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ESAIC Newsletter #82: On entering the field of anaesthesiology in the time of COVID-19

Jacob Michael Lurie, Debbie Chi, Maryna Khromava

Icahn School of Medicine at Mount Sinai, New York, NY, USA

Email: jacob.lurie@icahn.mssm.edu

On March 20th, final-year medical students across the United States learned where they matched for residency. At the same time, the drastic implications of the COVID-19 pandemic were being felt across all medical specialities, including anaesthesiology. As fourth-year medical students entering the field of anaesthesiology at a time of great uncertainty and change, we have been struck by incredible and selfless examples of anaesthesiologists fighting against COVID-19. These actions inspire us and — while the situation is tenuous and admittedly frightening — reaffirm our decision to become anaesthesiologists. There are countless media examples of anaesthesiologists demonstrating courage, innovation, and tenacity while treating patients affected by COVID-19. These anecdotes provide not only advice to other physicians, but also elements of reassurance amid feelings of fear and isolation and remind us that we are all in this together.

Anaesthesiology was the first field to champion patient safety with the founding of the Anesthesia Patient Safety Foundation (APSF) back in 19851, and anaesthesiologists continue to lead efforts in patient and healthcare worker safety. The expertise of anaesthesiologists is needed now more than ever in ensuring we can effectively combat this pandemic. Examples of anaesthesiologists spearheading efforts against COVID-19 include creatively repurposing more common hospital supplies into personal protective equipment (PPE) in the midst of N95 and powered air-purifying respirator (PAPR) shortages, sharing best practices for donning and doffing PPE, and creating designated airway teams. Additionally, the daily practice of anaesthesiologists with recurrent contingency planning for worst-case scenarios while maintaining a calm, collected modus operandi heightens the speciality’s aptitude for keeping the patient safe. Specifically, in this current pandemic, anaesthesiologists have been leading the way in properly converting anaesthesia machines to long-term ventilators and raising concerns about splitting ventilators between multiple patients2. These are extraordinary measures for extraordinary times, and oversight over such tactics is crucial for patient safety and wellbeing. According to the APSF, only anaesthesiologists can lead other health care workers on how to safely manipulate anaesthesia machines to use as long-term ventilators3, and we would like to underscore this sentiment.

Anaesthesiologists are unmatched in their ability to navigate the complex pathophysiology and pharmacology of many medical comorbidities and also in their training in critical care medicine. Anaesthesiologists are not simply glorified respiratory therapists, and their expertise in ventilatory support should not be understated. The Society for Critical Care Medicine recently published an infographic (since removed) demonstrating a tiered staffing strategy for pandemics, and anaesthesiologists were equated to Certified Registered Nurse Anaesthetists (CRNAs), advanced practice providers (APPs), and respiratory therapists (RTs) without distinction4. We would contend that treating all providers trained in ventilators as a monolith is unhelpful and belittles the expertise of each of these providers. Moreover, anaesthesiologists are experts in healthcare coordination on the system and individual level (it is no coincidence many administrators around the country are anaesthesiologists), and such training has proved important in the current COVID-19 crisis.

As final-year medical students preparing to join the physician workforce, we are inspired to continue the legacy of champions of patient safety, leaders in health system coordination and acute patient care, and innovators of ventilatory support, and we look forward to moving the field forward and inspiring the next generation of anaesthesiologists-to-be. As espoused in the concluding lines of the modern version of the Hippocratic Oath: “May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.”5

 

References:

  1. Stoelting RK. Foundation History. APSF: Anesthesia Patient Safety Foundation. Available at: https://www.apsf.org/about-apsf/foundation-history. Accessed March 26, 2020.
  2. Joint Statement on Multiple Patients Per Ventilator. APSF: Anesthesia Patient Safety Foundation. Available at: https://www.apsf.org/news-updates/joint-statement-on-multiple-patients-per-ventilator. Accessed March 26, 2020.
  3. APSF/ASA Guidance on Purposing Anesthesia Machines as ICU Ventilators. American Society of Anesthesiologists. Available at: https://www.asahq.org/ventilators?&ct=923510647ef33730cadf31438387d6462b8e17e17f8e0e0623e41cb3d88946f79dccb7a0c5a463b990269b34e8c88584ca196820c257aa4a8482667b0648d7b1. Accessed March 26, 2020.
  4. United States Resource Availability for COVID-19. Society of Critical Care Medicine. Available at: https://sccm.org/Blog/March-2020/United-States-Resource-Availability-for-COVID-19. Accessed March 26, 2020.
  5. Shiel WC. Medical Definition of Hippocratic Oath. MedicineNet. Available at: https://www.medicinenet.com/script/main/art.asp?articlekey=20909. Accessed March 26, 2020.

 

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