123: Effective Utilization of CRNAs at a Level 1 Trauma Center as COVID-19 Critical Care Team Members

INTRODUCTION: The COVID-19 pandemic presents a unique challenge to critical care teams during disaster surge scenarios due to the large number of highly trained personnel required to care for a potentially overwhelming number of critical ill patients Our hypothesis is that CRNAs possess a valuable skill set that can be effectively integrated into disaster ICU teams METHODS: Detailed medical planning factors were applied to specific personnel, equipment, and supply resources available at a Level 1 trauma center during the first surge period of the COVID-19 pandemic Regional modeling of COVID-19 cases was utilized to prepare a tiered staffing response Model included a variety of qualified specialties designed to complement each other on critical care teams Study team included anesthesiologists, CRNAs, and anesthesiology residents supervised by a surgical intensivist All CRNAs had recent exposure to critically ill patients in the perioperative period Clinical and didactic training program specific to COVID critical care was completed by all team members COVID specific web-based guidelines were developed by intensivists and practiced by all teams The State Governor expanded the disaster role for CRNAs RESULTS: The medical center is the major regional treatment center for the COVID-19 response The total number of COVID patients admitted to ICUs during the 10 weeks of peak surge -161: intubated-134, managed with NIV/HFNC-27 Number of intubated COVID patients in ICUs at peak of the surge (requiring CRNA utilization) was 41 COVID critical care patient-days provided by CRNA teams - 83 The CRNA pool trained to provide COVID critical care included 20 providers (27 CRNAs continued anesthesia/OR support) COVID ICU mortality was 38% (61/161, including CMO/DNR) Observed morbidity and mortality rates for CRNA teams was similar to other COVID ICU teams CONCLUSIONS: The COVID-19 pandemic requires an ?all hands-on deck? approach to maximize high quality, safe care for a high volume of critically ill patients The utilization of CRNAs has been demonstrated to provide effective, highly skilled critical care team augmentation during a disaster surge scenario Appropriate critical care team preparation and coordination, communication and training guidelines are essential during a disaster scenario