ICU Nurses and Doctors on Frontline of Battle Against the Coronavirus

Hospitals around the world are being pummeled by an unceasing surge of people ill with COVID-19. Patients are filling up coronavirus wards, including in some cases the hallways of those wards, and many require intensive care treatment.

Patients, physicians, nurses and families are all suffering.

Just this week, social media in Egypt was abuzz with reports that COVID-19 patients allegedly were dying in hospitals due to lack of supplemental oxygen. A video was posted by a man whose family member allegedly died after not receiving oxygen therapy, while another person was quoted as saying that another hospital in Egypt also could not supply enough oxygen to keep its coronavirus patients alive.

In Israel a video also circulated, this one showing an elderly COVID-19 patient lying on the floor in a puddle of his own urine after falling out of a chair in one of the country’s hospitals. According to another patient in the ward, the gentleman lay on the floor for at least 30 minutes.

Nurses are the professionals who work minute by minute to closely provide care for patients. The coronavirus pandemic has created immense challenges for these members of the staff who have most of the primary, one-on-one contact with patients. They are the people, alongside paramedics and emergency room personnel, at the most risk of infection.

For intensive care unit nurses working with critically ill COVID-19 patients, it is even more difficult.

“There are more and more difficult cases coming in every day. Terribly complicated ones that we must be aware of every day and every shift. We need to keep ourselves and our staff aware of every change and modify our treatment programs,” said Valery Nudelman, a registered nurse with a master’s degree in health administration, the head nurse of the General ICU at Sheba Medical Center, located outside Tel Aviv.

It is not easy, she told The Media Line, because ICU nurses are at a premium, and there are not enough to completely staff every shift. Hospitals, understanding the stress and the need for more manpower, allot nurses from other divisions to the ICUs to assist every shift.

“This,” Nudelman shared, “can only go so far. ICU nurses have specialty training that others do not. The reinforcement helps, but we are still missing ICU-trained personnel.”

The shortage is most felt in the use, operation and treatment of patients with ECMO machines.

ECMO (extracorporeal membrane oxygenation) technology is similar to that of heart-lung bypass machines used in open-heart surgery. It pumps and oxygenates a patient’s blood outside the body, allowing the heart and lungs to rest. The machine does the work when the body cannot.

For COVID-19 patients, it increases their chances to live.

At Sheba Medical Center there is one RN per ECMO patient, all the time. Due to the workload entailed in treating an ECMO patient, each nurse is on for three hours then off three hours, twice during a regular 12-hour shift.

Only nurses who have successfully completed a special training program can work with ECMO. They must pass written as well as hands-on tests and are certified after an accompanied practicum.

The nurses on ECMO duty are required to perform all bedside treatment, including moving the patient, ensuring the machine is working optimally, changing medications and treatment parameters, physical therapy and suction, and everything needed to help the patient.

“This is difficult, complex work, especially considering the risks of our exposure to the coronavirus,” said Nudelman.

There also is a high financial cost to keeping patients on ECMO machines, sometimes for weeks at a time.

There are more and more difficult cases coming in every day. Terribly complicated ones that we must be aware of every day and every shift. We need to keep ourselves and our staff aware of every change and modify our treatment programs

Meanwhile, supply of and demand for the special machines must also be taken into consideration.

For example, Sheba Medical Center has 11 ECMO machines spread out among the General ICU, Pediatric ICU, Heart Surgery ICU and Coronavirus ICU wards.

“We always need to keep one spare for another emergency. Our policy is to use these machines only in last-ditch cases and I am very, very aware of trying to keep their use to a bare minimum,” said Dr. Yael Haviv Yadid, head of the General ICU and the Coronavirus ICU at Sheba Medical Center.

“A year into the pandemic does not mean that all the ECMO machines go toward the coronavirus,” she told The Media Line. “It does mean that we have to always think how best to utilize them.”

As long as the region and world continue to see hospital caseloads rise, the situation will continue to be dire.

Here is a look at the regional coronavirus pandemic numbers for this week: