Jane Chao, Ceribell
MEDdesign

The New ICU

By Jane Chao, Ph.D., Jason Siegel, M.D., Sayona John, M.D.
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Jane Chao, Ceribell

The pace of innovation in the ICU is orders of magnitude slower than that of the cath lab and OR, and the COVID-19 crisis has pushed, tested, and exposed ICUs for lacking state-of-the-art technology and resources.

In perhaps the most famous low-tech hack in modern history, NASA engineers on the ground helped save the lives of three astronauts aboard the Apollo 13 by making a square peg fit into a round hole. Using only the materials the imperiled astronauts knew and had on hand while racing the clock as carbon dioxide rose to dangerous levels, they Macgyvered an adapter to the CO2 filtration system that the astronauts could build using spacesuit hoses, socks and duct tape.

During the COVID-19 pandemic, hospitals and healthcare workers have had to scramble to develop quick solutions to challenges including:

  • Not having enough PPE
  • Not having enough personnel to manage the influx of COVID patients
  • Having to quickly build negative pressure rooms
  • Relocating IV pumps
  • Protecting their staff by developing intense protocols to limit the amount of exposure time in the patient room

Much like the Apollo 13 engineers, ICU staff have been courageously improvising solutions, from modifying ventilators to be able to support two patients simultaneously on the same machine, to moving IV pumps into the hallway and running extension tubing into patients’ rooms to reduce close contact and preserve precious PPE.

ICU managers have also scrambled to find disposable versions of existing equipment in order to reduce the risk of infection for their staff. As an example, many ICUs perform a high volume of bronchoscopies. In the pre-COVID world, it was safe to use their bronchoscope cart and equipment; however, with COVID-19, some hospitals have transitioned to the use of disposable bronchoscopes to reduce the risk of infection, save space in the cluttered ICUs, and reduce costs for high-level disinfection. In addition, there’s never downtime for the equipment since it doesn’t need re-sterilization.

In addition, for the broader protection of the hospital staff, ICUs have had to limit non-essential personnel from entering patient rooms. At times, this means that a specialized technologist trained for a specific test or diagnostic is unable to provide the service.

How did we get to this? Why is it that ICUs are lagging in technology innovation relative to other departments in the hospital? Why is it that medtech companies disproportionally focus their attention and innovation on the cath lab and the operating room? Although this is a complicated dynamic, the overly simplistic answer is that it’s about money. The cath lab and operating rooms are revenue-generating departments that perform many elective procedures on an assembly line basis, whereas ICUs care for the sickest and most critical patients who often times have the longest length of stay thus resulting in significant costs for hospitals.

The pace of innovation in the ICU is orders of magnitude slower than that of the cath lab and OR, and the COVID-19 crisis has pushed, tested, and exposed ICUs for lacking state-of-the-art resources.

What can we do to prevent future situations like this?

Sayona John, M.D., medical director of the neuroscience ICU at Rush University Medical Center, explains that several of their ICUs were completely taken over by COVID patients. From her experience, the goal “is to provide the same level of pre COVID-19 ICU care while minimizing the risk of infection. How do you provide optimal care without necessarily seeing the patient as often? How can you get the detailed information without compromises?”

The first and most obvious is to develop technologies that reduce the risk of infection—equipment that is either disposable or easily sanitized. We should also aim to empower the ICU staff so that they are less reliant on specialized technologists and develop tools that are easy to set up and use without compromising quality.

Jason Siegel, M.D., a Mayo Clinic neurologist specializing in neuro critical care, points out, “we should accelerate telemedicine features that reduce the need to be in direct contact with the patient. All of our hospitalized non-ICU COVID-19 patients are telemonitored by our ICU personnel. This is a huge step forward in reducing risk of patients crashing on the floor.”

Lastly, we need to bring artificial intelligence to the ICU to improve patient care. Unlike the cath lab and OR where you most often know what is wrong with the patient, the patient’s condition in the ICU is often clouded with uncertainty. AI in the ICU can help bring granular processed data facilitating higher levels of information, which can help clinicians treat patients in a more timely and effective manner.

The COVID-19 crisis has hit home for us given the neurological impact that the virus can have on patients, as well as the risks it presents to our ICU partners.

Ceribell, EEG
Ceribell’s rapid-response EEG (electroencephalography) features a quick set up disposable headband and recorder that is easily sanitized with a bleach wipe that was originally designed to address some of the deficiencies we identified in the traditional EEG, including speed and ease of set up, limiting threat of infection transmission and portability. Given the current risk of COVID-19 infection is significantly based on exposure time, every second spent diagnosing a patient counts. (Image courtesy of Ceribell)

Our Challenge to the Rest of the Industry

Advancements in technology, materials and science have drastically improved so many aspects of our daily lives, yet the ICU remains relatively unimpacted by those gains. The need for innovation in the ICU has existed for many years, but the COVID-19 pandemic has underscored the need to move more quickly for patients and caregivers alike. With so many processes, diagnoses and treatments happening in the ICU at any given moment, there is tremendous opportunity for improvement. So, I challenge our peers in the industry: Focus on the ICUs, empower them, and help prevent their struggles during the next crisis.

About The Author

Jane Chao, Ceribell

About The Author

Jason Siegal, Mayo Clinic
Jason Siegel, M.D.
Neurointensivist

Jason Siegel, M.D. is a neurointensivist at the Mayo Clinic in Jacksonville, Florida. He graduated from Indiana University School of Medicine in 2012 and has more than eight years of diverse experience, particularly in critical care neurology. Siegel’s clinical focus includes neurological emergencies, strokes, intracerebral hemorrhages, subarachnoid hemorrhages, status epilepticus, neuromonitoring, neurologic prognostication, neuro-inflammation in acute brain injury, neurological complications of critical care medicine, and post-neurocritical care patient outcomes. Siegel is the vice chair for research for the Mayo Clinic Florida Department of Critical Care Medicine. He chairs the Mayo Clinic Florida COVID-19 Treatment Review Panel, is the local PI for several multicentered trials in areas from stroke to COVID-19.

About The Author

Sayona John, M.D., Rush University Medical Center
Sayona John, M.D.
Associate Professor, Neurology

Sayona John, M.D. is an associate professor of neurology at Rush University Medical Center. She is the section head for critical care neurology and medical director of the Neuroscience ICU. She also is the director of the Neuroemergency Transfer Program. She is a member of the board of directors of the Neurocritical Care Society. John is board certified in neurology, with subspecialty certification in neurocritical care by both the United Council on Neurological Subspecialties and the Committee on Advanced Surgical Training (CAST) of the Society of Neurological Surgeons.

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