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. 2020 Sep 8;40(2):71-77.
doi: 10.1016/j.eimc.2020.08.007. Online ahead of print.

Planning for the assistance of critically ill patients in a Pandemic Situation: The experience of Vall d'Hebron University Hospital

[Article in English, Spanish]
Ricard Ferrer  1 , Marcelino Báguena  2 , Joan Balcells  3 , Jordi Bañeras  4 , Alfons Biarnes  5 , Miriam de Nadal  5 , Rosa María Gracia  6 , Jesús Martinez  7 , Xavier Nuvials  6 , Jordi Riera  6 , Oriol Roca  6 , Juan Carlos Ruiz-Rodriguez  6
Affiliations

Planning for the assistance of critically ill patients in a Pandemic Situation: The experience of Vall d'Hebron University Hospital

[Article in English, Spanish]
Ricard Ferrer et al. Enferm Infecc Microbiol Clin (Engl Ed). .

Abstract

Introduction: In the context of community transmission of the virus, the impact of the pandemic on health-care systems, mainly on intensive care units (ICU), was expected to be devastating. Vall d́Hebron University Hospital (HUVH) implemented an unprecedented critical patient-care planning and management of resources.

Methods: We describe a cohort of critically ill patients during the first two months of the pandemic (from March 3, 2020, to May 2, 2020) in HUVH, Barcelona. In this manuscript, we report our previsions, strategies implemented, and the outcomes obtained.

Results: Three-thousand and thirty-three patients were admitted to the HUVH Critical Care Units. Throughout the study period, the proportion of patients on IMV or IMV and ECMO remained above 78%. Most patients were men (65%); the most common age group was 60-70 years. Twenty-three patients received ECMO, and eighteen were cannulated at another center and transferred to HUVH. At the end of the study, fourteen patients were successfully decannulated, three patients died, and the rest of the patients were still on ECMO. Eight pregnant women have been treated in the ICU, with a survival rate of 100%. The ICU mortality of patients younger than 60 years was 3.2%. The mean ICU stay of both survivors and nonsurvivors was 14 days.

Conclusion: The adequate preparation for resource expansion for critically ill patients care, main challenges, and overall positive results can serve as a precedent for similar future scenarios.

Keywords: Acute respiratory distress syndrome; COVID-19; Coronavirus; Distrés respiratorio; Health-care system; Hospital resources; ICU; Recursos hospitalarios; Sistema sanitario; UCI.

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Figures

Figura 1
Figura 1
Ficha de criterios de activación del ECMO team, junto con indicaciones y contraindicaciones.
Figura 2
Figura 2
Evolución de casos de COVID-19 ingresados en la unidad de cuidados intensivos. UCI: unidad de cuidados intensivos; CNAF: cánulas nasales de alto flujo; ECMO: oxigenación con membrana extracorpórea; VMI: ventilación mecánica invasiva.
Figura 3
Figura 3
Datos de mortalidad en la UCI en los diferentes grupos de edad.
See this image and copyright information in PMC

References

    1. Ferrer R. COVID-19 Pandemic: the greatest challenge in the history of critical care. Med Intensiva. 2020 https://doi.org/10.1016/j.medin.2020.04.002doi. - PMC - PubMed
    1. Rascado Sedes P., Ballesteros Sanz M.A., Bodí Saera M.A., Carrasco Rodríguez-Rey L.F., Castellanos Ortega A., Catalán Gonzalez C., et al. Plan de contingencia para los servicios de medicina intensiva frente a la pandemia COVID-19. Med Intensiva. 2020 https://doi.org/10.1097/ccm.0000000000002953. - PMC - PubMed
    1. Emanuel E.J., Persad G., Upshur R., Thome B., Parker M., Glickman A., et al. Fair Allocation of Scarce Medical Resources in the Time of Covid-19. N Engl J Med. 2020 - PubMed
    1. WHO. Coronavirus disease (COVID-2019) situation reports. World Health Organization Report C https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situatio.... Consultada el 12 de Mayo de 2020
    1. Hospital Universitario Vall d’Hebron. https://hospital.vallhebron.com/. Consultada el 12 de Mayo 2020

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