Early experience of a multidisciplinary bedside procedure team (SWAT) during the initial COVID-19 outbreak in New York.

Background - The outbreak of SARS-CoV-2 in March 2020 in New York required rapid expansion of intensive care unit (ICU) capacity and redeployment of physicians not formally trained in critical care to help staff these new units. A surgical workforce activation team (SWAT) was created by the Department of Surgery in conjunction with the Division of Interventional Radiology to meet increased demand for bedside procedures in these units.

Methods - This is a retrospective review of procedures performed by SWAT at the bedside in critically ill patients during a two-week period from March 23rd to April 8th. Demographic data, admission date, intubation date, discharge date and date of death as well as procedural data including type of procedure, catheter positioning, complications and radiographic verification of the catheter prior to use, were recorded and evaluated.

Results - 569 procedures were performed by the SWAT on 273 unique patients during 418 patient encounters. 260 of those patients tested positive for COVID-19 . Post-procedure radiographs resulted in 5 catheter repositioning procedures, with no adverse patient outcomes related to malpositioning. 1.2% of patients developed pneumothoraces following line placement. Catheter tip location in the brachiocephalic vein was significantly associated with non-salvageable catheter thrombosis (p<0.001) in COVID-19 positive patients.

Interpretation- A SWAT can be created to safely accommodate increased bedside procedure volumes of critically ill patients during COVID-19. Immediate follow up radiographs are not necessary following uncomplicated bedside image-guided procedures. However, placement of longer dialysis catheter lengths to ensure the tip is in the right atrium will likely reduce catheter related thrombosis and need for catheter revisions in COVID-19 patients with coagulopathies.

背景——2020年3月纽约暴发严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）后，需快速扩容重症监护病房（Intensive Care Unit, ICU）床位，并调配未接受过重症护理正规培训的医师支援新增病区。外科部与介入放射科联合组建了外科手术机动团队（Surgical Workforce Activation Team, SWAT），以满足新增重症病区床旁操作的需求。
方法——本研究为回顾性分析，对象为2020年3月23日至4月8日两周内，由SWAT团队为重症患者实施的所有床旁操作。研究记录并评估了患者人口学资料、入院日期、气管插管日期、出院日期、死亡日期，以及操作相关数据，包括操作类型、导管位置、操作并发症、操作前导管的影像学验证结果。
结果——研究期间，SWAT团队共为273名不同患者实施了569次操作，涉及418例次患者诊疗人次，其中260名患者新冠病毒核酸检测呈阳性。术后影像学检查提示共需对5根导管进行复位操作，未出现与导管错位相关的不良患者预后。1.2%的患者在管路置入后出现气胸。在新冠病毒核酸检测阳性的患者中，导管尖端位于头臂静脉与不可挽救的导管血栓形成显著相关（p<0.001）。
解读——新冠疫情期间，可组建SWAT团队安全应对重症患者床旁操作量的激增。对于无并发症的床旁影像引导操作，术后无需立即行影像学复查。但对于合并凝血功能障碍的新冠阳性患者，置入更长长度的透析导管以确保导管尖端位于右心房，或可降低导管相关血栓形成及导管修正需求。