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 OUTBREAK

May COVID-19 classified
as a haemostatic disorder?
A literature overview and Italian single centre experience

Maria Benedetto and Vittorio Ferrari

COVID-19 OUTBREAK

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

Marta Agulli

COVID-19 OUTBREAK

Mechanical Ventilation Strategies
and Feasibility of ECMO
for SARS-COVID-19

Maria Benedetto

COVID-19 OUTBREAK

Tips and tricks
for safe airway
management

Mohamed El Tahan

Helpful Resources

WEEKLY UPDATED! – The most recent resources are on top

  1. Ing RJ, Barrett C, Chatterjee D, et al. Perioperative Preparations for COVID-19: The Pediatric Cardiac Team Perspective. J Cardiothorac Vasc Anesth May 23, 2020, DOI:https://doi.org/10.1053/j.jvca.2020.04.032
  2. Rozental O, Thalappillil R, White RS, et al. Hemodynamic Monitoring Options in COVID-19. J Cardiothorac Vasc Anesth May 24, 2020. DOI:https://doi.org/10.1053/j.jvca.2020.04.050
  3. Ma L, Song K, Huang Y. Coronavirus Disease-2019 (COVID-19) and Cardiovascular Complications. J Cardiothorac Vasc Anesth May 24, 2020, https://doi.org/10.1053/j.jvca.2020.04.041
  4. Haye G, Fourdrain A, Abou-Arab O, et al. COVID-19 Outbreak in France: Setup and Activities of a Mobile Extracorporeal Membrane Oxygenation Team During the First 3 Weeks. J Cardiothorac Vasc Anesth May 24, 2020. DOI:https://doi.org/10.1053/j.jvca.2020.05.004
  5. Pisano A, Landoni G, Verniero L, Zangrillo A. Cardiothoracic Surgery at the Time of the Coronavirus Disease2019 Pandemic: Lessons From the East (and From a Previous Epidemic) for Western Battlefields. J Cardiothorac Vasc Anesth May 29, 2020. DOI:https://doi.org/10.1053/j.jvca.2020.04.051
  6. Laura Pasin L, Sella N, Correale C, et al. Regional COVID-19 Network for Coordination of SARS-CoV-2 outbreak in Veneto, Italy. J Cardiothorac Vasc Anesth May 25, 2020. DOI:https://doi.org/10.1053/j.jvca.2020.05.005
  7. Argenziano M, Fischkoff K, Smith CR. Surgery Scheduling in a Crisis. N Engl J Med 2020; May 27. DOI: 10.1056/NEJMc2017424
  8. Price‑Haywood EG, Burton J, Fort D, Seoane L. Hospitalization and Mortality among Black Patients and White Patients with Covid-19. N Engl J Med 2020; May 27. DOI: 10.1056/NEJMsa2011686
  9. Robba C, Robba C, Battaglini D, et al. Distinct phenotypes require distinct respiratory management strategies in severe COVID-19. Resp Physiol Neurobiol 11 May 11, 2020. https://doi.org/10.1016/j.resp.2020.103455
  10. Abbasi J. Prioritizing Physician Mental Health as COVID-19 Marches On. JAMA May 20, 2020. doi:10.1001/jama.2020.5205 – Read here an interview to dr Abbasi
  11. Schaller T, Hirschbühl K, Burkhardt K, et al. Postmortem Examination of PatientsWith COVID-19. JAMA May 21, 2020.  doi:10.1001/jama.2020.8907
  12. Ingelfinger JR. Personal Protective Equipment and Covid-19. Video and summary of the information provided in the video. N Engl J Med May 19, 2020. DOI: 10.1056/NEJMvcm2014809
  13. Wang E, Mei W, Shang Y, et al. Chinese Association of Anesthesiologists Expert Consensus on the Use of Perioperative Ultrasound in Coronavirus Disease 2019 Patients. J Cardiothorac Vasc Anesth May 15, 2020 https://doi.org/10.1053/j.jvca.2020.04.002
  14. Ackermann M, Verleden SE, Kuehnel M, et al. Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19. N Engl J Med May 21, 2020. DOI: 10.1056/NEJMoa2015432
  15. Hariri L, Hardin CC. Covid-19, Angiogenesis, and ARDS Endotypes. N Engl J Med May 21, 2020. DOI: 10.1056/NEJMe2018629

 

ESA COVID-19 Resource page

  1. Girgis AM, Aziz MN, Gopesh TC, et al. Novel Coronavirus Disease 2019 (COVID-19) Aerosolization Box: Design Modifications for Patient Safety. J Cardiothorac Vasc Anesth. 2020 May 22 https://doi.org/10.1053/j.jvca.2020.05.001
  2. Jain U. Caution Regarding Enclosures for Airway Procedures. Anesth Analg May 15, 2020. doi: 10.1213/ANE.0000000000004983
  3. Shapiro SD, Rothman PB. How Academic Health Systems Can Move Forward Once COVID-19 Wanes. JAMA May 20, 2020. doi: 10.1001/jama.2020.8002
  4. Haug G, Eapen MS. Renin–Angiotensin–Aldosterone System Inhibitors in Covid-19. N Eng J Med May 19, 2020, DOI: 10.1056/NEJMc2013707
  5. Patel AB, Verma A. Nasal ACE2 Levels and COVID-19 in Children. JAMA May 20, 2020 doi:10.1001/jama.2020.8946
  6. Soneru CN, Petersen TR, Bajracharya M, Hadid S. Can pediatric COVID-19 testing sensitivity be improved with sequential tests? Anestb Analg May 2020 DOI: 10.1213/ANE.0000000000004982
  7. Andrea Demeter MD, Jewell NP, Lewnard JA, Jewell BL. Predictive mathematical models of the COVID-19 Pandemic Underlying Principles and Value of Projections. 2020; 323(19):1893-1894. doi: 10.1001/jama.2020.6585
  8. Mello MM, Persad C, White DB. Respecting Disability Rights — Toward Improved Crisis Standards of Care. N Eng J Med May 19, 2020 DOI: 10.1056/NEJMp2011997
  9. Whitcroft KL, Hummel T. Olfactory Dysfunction in COVID-19 Diagnosis and Management. JAMA May 20, 2020 doi: 10.1001/jama.2020.8391
  10. Rubin R. Building an “Army of Disease Detectives” to Trace COVID-19 Contacts. JAMA May 21, 2020. doi: 10.1001/jama.2020.8880
  11. Sittig DF, Singh H. COVID-19 and the Need for a National Health Information Technology Infrastructure. JAMA. May 18, 2020. doi:10.1001/jama.2020.7239
  12. Shachar C, Engel J, Elwyn G. Implications for Telehealth in a Postpandemic Future: Regulatory and Privacy Issues. JAMA May 18, 2020. doi:10.1001/jama.2020.7943
  13. Rosenberg ES, Dufort EM, Udo T, et al. Association of Treatment with Hydroxychloroquine or Azithromycin with In-Hospital Mortality in Patients With COVID-19 in New York State. JAMA May 11, 2020. doi:10.1001/jama.2020.8630
  14. Kirkcaldy RD, King BA, Brooks JT. COVID-19 and Postinfection Immunity. Limited Evidence, Many Remaining Questions. JAMA May 11, 2020. doi:10.1001/jama.2020.7869
  15. Williams DR, Cooper LA. COVID-19 and Health Equity—A New Kind of “Herd Immunity”. JAMA May 11, 2020. doi: 10.1001/jama.2020.8051
  16. Sise ME, Baggett MV, Shepard JAO, et al. Case 17-2020: A 68-Year-Old Man with Covid-19 and Acute Kidney Injury. N Engl J Med May 13, 2020.  DOI: 10.1056/NEJMcpc2002418
  17. Puelles VG, Lütgehetmann M, Lindenmeyer MT, et al. Multiorgan and Renal Tropism of SARS-CoV-2. N Engl J Med May 13, 2020. DOI: 10.1056/NEJMc2011400
  18. Hamiel U, Kozer E, Youngste I. SARS-CoV-2 Rates in BCG-Vaccinated and Unvaccinated Young Adults. JAMA May 13, 2020. doi:10.1001/jama.2020.8189
  19. Halfmann PJ, Hatta M, Chiba S. Transmission of SARS-CoV-2 in Domestic Cats. N Engl J Med May 13, 2020. DOI: 10.1056/NEJMc2013400
  20. Hains DS, Schwaderer AL, Carroll AE, et al. Asymptomatic Seroconversion of Immunoglobulins to SARS-CoV-2 in a Pediatric Dialysis Unit. JAMA May 13, 2020. doi:10.1001/jama.2020.8438
  21. Hooper MW, Nápoles AN, Pérez-Stable EJ. COVID-19 and Racial/Ethnic Disparities. JAMA May 13, 2020. doi: 10.1001/jama.2020.8598
  22. Rosenbaum L. Facing Covid-19 in Italy — Ethics, Logistics, and Therapeutics on the Epidemic’s Front Line. N Engl J Med May 13, 2020. DOI: 10.1056/NEJMp2005492
  23. Ma L, Song K, Huang Y.  Coronavirus disease 2019 (COVID-19) and cardiovascular complications. J Cardiothorac Vasc Anesth. 2020 April 30. https://doi.org/10.1053/j.jvca.2020.04.041
  24. Sethuraman N, Jeremiah SS, Ryo A. Interpreting diagnostic tests for SARS-CoV-2. JAMA 2020; May 6. doi:10.1001/jama.2020.8259
  25. Moore B, Morgan N, Selzman C, Zimmerman J. Successful use of limited transthoracic echocardiography to guide VV ECMO placement in a COVID-19 patient. J Cardiothorac Vasc Anesth. 2020 May 6. https://doi.org/10.1053/j.jvca.2020.04.047
  26. Rozental O, Thalappillil R, White RS, et al. Hemodynamic monitoring options in COVID-19. J Cardiothorac Vasc Anesth. 2020 May 6. https://doi.org/10.1053/j.jvca.2020.04.050
  27. Pisano A, Landoni G, Verniero L, Zangrillo A. Cardiothoracic surgery at the time of COVID-19 pandemic: lessons from the East (and from a previous epidemic) for western battlefields. J Cardiothorac Vasc Anesth. 2020 May 6 https://doi.org/10.1053/j.jvca.2020.04.051
  28. Rosenblatt WH, Sherman JD. More on barrier enclosure during endotracheal intubation. N Engl J Med 2020; May 5. DOI: 10.1056/NEJMc2012960
  29. Bowles L, Platton S, Yartey N, et al. Lupus anticoagulant and abnormal coagulation tests in patients with Covid-19. N Engl J Med 2020; May 5. DOI: 10.1056/NEJMc2013656
  30. Kramer DB, Lo B, Dickert NW. CPR in the Covid-19 Era — An ethical framework. N Engl J Med 2020; May 6. DOI: 10.1056/NEJMp2010758
  31. Creel-Bulos C, Hockstein M, Amin N, et al. Acute cor pulmonale in critically ill patients with Covid-19. N Engl J Med 2020; May 6. DOI: 10.1056/NEJMc2010459
  32. Persad G, Emanuel EJ. The ethics of COVID-19 immunity-based licenses (“Immunity Passports”). JAMA 2020; May 6.  doi:10.1001/jama.2020.8102
  33. Berwick DM, Choices for the “New Normal”. JAMA 2020; May 5. doi:10.1001/jama.2020.6949
  34. Augoustides JG. Perioperative Echocardiography: Key Considerations During the Coronavirus Pandemic. J Cardiothorac Vasc Anesth. 2020 Mar 28, doi: 10.1053/j.jvca.2020.03.046
  35. Tryphonopoulos P, McFaul C, Gagne S, et al. COVID-19 and One Lung Ventilation. Anesth Analg April 27, 2020
  36. Christian R. Am I Part of the Cure or Am I Part of the Disease? Keeping Coronavirus Out When a Doctor Comes Home. N Engl J Med 2020; 382:1684-1685, DOI: 10.1056/NEJMp2004768
  37. García-Méndez N, Lagarda CJ, Otzen Tamara, et al. Anesthesiologists and the High Risk of Exposure to COVID-19. Anesth Analg April 27, 2020
  38. De Filippo O, D’Ascenzo F, Angelini F, et al. Reduced Rate of Hospital Admissions for AC during Covid-19 Outbreak in Northern Italy. N Engl J Med April 28, 2020, DOI: 10.1056/NEJMc2009166
  39. Qian SZ, Pan JY. COVID-19 With Limb Ischemic Necrosis. J Cardiothorac Vasc Anesth April 30, 2020. DOI: https://doi.org/10.1053/j.jvca.2020.03.063
  40. Rubin R. Testing an Old Therapy Against a NewDisease: Convalescent Plasma for COVID-19. JAMA  April 30, 2020. doi:10.1001/jama.2020.7456
  41. Baldi E, Sechi GM, Claudio Mare C, et al. Out-of-Hospital Cardiac Arrest during the Covid-19 Outbreak in Italy. N Engl J Med April 29, 2020, DOI: 10.1056/NEJMc2010418
  42. Haberman R, Axelrad J, Chen A, et al. Covid-19 in Immune-Mediated Inflammatory Diseases — Case Series from New York. N Engl J Med April 29, 2020, DOI: 10.1056/NEJMc2009567
  43. Vaduganathan M, Vardeny O, Michel T, McMurray JJV, Pfeffer MA, Solomon SD, Renin–Angiotensin–Aldosterone System Inhibitors in Patients with Covid-19. April 23, 2020 N Engl J Med 2020; 382:1653-1659. DOI: 10.1056/NEJMsr2005760
  44. Interim Guidance for Healthcare Providers during COVID-19 Outbreak. American Heart Association
  45. Yang M, Hailong Dong H, Lu Z, Role of anaesthesiologists during the coronavirus disease 2019 outbreak in China. Br J Anaesth. 2020 Apr 9 doi: 10.1016/j.bja.2020.03.022 [Epub ahead of print]
  46. D’Silva DF, McCulloch TJ, Lim JS, Smith SS, Carayannis D, Extubation of patients with COVID-19. Br J Anaesth. 2020 Apr 9 doi: 10.1016/j.bja.2020.03.016 [Epub ahead of print]
  47. van de Haar, J., Hoes, L.R., Coles, C.E. et al. Caring for patients with cancer in the COVID-19 eraNat Med (2020). https://doi.org/10.1038/s41591-020-0874-8
  48. Richardson S, Hirsch JS, Narasimhan M, et al, Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. April 22, 2020, JAMA. Published online April 22, 2020. DOI:10.1001/jama.2020.6775
  49. SARS-CoV-2 Infection in Children N Engl J Med 2020; 382:1663-1665. DOI: 10.1056/NEJMc2005073
  50. Late-Onset Neonatal Sepsis in a Patient with Covid-19 April 22, 2020. DOI: 10.1056/NEJMc2010614
  51. Coagulopathy and Antiphospholipid Antibodies in Patients with Covid-19 April 23, 2020 N Engl J Med 2020; 382:e38 DOI: 10.1056/NEJMc2007575
  52. ST-Segment Elevation in Patients with Covid-19 — A Case Series. April 17, 2020 DOI: 10.1056/NEJMc2009020
  53. Anesthetic Management of Patients Undergoing Aortic Dissection Repair With Suspected Severe Acute Respiratory Syndrome Coronavirus-2 Infection J Cardiothorac Vasc Anesth. 2020 Mar 16
  54. Anaesthesia Management and Perioperative Infection Control in Patients with the Novel Coronavirus
  55. Extracorporeal Membrane Oxygenation – Crucial considerations during the Coronavirus Crisis
  56. Cardiovascular Consequences and Considerations of Coronavirus Infection – Perspectives for the cardiothoracic anaesthesiologist and intensivist during the Coronavirus Crisis
  57. Potential Legal Liability for Withdrawing or Withholding Ventilators during COVID-19. Assessing the Risks and Identifying Needed Reforms 
  58. SCTS/ACTACC/SCPS guidance to UK cardiac and thoracic teams for procedures on patients with COVID-19
  59. Protecting High-Risk Cardiac Patients During the COVID-19 Outbreak
  60. Preparing for a COVID-19 pandemic: a review of operating room outbreak response measures in a large tertiary hospital in Singapore
  61. COVID-19 infections: Implications for perioperative and Critical Care Physicians
  62. Perioperative Management of Patients Infected with the Novel Coronavirus: Reccomendations from the Joint Task Force of the Chinese Society of Anaesthesiology and the Chinese Association of Anaesthesiologists
  63. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected. WHO
  64. Perioperative Considerations for the 2019 Novel Coronavirus (COVID-19). Apsf February 12
  65. COVID-19 Airway Management Principles (UK group). March 14
  66. Airway Management in patients suffering from COVID-19. ESA March 11 on behalf of SIAARTI
  67. van Doremalen, Bushmaker, Morris. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. Nejm March 16, 2020
  68. Murthy, Gomersall, Fowler. Care for Critically Ill Patients With COVID-19. JAMA March 11, 2020
  69. Audio Interview: What Clinicians Need to Know in Diagnosing and Treating Covid-19. Nejm March 5
  70. Anaesthesia and caring for patients during the COVID-19 outbreak. Draft 1.0. ASA (Australian)
  71. Coronavirus – guidance for anaesthesia and perioperative care providers. WFSA