"Red Detachment of Women" in ICU: Stick to the last line of defense

At 9:30 am on February 28, doctors from tongji Hospital and Huashan Hospital began to take Wang Qiang (pseudonym) off the invasive ventilator in the ICU ward of Tongji Hospital of Huazhong University of Science and Technology. His vital signs were very stable.More than two hours later, doctors removed the ECMO tube from Wang's blood vessels, meaning he was successfully removed from ECMO support and will soon be transferred to a regular hospital room.

It is difficult to get on ECMO, but even more difficult to withdraw ECMO. The improvement of Wang Qiang's condition has brought confidence to all medical staff.

"The management of ECMO is a delicate task," says Professor Wang Daowen, head of the cardiology department at Huazhong University of Science and Technology's Tongji Hospital. "Any mistake is not a life-saving but a fatal one.The biggest credit goes to our nurses."

ECMO, the ultimate lifesaver

With the spread of the epidemic, Tongji Hospital of Huazhong University of Science and Technology has become a designated hospital. Fever clinics and isolation wards have been set up in Zhongfa New Town hospital and Optical Valley Hospital respectively, and all patients treated are severe and critically ill with COVID-19.

Clinically, 20% of critically ill patients have heart damage.At the discussion on difficult cases in Optical Valley Hospital, Zhou Ning, a member of the heart care team of Tongji Hospital and deputy chief physician in the department of Cardiology, proposed that a human being is a whole. When novel Coronavirus is encountered, a patient's heart and lungs are fighting at the same time. Only when the heart is well protected can the patient fight against pulmonary infection wholeheartedly.

Despite being called a "life-sustaining device," ECMO is not a routine treatment, and many medical staff are not trained in the procedure.Guan Zhimin is the only specialist nurse in charge of ECMO operations in the intensive care unit of Optical Valley Hospital.

"The first week when Wang Qiang was on ECMO was the most painful time for me!No one can take over, the phone keeps ringing and I can't sleep all night!""Guan Zhimin recalled.

Fine management of "one person, one policy"

Although he was able to operate medical equipment skillfully at ordinary times, he still encountered many difficulties in the process of getting on the computer for Wang Qiang ECMO.

The first is the question of oxygen and air.In the past, ECMO equipment was provided by the hospital for central oxygen supply, but now because of COVID-19, all the patients in the hospital are using oxygen. The oxygen pressure is unstable, and the machine will keep alarming.

To be on the safe side, Guan Zhimin entered THE ICU more than two hours in advance, adjusted various parameters on the ECMO equipment, connected the mobile oxygen cylinder, and manually adjusted it a little bit, finally found a suitable oxygen pressure value.

"The hardest part is not the technical level, but the psychological pressure."Professor Wang Daowen, director of the Department of Cardiology, Tongji Hospital, said, "ECMO turns two to three thousand a minute. Once the operation is not standard, it will not only affect the operation of other equipment, destroy the whole system, and even let the patient's blood splash into the whole ward."

At first, Guan spent long hours in the ICU every day to make sure other nurses knew what to do, how to handle alarms and what to do in an emergency.

Stick to it to the best of your ability

During the 9 days from catheterization to extubation of ECMO, 7 people from the nursing team of Tongji Hospital and 6 people from the medical team of Huashan Hospital guarded ECMO in special shifts, working in shifts of 4 hours and 24 hours.

At 8 o 'clock one evening, just after handing in her shift, Nurse Chen Hong, who was on duty, heard the alarm of the instrument.'Don't panic. Think what went wrong!She calmed herself down, checked the tubes and called a doctor to contact the care team.After checking all the external factors, the alarm of the instrument was still not eliminated. Chen Hong immediately started the hand pump to ensure the patient's perfusion.Thirty minutes later, the team rushed to the ward with Doctors Zhou Ning, Wang Luyun and nurses Guan Zhimin and Zhang Panpan.They speculate that a slight change in the patient's position causes the junction to adhere to the wall of the vessel, resulting in a decrease in blood flow.Due to the timely adjustment, the patient was saved.

"Demand is command, and every second is life waiting."Everyone in the team is trying to get the patient back from death.