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Leshem: Trained medical staff of key importance in treatment of severe Covid cases

Text: Lejla Nuhanovic, Photo Sheba Medical Center

SARAJEVO/TEL AVIV, April 24 (FENA) - The most important thing in the treatment of patients with severe COVID-19 is the education and training of medical teams in intensive care units, said Israeli doctor Eyal Leshem, who spoke to FENA about the medical treatment of severe COVID-19 patients.

Dr. Leshem is a specialist in infectious diseases and internal medicine at the Tel Aviv University School of Medicine and the senior specialist at the Sheba Medical Center, one of the most prestigious hospitals in the world.

He points out that one critical issue is very often left out from numerous discussions on the use of ventilators.

“And that is the importance of training medical staff who treat patients with severe COVID-19. In order to effectively treat a patient who suffers from a severe form of the coronavirus and who is on a ventilator, you need a professional team at the intensive care units. You need doctors and nurses who are experts in internal medicine and intensive care,” said the doctor.

In his own experience, Dr. Leshem emphasizes that they did an excellent job in Israel at the beginning of the pandemic regarding the use of ventilators.

“At the beginning of the pandemic last year, we had thousands of mechanical ventilators, but the resources we lacked were doctors and nurses. You can put a person with severe COVID-19 on a ventilator, but if you do not have professional staff to treat that patient then it will not have much effect. These are very demanding patients,” explains Dr. Leshem.

Commenting on the most effective work schedule for the treatment of COVID-19 patients, he emphasized that each shift requires at least two nurses, who would take turns every eight hours, considering that these patients are more demanding than other patients in intensive care units.

“So, on the one hand, you need advanced mechanical ventilation techniques for patients. However, what we also found is that patients with severe forms of COVID-19, whose heart and lungs have already started to fail, must be placed on an ECMO machine,” says the Israeli expert.

Extracorporeal membrane oxygenation, or ECMO, is a therapy that adds oxygen to the patient’s blood and pumps it through their body like the heart. The process takes place outside the body.

The ECMO pump pulls blood that has no oxygen attached from a vein and pushes it into the machine’s artificial lung, or oxygenator. That’s where carbon dioxide is removed from the blood and oxygen is added. There’s a color change as the darker blood with no oxygen turns bright red when oxygen is attached to it. As the red blood leaves the oxygenator it is warmed before returning to the patient.

Dr. Leshem points out that the ECMO machine is more complex than the mechanical ventilator and requires even more expertise.

“At the beginning of the pandemic, we put patients on ventilators, but they died because we did not have enough ECMO machines,” explains Dr. Leshem.

He stressed the importance of good resource allocation in the treatment of patients with severe forms of COVID-19, saying the most important thing is trained staff.

“Once you know the number of health workers and the number of beds in intensive care, the next step is to create an algorithm that will determine which patients will be connected to mechanical ventilation. For example, for very old patients, who do not have a great chance of recovery even if you put them on mechanical ventilators, it is best to start palliative care,” says Dr. Leshem.

Speaking about the differences between ventilators used in different types of intensive care cases, he said that there are more advanced versions of ventilators that are not the same ones used for trauma patients.

“I don’t want to go into expert detail, but the main difference is that with a more advanced type of ventilator there is a reduced possibility of lung damage, which is something we must avoid in patients with severe cases of COVID-19,” he warns.

Asked how often respirators are used outside the pandemic, Dr. Leshem said that the number of patients who need mechanical ventilation has increased significantly.

“I cannot speak for other medical centers, but in Sheba, which has a capacity of two thousand beds, about 50 patients were put on ventilators on an average day before the COVID-19 pandemic. During the pandemic, that number increased by an additional 20 patients,” said the senior physician at the Sheba Medical Center.

(FENA) D.J.