilingual patient information videos are an effective way to deliver key information about SACT, improve patient experience and reduce anxiety. Next steps are to intensify signposting by increasing stakeholder exposure, and consider adapting the videos for national use. YouTube views will be counted to continue to monitor the use and sustainability of this intervention. Keywords: systemic anti-cancer therapy, digital, videos, patient education, patient experience, patient information, multilingual, staff experience, network collaboration, SACT, chemotherapy, immunotherapy Copyright © 2022
RESUMEN
Background: The successful establishment of the EBMT PSY Day, and recognising the value of community of practices (CoP), inspired a UK equivalent to be organised. Methods: An event was held in 2020 for psychological professionals working in UK Adult and Paediatric Stem Cell Transplant (SCT) services. It was free-of-charge, virtual (due to Covid-19 pandemic) and organised with Anthony Nolan who provided administrative and technical support. The aims were to provide an opportunity to meet and network, share learning and peer support and create a CoP to help develop services and improve psychological care for SCT patients. 31 attended consisting of clinical and counselling psychologists, psychotherapists, counsellors and trainees. The programme comprised presentations (on screening, prehab, research ideas, a service story, EMDR and self-care) and small group 'breakout' discussions. An online survey collected quantitative and qualitative data from attendees to evaluate the event. Results: To date, 22/31 attendees (71%) have completed the survey-18 in Adult, 4 in Paediatric services;18/22 (82%) have worked in SCT for more than 1 year;15/22 (68%) have never attended EBMT. The event was rated highly;when asked how valuable they found it the mean response was 8.8 (1-not valuable at all, 10-very valuable) and when asked how likely it is they would attend a similar event in future the mean was 9.6 (1-not likely at all, 10-very likely). Qualitative data was gathered from the following survey questions;key themes emerged which are outlined and illustrated with quotes. What did you find most valuable about the day? Opportunity to meet and connect with fellow professionals in the field, learn about other services, share experiences and best practice. "I really enjoyed hearing the talks from each person working into SCT as it got me thinking about what we do in our service, and how we could shape our service further. I also really enjoyed the breakout rooms and having the opportunity for discussions about each of our services " How could it have been improved? Most commonly, attendees felt no improvements were needed. "I think with all the restrictions of covid and remote meeting, it was the best it could be." Constructive suggestions were made regarding timings, preevent advertising/communication and content e.g. "Good to get a patient view or Expert by Experience?" What would future events be like to make you feel that attending them was a good use of your time? Similar format, key topics for learning and discussion covering clinical practice and service development, opportunity to participate in collaborative projects. "Again, learning from others" experiences in service development/xpathways/innovative ways to improve patient experience. "That they build up to more collective work on policy/quality/influence/research." Preferred frequency and duration of future meetings-biannual virtual meeting, 3-4 h. Conclusions: Feedback from attendees demonstrated the event achieved its aims and will also shape the development of a CoP for SCT psychological professionals in the UK. Establishing this has promising potential benefits for its members, their services and SCT patients.