We are nominating Bryce Bandfield for a critical patient he cared for, navigating a decompensating patient scenario and stellar communication with multiple interdisciplinary teams, and importantly communicating with the family of the patient. The patient had been in critical condition following a liver transplant. An ECHO was performed, and it was determined that the patient was having an MI and needed to go to the Cath Lab ASAP for intervention. At this time, the patient was on CRRT, and the blood was returned in preparation for going to Cath Lab. Upon coming off CRRT, the patient became increasingly unstable. 

The patient remained unstable, requiring constant intervention of PRN medications and drip titrations to maintain hemodynamic stability. The decision was made to call Code ECMO r/t availability of Cath Lab and the patient needed immediate cardiac support. ECMO was placed at bedside by CT surg, and during this AACM, SCCM, Cardiology, CT surg, liver transplant team, pharmacy, and nursing were all at bedside determining the best route for the patient. After cannulation for VA ECMO, the doctor highly recommended to restart CRRT, r/t inability to maintain electrolyte balance. There was a lengthy discussion, for approximately 3 hours, related to continuing CRRT in the Cath Lab and that despite concern, it was the best intervention for this patient. 

Nursing expressed concerns related to running CRRT in the cath lab related inability to check labs, and the potential for inaccurate I & O. All physician teams agreed that the patient would severely decline without the continuation of CRRT. CRRT was started through the ECMO circuit and once again the primary RN made sure that all teams were agreeable to the plan of care, including nephrology, who was notified through the two dialysis nurses at the bedside. The patient was transported to the Cath lab with dialysis nurses, ICU nurses, RT, ACCM, and pharmacy. The teams confirmed that the machine could be transported, they walked with the team to Cath lab and made sure the patient was settled and CRRT running appropriately prior to leaving.  

CRRT was continued in the Cath lab. CRRT numbers were complicated by the fact that CRRT had just started in the ICU, so the complexity of the numbers were based on the machine restarting and boluses being given. MDs were aware of the changes to the standard lab processing and supported the plan that had been developed. Through these developments in an extraordinary circumstance, Bryce maintained composure, acting on behalf of the best interests of the patient. Bryce was able to navigate multiple provider disciplines, presented objective information to all teams while optimizing the critically ill patient. Challenging interactions were encountered, yet Bryce remained calm and collaborative, integrating the Nursing, Critical Care, Transplant, Nephrology, and ECMO teams. Bryce has received praise from all noted above for his clinical excellence, patient advocacy, and for caring for the family in a manner above and beyond the call set forth.