Arterial Line Patency in ICU Bound COVID-19 Patients
Condition: SARS-CoV-2 ICU Bound
Study type: Observational

Summary: 
      The health care system was completely overwhelmed by the SARS-Cov-2 virus, and ICU admissions
      soared as a result of the ICU doctors' increased workload. A committed crew inserts invasive
      line procedures to guarantee a secure and efficient performance. When COVID-19 bound patients
      were followed up on in the second wave, frequent requests for arterial line placement were
      noted. These critically ill individuals had high rates of thrombosis, which was linked to
      thrombotic consequences. Many factors, such as patient morbidities, insertion technique, and
      operational health care trained personnel's qualifications, contribute to the lowering of
      arterial line patency.

      Our ICU management committee approved the use of systemic anticoagulation of ICU admitted
      patients starting on March 21, 2021 in response to an increase in the incidence of thrombosis
      and pulmonary embolic events in patients with COVID-19 admitted to the ICU in the second wave
      of the epidemic.
    

Detailed description: 
      1. Introduction / Background The number of Coronavirus Disease 2019 (COVID-19) patients
      admitted to the intensive care unit has increased, and it has been noted that this pandemic
      is linked to high rates of thrombosis, which has exacerbated its effects on those critically
      ill patients.

      In order to provide a multidisciplinary, safe service for invasive vascular procedures, as
      well as endotracheal intubations and the rapid response team (RRT) for quick assessment of
      deteriorating patients in the ward who were in need of ICU admission, which was reported
      before at a USA institute, we established a dedicated invasive procedure team from
      anesthetists during the peak admission of patients with COVID-19 to the ICU.

      Invasive vascular access was employed for hemodynamic monitoring and management in patients
      undergoing high-risk surgery, especially in patients who were admitted to the intensive care
      unit.Different techniques, such as the use of heparinized fluids, are utilized to lower the
      incidence of arterial line failure.

      Their main goal was to extend the average patency time of 5 to 10 days. When the arterial
      line was implanted for more than 2-3 days, the occlusion was documented. One frequent
      consequence is a transient arterial blockage.

      We observed an upsurge in demand for arterial line insertions either in newly admitted or
      existing ICU patients during the COVID crisis. In addition to posing challenges for the ICU
      staff member, the repeated insertion of arterial lines raises the patient's risk for ischemia
      thrombosis and infectious occurrences in their limbs. However, there aren't many publications
      on the risk factors for arterial line blockages in ICU patients with COVID-19.

      Our ICU management committee approved the use of systemic anticoagulation of ICU admitted
      patients starting on March 21, 2021 in response to an increase in the incidence of thrombosis
      and pulmonary embolic events in patients with COVID-19 admitted to the ICU in the second wave
      of this epidemic.

      This observational study compares patients before and after the implementation of systemic
      anti coagulation to examine the effects of the medication on arterial line patency and the
      incidence of arterial line failure.

      Identifying risk factors for impaired arterial line patency in both groups will be the
      secondary outcome.
    

Intervention name(s): arterial line
Intervention type(s): Procedure
Intervention description(s): arterial line inserted for invasice mointroing and sampling
Observational model: Cohort
Time perspective: Retrospective
Sampling method: Probability Sample
Study population: 
        Consecutive ICU patients at HMGH Hospital; Hamad Medical Corporation with continuous
        invasive monitoring will be enrolled if they met following eligibility criteria: peripheral
        artery cannulation with a suitable arterial cannula and a functional arterial line
        established after insertion.
      
Keywords: SARS-CoV-2; arterial line patency; Risk factors; ICU