Background: With the escalation of the coronavirus disease (COVID-19) pandemic, critical care specialists have been challenged by ethical issues related to the distribution of scarce resources. Many relevant guidelines have been published worldwide. The Saudi Critical Care Society included a local framework for ethics in its first clinical guidelines for clinical decisions regarding the allocation of scarce resources during the COVID-19 pandemic for COVID-19 patients in intensive care units (ICUs). This study aimed to assess the awareness, opinions, and attitudes of ICU specialists concerning these ethical guidelines and the proposed definitions. Methods: A descriptive cross-sectional study using a self-administered questionnaire was conducted. The study population included 300 ICU physicians in Saudi Arabia who were members of the Saudi Critical Care Society. Results: A total of 70 participants (23.3%) responded to the questionnaire. Most were male, non-Saudi, and Muslim. Professionally, they were mostly intensivists with 10 or more years of experience. The most agreed-upon suggested definitions were “health crisis,” “salvageable patients” category, and the “necessity scale” (32; 45.7%, 37; 52.9%, 52; 74.3%, and 34; 48.6%, respectively). Less agreement was observed for the definitions of “de-escalation without omission” and “primary triage scale” (20; 28.6%, and 21; 3%, respectively). The most agreed-upon statements were those requiring healthcare providers to receive training on contagious diseases and calling for providing them with housing if a situation requires them to leave their homes (56; 80%), while the least agreed-upon statements concerned withholding mechanical ventilation from patients (29; 41.4%). Conclusion: During epidemics, health-care workers provide services in unusual, challenging situations. Doing so necessitates support in social, psychological, and professional areas. A decision-making framework is needed that endorses the cultural and religious contexts, as well as the lived experiences of frontline clinicians, including a clear de-escalation plan and a primary triage system during the pandemic.

Background: Critical care response team (CCRT) intervenes quickly in life-threatening situations to reduce adverse outcomes and improve patient safety. Nurses play an essential role in CCRT activation. Despite clearly satisfied criteria, there have been instances where nurses have failed to activate CCRT. Objective: This study examined the factors that influence nurses' CCRT activation. Methodology: The proposed study was done in an acute health-care setting using a cross-sectional survey approach. The study participants included 206 nurses working in inpatient care units. Nursing staff in intensive care units, pediatric intensive care units, operating rooms, outpatient departments, and main emergency rooms were excluded from the study. Results: Moreover, half of the majority (54.4%) of the 206 responders are knowledgeable about CCRT activation. Nearly 83 (40.3%) choose not to activate CCRT due to fear of being chastised. Nurses were more reliant on physicians to trigger CCRT. The activation score significantly correlated with the nurse participants' job title and working unit. Conclusions: Nursing staff avoided using the CCRT for fear of being blamed despite having a positive impression. They are primarily reliant on physicians to initiate CCRT. In addition to education and training that engages all health-care workers, hospitals should empower nurses to reduce barriers and improve CCRT activation.

The utilization of mechanical circulatory support devices in high-risk percutaneous coronary interventions (PCI) has recently evolved. In Saudi Arabia, the use of such devices is under-reported. Here, we present a 36-year-old patient who was admitted to the hospital with a non-ST-elevation myocardial infarction with biventricular dysfunction. A high-risk PCI consist of unprotected left main stenting was performed with the assistance of venoarterial extracorporeal membrane oxygenation that allowed smooth and successful intervention. Two days later, Impella was used to augment the recovery of the myocardium. The implementation of this approach helped our patient hemodynamically and allowed the recovery of the myocardium.