Florida CRNAs prepare for COVID-19 patient surge with collaboration and innovation

If there’s one quality that could summarize advanced practice nurses during the COVID-19 pandemic, it’s problem solvers.

A team of nurse anesthetists at a hospital in Tampa has devised a plan for stemming the spread of the coronavirus among surgical providers — a plan based on what healthcare facilities in New York and Washington state have employed to curb the spread.

What makes CRNAs uniquely positioned to combat COVID-19 is their capacity to identify problems and work through solutions.

“That’s what CRNAs do,” said Ben Cayer, a Certified Registered Nurse Anesthetist (CRNA) at Tampa General Hospital.

CRNAs are proven experts in triage, rapid system assessment, and respiratory and cardiovascular management while administering anesthetics. While the COVID-19 patient surge in Tampa has yet to threaten facilities, CRNAs have mounted a plan to counterattack the spread of the disease among their colleagues as they work on infected patients.

The most likely time for aerosolization and spread of COVID-19 to anesthesia providers is during intubation and extubation. To address that, Tampa General Hospital has formed a COVID-19 airway team to perform all intubations and extubations in four specifically designated operating rooms.

A CRNA in complete personal protective equipment (PPE) is assigned to each of these four operating rooms with one anesthesiologist covering all four rooms. The surgical patient is transferred to one of these rooms for intubation.

CRNAs use a technique referenced as “rapid sequence inductions” with a video laryngoscope to minimize the risk of aerosolization. After intubating the patient, a special viral filter is secured to the breathing tube to prevent the spread of viral particles to other team members.

The patient is then transferred to another operating room where the surgery is performed. By transferring the intubated patient to a different room for surgery, the need for the entire surgical team to wear full PPE is eliminated.

“Only the CRNAs on the airway team in the intubation/extubation rooms wear the complete recommended PPE,” which, Cayer explained, helps manage the hospital’s supply.

Once the surgery is complete, the patient is transferred back to a designated extubation room where a CRNA in full protective equipment emerges the patient from anesthesia and carefully extubates.

Cayer admits that the training to implement this plan has been intense.

“We were in between cases when we realized that what we’re going through is an unprecedented thing. We came to a moment where we acknowledged that, together, we’ve chosen to serve and act,” said Cayer.

To date, the hospital does not have a huge influx of patients who have tested positive for the virus, but the team stands at the ready, he said. The climate is one of “anticipation and uncertainty.” While the CRNAs have a game plan, Cayer said the support extended to healthcare providers by the hospital and general public has been inspiring.

“It’s been great teamwork — all CRNAs coming together and doing the work. Initially, there were 12 of us who volunteered to be on the airway team and now we’re up to 20. More people are jumping in and volunteering on the airway management team. We have some amazing co-workers. Everyone has been collaborative. Everyone is supportive,” said Cayer.

“CRNAs have the gift of knowing to expect the unexpected. We’ve done a really good job of being proactive to prepare for what may come,” he said. “CRNAs know what it’s going to take. We have a lot of responsibility and take pride in paying attention to details, all to keep staff and patients safe. We are forward-thinking professionals. What we do is highly complex, painstaking work, but CRNAs are deeply committed to keeping our patients and the population safe.”

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Melissa Ramirez Cooper is the Director of Public Relations and Communications at the American Association of Nurse Anesthetists.