Mechanically Ventilated Patients at the Massachusetts General Hospital During the COVID-19 Pandemic

Abstract

Background: The COVID-19 pandemic of 2020 placed enormous stress on the national and individual state health care systems but especially on individual healthcare institutions, with relation to a number of areas; insufficient staffing, ICU beds, and mechanical ventilators. In this abstract we describe the initial experiences at the Massachusetts General Hospital from March 23, to May 25, 2020.

Methods: This retrospective study was done with local IRB approval. Staffing was addressed by voluntarily suspending vacation time and working overtime, hiring traveling therapists, and the temporary movement of staff from other institutions not experiencing a surge to the MGH. Workflow was also adjusted. ICU beds were increased by conversion of many general care floors. Number of mechanical ventilators was increased by purchasing new ICU ventilators, borrowing from other hospitals not experiencing a surge and the rental of ventilators.

Results: Minimal staff took vacation and most worked at least one overtime shift a week. A total of 24 travelers were hired, 8 staff temporarily reassigned from other institutions and 8 staff employed on a provisional basis. As the surge increased the number of routine patient/ventilator assessments decreased from every 4 hours to every 6 hours then to every 12 hours. The conversion of general care floors increased adult ICU beds from 119 to 256. The number of available ventilators increased from 167 (121 ICU, 30 transport, 16 NIV) to 321 (186 ICU, 63 transport, 72 NIV). At the peak, 156 COVID-19 patients were ventilated. During this period a total of 394 COVID-19 patients were ventilated with a median length of 16.3 days. Of these patients 263 (66.8%) were successfully liberated from the ventilator, 42 (10.7%) remained intubated and 89 (22.6%) died. In addition, 19 patients were maintained on ECMO at a median length of 12.5 days. A total of 8 patients were successfully decannulated (4 survived to hospital discharge to date), 4 died, and 7 remain on ECMO.

Conclusions: We were able to successfully negotiate the COVID-19 surge first as a result of the unselfish dedication and professionalism of the Massachusetts General Hospital Respiratory Care staff. Second, the ability to cooperate with other institutions regarding temporary transfer of ventilators and staff. Third, willingness to innovate by all involved. Fourth, the Massachusetts General Hospital and the Partners Healthcare System’s willingness to ensure that resources were available to meet the needs of all of our patients.