In COVID-19 hotspots like Wuhan, China, or New York City, death rates for patients on ventilators have been as high as 90%, causing hospitals to develop new protocols and innovate on the fly. That's what happened at Parkland Hospital in Dallas, and so far 3 out of every 4 patients placed on a ventilator at Parkland are expected to recover.
Of the 42 patients that have been placed on life support, nine have died.
Todd Aycock spends 12 hours a day, four days a week taking care of the sickest COVID-19 patients at Parkland Hospital. He’s been a nurse anesthetist for 19 years at Parkland, and he wanted to be on the front line.
“Once you get in there and you start taking care of patients, you kind of forget those fears,” Aycock said. “You know last night we extubated a patient who I intubated 4 weeks ago. So, they are finally, four weeks later, getting off a ventilator, and it’s very rewarding to see that.”
Parkland has seen extraordinary results for coronavirus patients who are on life support. Almost 80% of patients on ventilators are expected to recover. In fact, almost half have already gone home.
Critical care physician Matthew Leveno is the head of the medical ICU at Parkland Hospital. In March, he was charged with putting together a plan on how to handle COVID-19.
“I have to be able to figure out not only how to care for these patients, but how to make sure that everybody that I was asking to come with me was actually going to be safe,” Leveno recalled. “That was extremely stressful.”
In less than five days, the third floor of Parkland hospital was converted into a 100-bed Tactical Care Unit. The large negative pressure room maintains air flow preventing cross contamination. The unit is set up kind of like a car wash — one way in and one way out — with an experienced surgical team helping staffers put on and take off their protective gear.
“First, the safety of the staff going in and out. The fact that they're in their gear the entire time decreases the number of opportunities for mistakes in terms of getting in and out,” Leveno explained. “It also decreases the amount of PPE we're consuming, and again it allows us to really optimally care for our patients.”
Leveno said having all the COVID-19 patients in one space allows physicians to easily move them to the ICU if their condition worsens – it’s literally 20 feet away. He also identified a small intubation team that includes Todd Aycock. They handle the precarious procedure of placing the patients on ventilators.
“I’ve been so impressed with the teamwork from, literally, the techs, environmental services, all the way up to the intensive care pulmonologist,” Aycock said. “Everybody truly works as a team.”
Leveno said creating this controlled, collaborative environment has been key to Parkland’s high recovery rates.
“We really went into this thinking that we were going to lose 40, 50, 60, 70% of the patients who require mechanical ventilation,” he said. “I think it's been a real source of rejuvenation for the people who are down there knowing that basically what they're doing is helping people.”
Medical staff in some of the hardest hit hospitals worldwide have seen a much higher risk for infection compared to the general public. While Parkland couldn’t release numbers of medical personnel who have been infected with COVID-19, Leveno said he feels that staffers at Parkland are no more likely to test positive than folks in the general public.
Aycock isn’t surprised. He feels safer in the COVID Unit than he does at the grocery store.
“When I talk to a lot of my colleagues, they all tell you the same thing — that they feel very comfortable in there,” Aycock said. “We have the personal protective equipment. We know what we’re getting into, take time to do things the correct way and the best way possible. So, you really eliminate all of those risks as much as possible.”
Right now, the COVID Unit is three-quarters full, but Parkland doctors said they’re prepared for more patients as the state continues to reopen.