COVID-19 Outbreak

Dear Friends and Colleagues,

it is more than one month ago when the first case of patient affected by COVID-19 in Italy has been detected. The rapid escalation of the situation not only in Italy and Europe, but worldwide, has an unprecedented effect on all aspects of daily life and is shutting down our life as it was, our habits, and is shaping a ‘world after the COVID-19’ very different from the one we were used to.
Health and healthcare are being impacted in a seismic way. In particular we, as cardiothoracic anaesthesiologists, are in the front line in fighting the virus and forced to think about new ways for our everyday activities, developing new guidelines and best practices.
These are indeed challenging and busy times, we are all working under extremely stressful and dangerous conditions, with decreasing resources – due to decreased number of (sick) staff, and due to limited access to fully equipped ICU beds.
The public health response to COVID-19 continues, and this is thanks to your indefatigable work. Covid and non Covid patients need us to treat their cardiovascular disease, and we are all doing our best to allow all of them to receive the care they need.
As EACTA, we are in the process of creating videos and webinars that could support you in this fight. The first one is already available in open access in the EACTA e-Academy.

My thoughts are with you, the whole Board of Directors is with you.
Stay strong, together we will face it.

Fabio Guarracino
EACTA President

– March 2020


COVID-19 and the Heart:
A literature overview
and local experience

Luisa Baca, Maria Benedetto


Protocolized approach for
resuming elective cardiothoracic
cases during the COVID-19 outbreak

Felipe Unigarro Londoño, Ricard Navarro


May COVID-19
classified as a haemostatic

Maria Benedetto and Vittorio Ferrari


Sedation Strategies And
Neurological Assessment
in COVID-19 ICU Patients

Sara Tomasini


COVID-19 in the Paediatric
Population: Literature Overview
and Clinical Experience

Marta Agulli


Mechanical Ventilation Strategies
and Feasibility of ECMO

Maria Benedetto


Tips and tricks
for safe airway

Mohamed El Tahan

Helpful Resources

WEEKLY UPDATED! – The most recent resources are on top

  1. Cook TM. Risk to health from COVID-19 for anaesthetists and intensivists – a narrative review. Anaesthesia July 25, 2020. doi:10.1111/anae.15220
  2. De Filippis EM, Sinnenberg L, Reza N, et al. Trends in US Heart Transplant Waitlist Activity and Volume During the Coronavirus Disease 2019 (COVID-19) Pandemic. JAMA Cardiol. July 22, 2020. doi:10.1001/jamacardio.2020.2696
  3. Bilaloglu S, Aphinyanaphongs Y, Jones S, et al. Thrombosis in Hospitalized PatientsWith COVID-19 in a NewYork City Health System. JAMA July 20, 2020. doi:10.1001/jama.2020.13372
  4. Wessler BS, Kent DM, Konstam MA. Fear of Coronavirus Disease 2019—An Emerging Cardiac Risk. JAMA July 22, 2020. doi:10.1001/jamacardio.2020.2890
  5. Cavalcanti AB, Zampieri FG, Rosa RG, et al. Hydroxychloroquine with or without Azithromycin in Mild-to-Moderate Covid-19. N Eng J Med July 23, 2020.  DOI: 10.1056/NEJMoa2019014
  6. Laterre PF, Franois B, Collienne C, et al. Association of Interleukin 7 Immunotherapy with Lymphocyte Counts Among Patients with Severe Coronavirus Disease 2019 (COVID-19). JAMA Network Open. 2020;3(7):e2016485. doi:10.1001/jamanetworkopen.2020.16485
  7. Kamrath I, Mönkemöller K, Biester T, et al. Ketoacidosis in Children and Adolescents with Newly Diagnosed Type 1 Diabetes During the COVID-19 Pandemic in Germany. JAMA July 20, 2020. doi:10.1001/jama.2020.13445
  8. Tromberg BJ, Schwetz TA, P.rez‑Stable EJ, et al. Rapid Scaling Up of Covid-19 Diagnostic Testing in the United States — The NIH RADx Initiative. N Eng J Med July 22, 2020. DOI: 10.1056/NEJMsr2022263
  9. McCulloch DJ, Kim AE, Wilcox NC, et al. Comparison of Unsupervised Home Self-collected Midnasal Swabs with Clinician-Collected Nasopharyngeal Swabs for Detection of SARS-CoV-2 Infection. JAMA Network Open. 2020;3(7):e2016382. doi:10.1001/jamanetworkopen.2020.16382
  10. Havers FP, Reed C, Lim T, et al. Seroprevalence of Antibodies to SARS-CoV-2 in 10 Sites in the United States, March 23-May 12, 2020. JAMA Intern Med. July 21, 2020. doi:10.1001/jamainternmed.2020.4130
  11. Ibarrondo FJ, Fulcher JA, Goodman‑Meza D, et al. Rapid Decay of Anti–SARS-CoV-2 Antibodies in Persons with Mild Covid-19. N Eng J Med July 21, 2020. DOI: 10.1056/NEJMc2025179
  12. Brown TS, Walensky RP. Serosurveillance and the COVID-19 Epidemic in the US Undetected, Uncertain, and Out of Control. JAMA July 21, 2020. doi:10.1001/jama.2020.14017
  13. Wong BJ, Lu AC, Tarlow BD, et al. N95 Respirator Alternatives and Conservation Strategies. Anesth Analg July 16, 2020. DOI: 10.1213/ANE.0000000000005134
  14. Mahajan V, Ray A, Puri GD. Administering CPR to PPE-Protected Healthcare Worker during COVID-19. Anesth Analg July 17, 2020. DOI: 10.1213/ANE.0000000000005135
  15. Lu AC, Wong BJ, Sastry SG, et al. Resuscitation on collapsed healthcare worker while taking care of suspected or confirmed COVID patient: Questions and Answers. Anesth Analg July 16, 2020. DOI: 10.1213/ANE.0000000000005136

ESA COVID-19 Resource page

  1. van der Made CI, Simons A, Schuurs-Hoeijmakers J, et al. Presence of Genetic Variants Among Young Men with Severe COVID-19. JAMA July 24, 2020. doi: 10.1001/jama.2020.13719
  2. Rizzo M, Foresti L, Montano N. Comparison of Reported Deaths From COVID-19 and Increase in Total Mortality in Italy. JAMA Internal Medicine. July 20, 2020. doi:10.1001/jamainternmed.2020.2543
  3. The RECOVERY Collaborative Group. Dexamethasone in Hospitalized Patients with Covid-19 — Preliminary Report.  N Eng J Med July 17, 2020. DOI: 10.1056/NEJMoa2021436
  4. Jackson LA, Anderson EJ, Rouphae NGl, et al. An mRNA Vaccine against SARS-CoV-2 —Preliminary Report.  N Eng J Med July 14, 2020. DOI: 10.1056/NEJMoa2022483
  5. Heaton PM. The Covid-19 Vaccine-Development Multiverse. N Eng J Med July 14, 2020. DOI: 10.1056/NEJMe2025111
  6. Burel-Vandenbos F, Cardot-Leccia N, Passeron T. Pulmonary Vascular Pathology in Covid-19. N Eng J Med July 17, 2020. DOI: 10.1056/NEJMc2022068
  7. Giannopoulos G, Vrachatis DA, Deftereos SG. Myocardial Injury in COVID-19—Can We Successfully Target Inflammation? JAMA Cardiology July 15, 2020. doi:10.1001/jamacardio.2020.2569
  8. Misra A, Elayat A. Novel Closed-Loop Bronchoscopy Barrier Sheath: Valuable Addition for One-Lung Ventilation During the Coronavirus Disease 2019 Pandemic. J Cardiothorac Vasc Anesth July 18, 2020. doi:10.1053/j.jvca.2020.06.070
  9. Grasselli G, Greco M, Zanella A, et al. Risk Factors Associated With Mortality Among Patients With COVID-19 in Intensive Care Units in Lombardy, Italy. JAMA Internal Medicine July 15, 2020. doi:10.1001/jamainternmed.2020.3539
  10. Gupta S, Hayek SS, Wang W, et al. Factors Associated With Death in Critically Ill Patients With Coronavirus Disease 2019 in the US. JAMA Intern Med. July 15, 2010. doi:10.1001/jamainternmed.2020.3596
  11. Suwanwongse, K, Shabarek, N. Pneumomediastinum in Mechanically Ventilated Coronavirus Disease 2019 Patients. J Cardiothorac Vasc Anesth July 18, 2020.
  12. Kapp CM. Zaeh S,  Niedermeyer S, et al. The Use of Analgesia and Sedation in Mechanically Ventilated Patients with COVID-19 ARDS. Anesth Analg July 17, 2020. DOI: 10.1213/ANE.0000000000005131
  13. Green JS, Dillane D. Pre-loading head supports to avoid anesthesia circuit disconnections during the COVID-19 pandemic. Anesth Analg July 13, 2020. DOI: 10.1213/ANE.0000000000005128
  14. Bigelow BF, Olive T, Bryan B, et al. Outcomes of Universal COVID-19 Testing Following Detection of Incident Cases in 11 Long-term Care Facilities. JAMA Internal Medicine July 14, 2020. doi:10.1001/jamainternmed.2020.3738
  15. Hade AD. Estimating the risk of an anaesthetist acquiring COVID-19 by anaesthetising an asymptomatic patient. Anesth Intensive Care July 6, 2020. DOI: 10.1177/0310057X20937316
  16. Klompas M, Baker MA, Rhee C. Airborne Transmission of SARS-CoV-2. Theoretical Considerations and Available Evidence. JAMA July 13, 2020. doi:10.1001/jama.2020.12458
  17. Harris EJ. Dressing Up. JAMA July 16, 2020. doi:10.1001/jama.2020.12779
  18. Lane HC, Fauci AS. Research in the Context of a Pandemic. N Eng J Med July 18, 2020. DOI: 10.1056/NEJMe2024638
  19. Saitz R, Schwitzer G. Communicating Science in the Time of a Pandemic. JAMA July 13, 2020. doi:10.1001/jama.2020.12535
  20. Wiersinga WJ, Rhodes A, Cheng AC, et al. Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19). A Review. JAMA. July 10, 2020 doi: 10.1001/jama.2020.12839
  21. Hu C, Wang G, Zhou D, et al. The Anesthetic Management of the First Lung Transplant for a Patient with COVID-19 Respiratory Failure. J Cardiothorac Vasc Anesth July 7, 2020.
  22. Sakai W, Tachibana S, Yamakage M, et al. Cross-Holes on a Plastic Bag can Prevent Droplet Spread during Extubation. Anesth Analg July 8, 2020. DOI: 10.1213/ANE.0000000000005090
  23. Senniappan K, Damodaran S, Kanchi M. Epicardial Echocardiography—A Plausible Alternative Cardiac Imaging Technique in COVID-19 Pandemic. J Cardiothorac Vasc Anesth July 9, 2020
  24. Seelhammer TG, Rowse P, Yalamuri S. Bivalirudin for Maintenance Anticoagulation During Venovenous Extracorporeal Membrane Oxygenation for COVID-19. J Cardiothorac Vasc Anesth July 9, 2020.
  25. Orser BA, Byrick R, Cooper R, et al. Locating and repurposing anesthetic machines as intensive care unit ventilators during the COVID-19 pandemic. Can J Anesth/J Can Anesth (2020) 67:1066–1067.
  26. Jabri A, Kalra A, Kumar A, et al. Incidence of Stress Cardiomyopathy During the Coronavirus Disease 2019 Pandemic. JAMA Network Open. 2020;3(7):e2014780. doi:10.1001/jamanetworkopen.2020.14780
  27. Antuña P, Rivero F, del Val D, et al. Late Coronary Stent Thrombosis in a Patient with Coronavirus Disease 2019. JAMA July 8, 2020. doi:10.1001/jamacardio.2020.2459
  28. Gillenwater S, Rahaghi F, Hadeh A. Remdesivir for the Treatment of Covid-19— Preliminary Report. JAMA July 10, 2020. DOI: 10.1056/NEJMc2022236
  29. Ip V,  Ozelsel TJP, Sondekoppam RV, et al. COVID-19 pandemic: the 3R’s (reduce, refine, and replace) of personal protective equipment (PPE) sustainability.  Can J Anesth/J Can Anesth (2020) 67:1070–1071.
  30. Alikhani R, Salimi A, Hormati A, et al. Mental health advice for frontline healthcare providers caring for patients with COVID-19. Can J Anesth/J Can Anesth 2020; 67:1068–1069.
  31. Urdanet F, Stacey M, Sorbello M. The Adverse Impact of COVID-19 on Healthcare Providers: Time to Start Measuring. Anesth Analg July 8, 2020. DOI: 10.1213/ANE.0000000000005088
  32. Hammoud MM, Standiford T, Carmody JB. Potential Implications of COVID-19 for the 2020-2021Residency Application Cycle. JAMA June 3, 2020. doi:10.1001/jama.2020.8911
  33. Fleming TR, Labriola D; Wittes J. Conducting Clinical Research During the COVID-19 Pandemic Protecting Scientific Integrity. JAMA2020;324(1):33-34. doi:10.1001/jama.2020.9286
  34. Naldi L, Cazzaniga S. More on Covid-19 in Immune-Mediated Inflammatory Diseases. N Eng J Med July 10, 2020, DOI: 10.1056/NEJMc2018011
  35. Ortega R,  Chen R. Beyond the operating room: the roles of anaesthesiologists in pandemics. Br J Anaesth July 5, 2020. doi: 10.1016/j.bja.2020.06.005
  36. Miller TR, Radcliff TA. Economic Shocks From the Novel COVID-19 Pandemic for Anesthesiologists and Their Practices. Anesth Analg July 5, 2020.  DOI: 10.1213/ANE.0000000000004882
  37. Rubin R. School Superintendents Confront COVID-19—“There Are No Good Options for Next Year”. JAMA  July 9, 2020. doi:10.1001/jama.2020.12575
  38. Guarracino F, Vetrugno L, Forfori F, et al. Lung, Heart, Vascular, and Diaphragm Ultrasound Examination of COVID-19 Patients: A Comprehensive Approach. J Cardiothorac Vasc Anesth July 3, 2020.
  39. Fiorelli S, Cecilia Menna C, Piccioni F, et al. The Cutting Edge of Thoracic Anesthesia During the Coronavirus Disease 2019 (COVID-19) Outbreak. J Cardiothorac Vasc Anesth July 4, 2020.
  40. Sinha P, Matthay MA, Calfee CS. Is a “Cytokine Storm” Relevant to COVID-19? JAMA Internal Medicine June 30, 2020. doi:10.1001/jamainternmed.2020.3313
  41. Feldstein LR, Rose EB, Horwitz SM, et al. Multisystem Inflammatory Syndrome in U.S. Children and Adolescents. N Eng J Med July 2, 2020. DOI: 10.1056/NEJMoa2021680
  42. Levin M. Childhood Multisystem Inflammatory Syndrome— A New Challenge in the Pandemic. N Eng J Med July 2, 2020. DOI: 10.1056/NEJMe2023158
  43. Ing RJ, Chatterjee D, Twite MD. Resuscitating Children with COVID-19: What the Pediatric Anesthesiologist Needs to Know. J Cardiothorac Vasc Anesth July 4, 2020.
  44. Cavarretta E, Biondi-Zoccai G, Frati G, et al,Veneto’s Successful Lesson for a World Shocked by COVID-19: Think Globally and Act Locally.  J Cardiothorac Vasc Anesth July 4, 2020.
  45. Cheruku S, Dave S, Goff K, et al. Cardiopulmonary Resuscitation in Intensive Care Unit Patients with Coronavirus Disease 2019. J Cardiothorac Vasc Anesth July 2, 2020.
  46. Valchanov K, Salaunkey K, Parmar J. Percutaneous Dilatational Tracheostomy in Coronavirus Disease 2019 Extracorporeal Membrane Oxygenation Patients: A Case Serie. J Cardiothorac Vasc Anesth July 1, 2020.
  47. Chen D, Li X, Song Q, et al. Assessment of Hypokalemia and Clinical Characteristics in Patients with Coronavirus Disease 2019 inWenzhou, China. JAMA Network Open. 2020;3(6):e2011122. doi:10.1001/jamanetworkopen.2020.11122
  48. Parasa S, Desai M, Chandrasekar VT, et al. Prevalence of Gastrointestinal Symptoms and Fecal Viral Shedding in Patients with Coronavirus Disease 2019 A Systematic Review and Meta-analysis. JAMA Network Open. 2020;3(6):e2011335. doi:10.1001/jamanetworkopen.2020.11335
  49. Kelly SA, Schesing KB, Thibodeau JT, et al. Feasibility of Remote Video Assessment of Jugular Venous Pressure and Implications for Telehealth. JAMA Cardiology July 1, 2020. doi:10.1001/jamacardio.2020.2339
  50. Miller TR, Radcliff TA. Economic Shocks from the Novel COVID-19 Pandemic for Anesthesiologists and Their Practices. Anesth Analg 2020; 131(1): 112-116. DOI: 10.1213/ANE.0000000000004882
  51. Zylke JW, MBauchner H. Mortality and morbidity. The Measure of a Pandemic. JAMA July 1, 2020. doi:10.1001/jama.2020.11761
  52. Woolf SH, Chapman DA, Sabo RT, et al. Excess Deaths From COVID-19 and Other Causes, March-April 2020. JAMA July 1, 2020. doi:10.1001/jama.2020.11787
  53. Sajadi MM, Habibzadeh P, Vintzileos A, et al. Temperature, Humidity, and Latitude Analysis to Estimate Potential Spread and Seasonality of Coronavirus Disease 2019 (COVID-19). JAMA Network Open. 2020;3(6):e2011834. doi:10.1001/jamanetworkopen.2020.11834
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  57. Madathil RJ, Tabatabai A, Rabin J, et al. Thromboelastometry and D-Dimer Elevation in Coronavirus-2019. J Cardiothorac Vasc Anesth June 25, 2020.
  58. Guo SH, Zhu SM, Yao YX. Giant Retroperitoneal Hematoma During Extracorporeal Membrane Oxygenation in a Patient with Coronavirus Disease-2019 Pneumonia. J Cardiothorac Vasc Anesth June 27, 2020.
  59. Marco AP. Anesthesiology, the Tragedy of the Commons, and Coronavirus Disease 2019. Anesth Analg 2020 Jul;131(1):120-123. DOI: 10.1213/ANE.0000000000004927
  60. Zhao S, Ling K, Yan H, et al. Anesthetic Management of Patients with COVID 19 Infections During Emergency Procedures. J Cardiothorac Vasc Anesth 2020 May;34(5):1125-1131. doi: 10.1053/j.jvca.2020.02.039
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  66. Conway H, Lau G, Zochios V. Personalizing Invasive Mechanical Ventilation Strategies in Coronavirus Disease 2019 (COVID-19) Associated Lung Injury: The Utility of Lung Ultrasound. J Cardiothorac Vasc Anesth. May 15, 2020. doi: 10.1053/j.jvca.2020.04.062
  67. Nabil K. Thalji, Prakash A. Patel, et al. Hematologic Consequences of the Coronavirus Crisis—Focus on Relevant Clues and Complications for the Perioperative Cardiothoracic and Vascular Community. J Cardiothorac Vasc Anesth. 2020 May 27 doi: 10.1053/j.jvca.2020.05.032
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  93. Galea S, Abdalla SM. COVID-19 Pandemic, Unemployment, and Civil Unrest. Underlying Deep Racial and Socioeconomic Divides. JAMA 2020; doi: 10.1001/jama.2020.11132
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  95. Richard Thalappillil R, Tam CW. POCUS to Guide Fluid Therapy in COVID-19. Cardiothorac Vasc Anesth June 2, 2020.
  96. Hammoud MM, Standiford T, Carmody JB. Mahajan C, Kapoor I, Prabhakar H. Psychological effects of Corona Virus Disease (COVID 19) on children of Health Care Workers. Anesth Analg June 1, 2020. DOI: 10.1213/ANE.0000000000005034
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