Julia T. Herrera1, Gonzalo Tamayo1, María L. Hernández-Sanz1, Carlos Ferrando2,3, for the COVID-19 Spanish ICU Network*.
1 Department of Anaesthesiology and Critical Care, Hospital Universitario Cruces, Spain.
2 Department of Anaesthesiology and Critical Care, Hospital Clínic, Institut D’investigació August Pi i Sunyer, Barcelona, Spain;
3 CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain;
We would like to thank Ubikare company that freely made available to us all of its human and technological resources to develop the data collection tool in a very short period of time and to Alfredo Egea PhD. Preventive Medicine and Public Health Department, University of Navarra, for his support.
In December 31st, 2019 several cases of unknown etiology pneumonia in Wuhan were reported to the Chinese WHO office. A month later, the new coronavirus outbreak was declared a Public Health Emergency of International Concern by the WHO. By 11 March 2020, with over 118,000 confirmed cases and 4,291 deaths in 114 countries, the coronavirus disease (COVID-19) was declared a pandemic.1 The news from China, though geographically distant, coupled with the outbreak of cases in Italy of critically ill patients caused health authorities and governments across the continent to prepare for what was to come. The Spanish government declared the state of alert on 14 March 2020 with 5,723 confirmed cases and 183 deaths. Two months later, on 14 May 2020, official cases sum up to 230,187 and 27,459 people have died in Spain2.
The COVID-19 pandemic merits the Mass Casualty Incident (MCI) label, which is defined as an event that interrupts the normal functioning of a community, exceeding its coping mechanisms and in which external assistance is often needed to return to normal functioning3. The MCI should be managed in the phases of mitigation, planning, response, and recovery. These events represent a challenge for health systems, but also an economic, political and social challenge for any country. The pandemic outbreak has demonstrated our unpreparedness to calamities. In a few weeks, our highly developed healthcare system was shown very vulnerable. And as an example, the collapse suffered in some Spanish regions by an unforeseen increase in the demand for intensive care beds. Thousands of healthcare workers were infected due to strenuous working conditions and scarcity of personal protective equipment. We have faced uncertainty, fear and risks to our own health and that of our loved ones.
Resilience has been key to deal with this not-ever-seen challenge. Resilience is the ability to recover from or adjust easily to misfortune or change. In health sciences, the ability of healthcare organizations to resist, absorb and respond to a crisis while maintaining essential services and recover to the previous situation or adapt to a new one4. It is determined by structural components (facilities), nonstructural components (healthcare workers, supplies) and by healthcare systems (competencies) and management abilities (plans, procedures, communication strategy). Organizations that share goals, values and projects, based on transversal management and collaborative leadership are more resilient. Improving resilience in our organizations will allow to better cope with future crisis and minimize its impact in society. So, this loom of recovery should be no opportunity lost to simultaneously start planning and shoring up our healthcare systems to resist future onslaughts. Resilience depends on resources, and therefore adaptability and ingenuity to cope with new and changing situations are essential. A good hospital response plan must be based on efficiency and simplicity, it must be activated in a short period of time and use ordinary resources. It should also develop mechanisms for continuous evaluation and improvement.
Anaesthesiology and Critical Care Departments have shown countless evidence of resilience in this outbreak, being able to increase by two or threefold their baseline capacity, and hence providing care to every critically ill patient. Our adaptability to a different scenario day after day and the redistribution of own resources of the planned surgical activity, such as specialists, nurses, anaesthesia machines, infusion pumps, recovery and operating rooms, as the demand for intensive care grew it has been crucial. At the same time, and to maintain the right to equity, other ICUs were organized to offer assistance to critically ill non-COVID-19 patients.5-7. For so, different specialities, backgrounds, collaborative leaderships and synergies have come together just for one common objective: provide the best care possible to our patients in safe conditions.
Work overload and lack of planning entail a major obstacle for data gathering and information sharing, and thus alternative channels to scientific papers have burst in this pandemic. Early March, foreseeing the situation to come, we developed a tool for statistical analysis in an altruistic collaboration with ubikare, a bioengineering group that created an online registry together with anaesthesiologists specialized in critical care. The Spanish Society of Anaesthesiology and Critical Care (SEDAR) embraced the project and thus more than 80 centres along Spain have joined their efforts. RegCov19 is a prospective cohort registry with the ability of continuous and immediate data analysis aimed to provide de-identified online information to the critical care units. Recorded data included demographics and comorbidities, symptoms before ICU admission, vital signs, chemistry panel (blood test, coagulation and biochemical), respiratory support (mechanical ventilation, haemodialysis, extracorporeal membrane oxygenation, etc.), pharmacological treatments, medical and infectious complications during admission, disease chronology and ICU length of stay (LOS)]. Severity scores, number of patients, patients discharged from ICU, patients who had died or still ongoing in the ICU, 28-day mortality. A user’s manual and tutorial videos were facilitated to ensure appropriate data entry and interpretation. After Ethics Committee approval this registry has gathered, as by 12 May 2020, clinical data from 809 ICU patients affected by COVID-19. This tool provided by ubikare with the motto “Juntos!” (Together in Spanish) bases it strengths in the cooperation between different professionals, centres and regions, and so all data contained is open to all collaborators.
We all have a long way to go to defeat COVID-19, and for such daring endeavour we need to rely on each other, offer our experience selflessly, sum up all the knowledge we can gather in a solid, evidence-based manner and publicly share validated resources and scientifically validated information, thus avoiding harmful therapies and identifying better treatment strategies. Therefore we tender a prospective cohort of COVID-19 ICU patients, specifically designed by critical care anesthesiologist (COVID-19 Spanish ICU Network).
- Coccolini F, Sartelli M, Kluger Y, et al.. World J Emerg Surg. 2020;15(1):26. Published 2020 Apr 9. doi:10.1186/s13017-020-00304-5
- Zhong S, Clark M, Hou XY, et al.. Emergencias. 2014;26:69-77
- Griffin KM, Karas MG, Ivascu NS, Lief L. [published online ahead of print, 2020 Apr 16]. Am J Respir Crit Care Med. 2020;10.1164/rccm.202004-1037CP. doi:10.1164/rccm.202004-1037CP
- Carenzo L, Costantini E, Greco M, et al. [published online ahead of print, 2020 Apr 4]. Anaesthesia. 2020;10.1111/anae.15072. doi:10.1111/anae.15072
- Gupta S, Federman DG. [published online ahead of print, 2020 Apr 24]. Postgrad Med. 2020;10.1080/00325481.2020.1761668. doi:10.1080/00325481.2020.1761668
- Peiffer-Smadja N, Lucet JC, Bendjelloul G, et al. [published online ahead of print, 2020 Apr 8]. Clin Microbiol Infect. 2020;S1198-743X(20)30187-7. doi:10.1016/j.cmi.2020.04.002
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