Front-line Opportunity for Electrophysiologists During COVID-19: Form an ICU “Line Team”

At the time of this writing, more than 41,758 people in the United States have already died from COVID-19. Some cities, like New York, have been hit harder than others, and some hospitals, such as DMC Sinai-Grace Hospital in Detroit, have been overwhelmed. Nurses, doctors, and other healthcare workers are running to the fire and bearing the brunt. Electrophysiologists from around the world have been needed on the front lines, and are taking care of patients on COVID units, emergency rooms, etc. However, most electrophysiologists have been practicing within their subspecialty, performing urgent EP procedures that cannot be postponed, and managing their outpatients using telemedicine. 

What more can EPs do to contribute? Consider forming a “Line Team” to place central lines and arterial lines in the intensive care unit (ICU). The COVID ICUs are places that are stressed at many hospitals. A fair number of patients who are intubated for COVID pneumonia require central venous access and an arterial line. Many ICU teams would appreciate and benefit from a special team of doctors — EPs, cardiologists, vascular surgeons, and interventional radiologists — to place central venous catheters, dialysis catheters, and arterial lines. Below are some considerations when developing a vascular access team for the COVID ICUs:

• Find volunteers and create a schedule.
• Minimize participation by trainees.
• Let the ICU teams know about the “Line Team” service.
• Create a virtual pager.
• Familiarize yourself with the environment.
• Different COVID units have different supplies in stock at different times. Create a portable supply cart. Include items that are not necessarily contained in the standard central line kits such as saline flush, micropuncture kits, hand-held vascular ultrasound probe, sterile probe covers, gowns, gloves, masks, hair clippers, etc.
• When paged to help with vascular access, briefly review the case, which lines are needed, the optimal access site, and the degree of urgency.
• Ask the ICU team to obtain phone consent from the family.
• Ask the ICU team for assistance with standard supply kits and supplement from the supply cart.
• Strive to enter the ICU patient room with the nurse only once, so be prepared with supplies. 
• The patients often require additional sedation for the procedure.
• Huddle with the nurse outside the room. Discuss supplies, sedation plan, bed positioning, and patient positioning.
• Gather equipment, don Personal Protective Equipment (PPE), and enter the patient room.
• After the procedure, ask the nurse to enter an order for a portable CXR if indicated. 
• Document procedure note, review CXR, and update the ICU team.

At the time of this writing, there is a sense that we are reaching a plateau in the number of COVID-19 ICU admissions. There is hope, but there is also continued uncertainty and anxiety. Hospitals are being held together by healthcare workers, many of whom have become infected with COVID-19. For electrophysiologists who are in a position to contribute more on the front lines, consider forming a “Line Team” to help your ICU colleagues.

Disclosure: Dr. Knight reports that he is a consultant, speaker, investigator, and offers fellowship support for Abbott, Baylis Medical, Biosense Webster, Inc., BIOTRONIK, Boston Scientific, Medtronic, and SentreHEART.