Early experience of a multidisciplinary bedside procedure team (SWAT) during the initial COVID-19 outbreak in New York.
Description
Background - The outbreak of SARS-CoV-2 in March 2020 in New York required rapid expansion of intensive care unit (ICU) capacity and redeployment of physicians not formally trained in critical care to help staff these new units. A surgical workforce activation team (SWAT) was created by the Department of Surgery in conjunction with the Division of Interventional Radiology to meet increased demand for bedside procedures in these units. Methods - This is a retrospective review of procedures performed by SWAT at the bedside in critically ill patients during a two-week period from March 23rd to April 8th. Demographic data, admission date, intubation date, discharge date and date of death as well as procedural data including type of procedure, catheter positioning, complications and radiographic verification of the catheter prior to use, were recorded and evaluated. Results - 569 procedures were performed by the SWAT on 273 unique patients during 418 patient encounters. 260 of those patients tested positive for COVID-19 . Post-procedure radiographs resulted in 5 catheter repositioning procedures, with no adverse patient outcomes related to malpositioning. 1.2% of patients developed pneumothoraces following line placement. Catheter tip location in the brachiocephalic vein was significantly associated with non-salvageable catheter thrombosis (p<0.001) in COVID-19 positive patients. Interpretation- A SWAT can be created to safely accommodate increased bedside procedure volumes of critically ill patients during COVID-19. Immediate follow up radiographs are not necessary following uncomplicated bedside image-guided procedures. However, placement of longer dialysis catheter lengths to ensure the tip is in the right atrium will likely reduce catheter related thrombosis and need for catheter revisions in COVID-19 patients with coagulopathies.