Rapid Response of an Academic Surgical Department to the COVID-19 Pandemic: Implications for Patients, Surgeons, and the Community.

BackgroundAs the coronavirus disease 2019 (COVID-19) pandemic continues to spread, swift actions and preparation are critical for ensuring the best outcomes for patients and providers. We aim to describe our hospital and Department of Surgery's experience in preparing for the COVID-19 pandemic and caring for surgical patients during this unprecedented time.Study designThis is a descriptive study outlining the strategy of a single academic health system for addressing the following 4 critical issues facing surgical departments during the COVID-19 pandemic: developing a cohesive leadership team and system for frequent communication throughout the department; ensuring adequate hospital capacity to care for an anticipated influx of COVID-19 patients; safeguarding supplies of blood products and personal protective equipment to protect patients and providers; and preparing for an unstable workforce due to illness and competing personal priorities, such as childcare.ResultsThrough collaborative efforts within the Department of Surgery and hospital, we provided concise and regular communication, reduced operating room volume by 80%, secured a 4-week supply of personal protective equipment, and created reduced staffing protocols with back-up staffing plans.ConclusionsBy developing an enabling infrastructure, a department can nimbly respond to crises like COVID-19 by promoting trust among colleagues and emphasizing an unwavering commitment to excellent patient care. Sharing principles and practical applications of these changes is important to optimize responses across the country and the world

EACTA/SCA Recommendations for the Cardiac Anesthesia Management of Patients With Suspected or Confirmed COVID-19 Infection: An Expert Consensus From the European Association of Cardiothoracic Anesthesiology and Society of Cardiovascular Anesthesiologists With Endorsement From the Chinese Society of Cardiothoracic and Vascular Anesthesiology

: The European Association of Cardiothoracic Anaesthesiology (EACTA) and the Society of Cardiovascular Anesthesiologists (SCA) aimed to create joint recommendations for the perioperative management of patients with suspected or proven severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection undergoing cardiac surgery or invasive cardiac procedures. To produce appropriate recommendations, the authors combined the evidence from the literature review, reevaluating the clinical experience of routine cardiac surgery in similar cases during the Middle East Respiratory Syndrome (MERS-CoV) outbreak and the current pandemic with suspected coronavirus disease 2019 (COVID-19) patients, and the expert opinions through broad discussions within the EACTA and SCA. The authors took into consideration the balance between established procedures and the feasibility during the present outbreak. The authors present an agreement between the European and US practices in managing patients during the COVID-19 pandemic. The recommendations take into consideration a broad spectrum of issues, with a focus on preoperative testing, safety concerns, overall approaches to general and specific aspects of preparation for anesthesia, airway management, transesophageal echocardiography, perioperative ventilation, coagulation, hemodynamic control, and postoperative care. As the COVID-19 pandemic is spreading, it will continue to present a challenge for the worldwide anesthesiology community. To allow these recommendations to be updated as long as possible, the authors provided weblinks to international public and academic sources providing timely updated data. This document should be the basis of future task forces to develop a more comprehensive consensus considering new evidence uncovered during the COVID-19 pandemic

COVID-19 Infection: Implications for Perioperative and Critical Care Physicians.

Healthcare systems worldwide are responding to Coronavirus Disease 2019 (COVID-19), an emerging infectious syndrome caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus. Patients with COVID-19 can progress from asymptomatic or mild illness to hypoxemic respiratory failure or multisystem organ failure, necessitating intubation and intensive care management. Healthcare providers, and particularly anesthesiologists, are at the frontline of this epidemic, and they need to be aware of the best available evidence to guide therapeutic management of patients with COVID-19 and to keep themselves safe while doing so. Here, the authors review COVID-19 pathogenesis, presentation, diagnosis, and potential therapeutics, with a focus on management of COVID-19-associated respiratory failure. The authors draw on literature from other viral epidemics, treatment of acute respiratory distress syndrome, and recent publications on COVID-19, as well as guidelines from major health organizations. This review provides a comprehensive summary of the evidence currently available to guide management of critically ill patients with COVID-19

Anesthesia guidelines for COVID-19 patients: a narrative review and appraisal.

The coronavirus disease 2019 (COVID-19) pandemic has challenged health systems globally and prompted the publication of several guidelines. The experiences of our international colleagues should be utilized to protect patients and healthcare workers. The primary aim of this article is to appraise national guidelines for the perioperative anesthetic management of patients with COVID-19 so that they can be enhanced for the management of any resurgence of the epidemic. PubMed and EMBASE databases were systematically searched for guidelines related to SARS-CoV and SARS-CoV-2. Additionally, the World Federation Society of Anesthesiologists COVID-19 resource webpage was searched for national guidelines; the search was expanded to include countries with a high incidence of SARS-CoV. The guidelines were evaluated using the Appraisal of Guidelines for Research and Evaluation II tool. Guidelines from Australia, Canada, China, India, Italy, South Africa, South Korea, Taiwan, the United Kingdom, and the United States of America were evaluated. All the guidelines focused predominantly on intubation and infection control. The scope and purpose of guidelines from China were the most comprehensive. The UK and South Africa provided the best clarity. Editorial independence, the rigor of development, and applicability scored poorly. Heterogeneity and gaps pertaining to preoperative screening, anesthesia technique, subspecialty anesthesia, and the lack of auditing of guidelines were identified. Evidence supporting the recommendations was weak. Early guidelines for the anesthetic management of COVID-19 patients lacked quality and a robust reporting framework. As new evidence emerges, national guidelines should be updated to enhance rigor, clarity, and applicability

An Educational Intervention on the Clinical Utility of Point-Of-Care Ultrasound (POCUS) in the Timely Detection of Perioperative Thromboembolic Complications in COVID-19 Patients Undergoing Noncardiac Surgery

Background: Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a rare but most likely fatal perioperative complication associated with increased patient morbidity and mortality. COVID-19-positive patients with VTE who present for surgery are predominantly asymptomatic and do not meet the conventional definition and traditional diagnostic criteria. This presents a challenge in identifying VTE in this patient population without proper surveillance and monitoring. Objectives: The purpose of this study is to improve anesthesia providers’ knowledge of the value of POCUS modality in preventing perioperative VTE in patients with COVID-19 undergoing noncardiac surgical procedures and improve recognition of associated risk factors that predispose patients to the development of VTE. Investigators used CINAHL, MEDLINE, and EMBASE databases to answer the PICO (i.e., population, intervention, comparison, outcome) question: “In the adult patients with COVID-19 (P), does the use of the POCUS modality as an adjunct to preoperative screening for DVT (I), compared to its non-use (C), improve the early identification of perioperative VTE ( O)? The literature review provides the educational framework to improve provider knowledge. The overall objective of the project is to increase the quality of healthcare delivery to improve healthcare outcomes for patients with COVID-19 undergoing noncardiac surgery. Methodology: The primary methodology of the proposed project is to administer an online educational intervention to providers which focuses on the benefits of perioperative POCUS utilization in the early identification of VTEs. Pre- and post-assessment surveys will be used to measure the improvement of provider knowledge before and after the intervention. Results: Overall, there was an improvement in provider knowledge following the education intervention. Additionally, the likelihood of utilizing the perioperative POCUS modality increased among anesthesia providers. Conclusion: The perioperative incorporation of the POCUS modality has been shown to accurately assess the presence of DVT. The educational intervention provided effectively improved anesthesia provider knowledge on the value of POCUS modality in preventing perioperative VTE in patients with COVID-19 undergoing noncardiac surgical procedures and improving recognition of associated risk factors that predispose patients to the development of these events. Increasing awareness of the high incidence of thromboembolic events in patients with COVID-19 and the role of POCUS in their early detection can reduce mortality and improve postoperative outcomes

COVID-19 Pandemi Sırasındaki Acil Cerrahi Bakım ve Ameliyathane Uygulamalarında Perioperatif Uygulama ve Rehberlik; Deneyimlerimiz

Aim: The novel coronavirus SARS-CoV-2 (COVID-19) can infect healthcare workers. We developed an institutional algorithm to protect operating room team members during the COVID-19 pandemic and rationally conserve personal protective equipment (PPE). We aimed to review the latest data on the COVID-19 pandemic and essential information for practice in emergency surgery and the operating room.Materials and Methods: An interventional platform (operating room, interventional suite, and endoscopy) with our committee formed with our doctors consisting of different branches, we developed our guidelines based on potential patterns of spread, risk of exposure, and conservation of PPE. We aimed to share our experiences with 128 patients who were taken into operation in a 2-month period.Anesthetic management and infection control guidelines for emergency procedures for patients with suspected 2019-nCoV were drafted and applied in Medical Faculty of Namık Kemal University.Results: A decision tree algorithm describing our institutional guidelines for precautions for operating room team members was created. This algorithm is based on the urgency of operation, anticipated viral burden at the surgical site, the opportunity for a procedure to aerosolize virus, and the likelihood a patient could be infected based on symptoms and testing.Conclusion: Despite COVID-19 being a new threat, we have shown that by developing an easy-to-follow decision algorithm for the interventional platform teams, we can ensure optimal healthcare worker safety.Amaç: Yeni koronavirüs SARS-CoV-2 (COVID-19) sağlık çalışanlarını enfekte edebilir. COVID-19 salgını sırasında ameliyathane ekip üyelerini korumak ve rasyonel olarak kişisel koruyucu ekipman (KKE) için kurumsal bir algoritma geliştirdik. Acil cerrahi ve ameliyathanede COVID-19 salgını ile ilgili en güncel bilgileri gözden geçirmeyi amaçladık. Materyal ve Metot: Farklı branşlardan oluşan doktorlarımızla oluşturduğumuz komitemiz ile girişimsel bir platform (ameliyathane, girişimsel ve endoskopi), potansiyel yayılma örüntüleri, maruz kalma riski ve KKE'nin korunmasına dayanan kılavuzlarımızı geliştirdik. Deneyimlerimizi 2 aylık bir sürede ameliyat edilen 128 hasta ile paylaşmayı amaçladık. 2019-nCoV şüphesi olan hastalar için acil durum prosedürleri için anestezi yönetimi ve enfeksiyon kontrol kılavuzları Namık Kemal Üniversitesi Tıp Fakültesi'nde hazırlanmış ve uygulanmıştır. Bulgular: Ameliyathane ekibi üyelerine yönelik önlemler için kurumsal yönergelerimizi açıklayan bir karar algoritması oluşturuldu. Bu algoritma ameliyatın aciliyetine, cerrahi bölgede beklenen viral yüke, virüsü aerosol haline getirme prosedürü fırsatına ve hastanın semptomlara ve testlere dayanarak enfekte olma olasılığına dayanır. Sonuç: COVID-19'un yeni bir tehdit olmasına rağmen, girişimsel platform ekipleri için izlemesi kolay bir karar algoritması geliştirerek, optimum sağlık çalışanı güvenliğini sağlayabildiğimizi gösterdik

Anesthesia Services in the Time of COVID

Our hospital is a 400-bed Level-1 trauma center with 78 ICU beds serving the greater Louisville metropolitan area. The COVID-19 pandemic forced our hospital to re-evaluate our core business operations and to develop a coherent response to a fluid situation. Between March 15 and May 15, 2020, the University of Louisville Hospital admitted more than 100 COVID-19 inpatients, approximately 30 were admitted to the intensive care unit (ICU) and most required endotracheal intubation. The following review describes our Department of Anesthesiology & Perioperative Medicine foci, actions and rationale during the COVID-19 pandemic. While we hope not to experience another pandemic in the near future, this review may be a helpful starting point for preparing for future respiratory spread pandemics