#covid19 – The extreme clinical challenge of taking care of patients affected by COVID-19

As we know COVID-19 cases are soaring in the US. Yesterday the US became the first country in the world for number of cases and unfortunately this is only the beginning of the pandemic wave hitting the country. There are more than 80,000 cases and 1000 deaths (The New York Times, 3/26/20), even though we are at the beginning of the infection curve. Epidemiologic analysis of the infection curve projects New York City infection rate to surpass the numbers of cases and deaths seen in Italy and Spain (he New York Times, 3/25/20).

 

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As seen over the entire nation, cases in Florida are growing rapidly as more individuals get tested for the disease. Baptist South Florida is producing a huge effort to provide healthcare workers with the adequate Personal Protective Equipment (PPE) and in fact non-disposable respirators have been distributed in the past few days to improve the level of protection for healthcare providers.

Approximately 2 weeks ago we had our very first critical case. A middle-age patient with no comorbidities was admitted to the hospital with acute respiratory failure requiring intubation for mechanical assisted ventilation. He had been spending time with a friend of his who subsequently had been hospitalized in Europe and who had been diagnosed with COVID-19.

The patient’s conditions deteriorated rapidly to a point that because of the worsening pneumonia, his level of blood oxygenation was incompatible with survival. In cases as such the only therapy capable of keeping patients alive is to establish Extracorporeal Membrane Oxygenation (ECMO). This technology can be implemented with two different modalities.

Of these, the veno-venous configuration is based on the use of a pump able to drain de-oxygenated blood from the venous system, oxygenating the blood outside the body and reinfusing oxygenated blood in the heart chambers. With this therapy the function of failing lungs can be supported temporarily allowing the lungs to recover from the damage produced by the infection process.

The implementation of this therapy, which can only be considered as a last treatment resource and is not applicable on a large scale, requires a high degree of specialization of the healthcare teams and a substantial organizational effort by hospitals, but having it available can truly make a difference between life and death.

 

 

By: Domenico Calcaterra MD, PhD, Chief of Cardiothoracic Surgery, Bethesda Hospital East, Baptist Health South Florida and delegate Midwest of Miami Scientific Italian Commuity,

 

 

 

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