Surgeons in surge — the versatility of the acute care surgeon: outcomes of COVID-19 ICU patients in a community hospital where all ICU patients are managed by surgical intensivists

Abstract

BackgroundReported characteristics and outcomes of critically ill patients with COVID-19 admitted to the intensive care unit (ICU) are widely disparate with varying mortality rates. No literature describes outcomes in ICU patients with COVID-19 managed by an acute care surgery (ACS) division. Our ACS division manages all ICU patients at a community hospital in New Jersey. When that hospital was overwhelmed and in crisis secondary to COVID-19, we sought to describe outcomes for all patients with COVID-19 admitted to our closed ICU managed by the ACS division.MethodsThis was a prospective case series of the first 120 consecutive patients with COVID-19 admitted on March 14 to May 10, 2020. Final follow-up was May 27, 2020. Patients discharged from the ICU or who died were included. Patients still admitted to the ICU at final follow-up were excluded.ResultsOne hundred and twenty patients were included (median age 64 years (range 25–89), 66.7% men). The most common comorbidities were hypertension (75; 62.5%), obesity (61; 50.8%), and diabetes (50; 41.7%). One hundred and thirteen (94%) developed acute respiratory distress syndrome, 89 (74.2%) had shock, and 76 (63.3%) experienced acute kidney injury. One hundred (83.3%) required invasive mechanical ventilation (IMV). Median ICU length of stay (LOS) was 8.5 days (IQR 9), hospital LOS was 14.5 days (IQR 13). Mortality for all ICU patients with COVID-19 was 53.3% and 62% for IMV patients.ConclusionsThis is the first report of patients with COVID-19 admitted to a community hospital ICU managed by an ACS division who also provided all surge care. Mortality of critically ill patients with COVID-19 admitted to an overwhelmed hospital in crisis may not be as high as initially thought based on prior reports. While COVID-19 is a non-surgical disease, ACS divisions have the capability of successfully caring for both surgical and medical critically ill patients, thus providing versatility in times of crisis.Level of evidenceLevel V.

Mobilization of Resources and Emergency Response on the National Scale

“…Natural disasters such as landslides, tornadoes, earthquakes, and tsunamis are a type of MCI where more than 100,000 people are killed around the world and millions more are injured or disabled each year. 8 , 9 Unfortunately, in most natural disasters, people have either minimal or no time to prepare or seek shelter during these, contributing to the severity of the MCI. Other contributing factors that must be accounted for is the widespread destruction that can affect hospitals and emergency response teams that impairs their ability to respond.…”

The specialty of surgical critical care: A white paper from the American Association for the Surgery of Trauma Critical Care Committee

“…The versatility of SCC physicians in providing trauma triage, initial stabilization, operative intervention, and subsequent critical care grants hospitals a ready-to-deploy team while preserving continuity of care and redundancy in operations. Lessons from military combat have been integrated into routine trauma training, bringing adaptability in extraordinary circumstances and experience with resource distribution in environments of scarcity, making SCC providers particularly prepared to lead during crises 74,75 …”

“…Lessons from military combat have been integrated into routine trauma training, bringing adaptability in extraordinary circumstances and experience with resource distribution in environments of scarcity, making SCC providers particularly prepared to lead during crises. 74,75 The COVID-19 pandemic has brought glaring visibility to the necessity of hospitals and health systems to maintain flexibility and built-in safety systems to navigate through crises. While blunt trauma volumes decreased noticeably during the pandemic, penetrating trauma rates and proportions increased.…”

Important role of acute care surgery during pandemic time

“…Lack of earlier diagnosis and screening for disease and routine follow-up may be the major reason that causes the severity of disease during the pandemic period[ 11 ]. Moreover, one study reported that an acute care surgery division is able to manage the intensive care for COVID-19 patients independent of surgical procedures[ 12 ].…”