Take home message
- Healthcare workers are at high risk for infection with the highly contagious COVID-19 infection. So, you should be well prepared and protected with proper donning and doffing of PPE.
- Elective procedures have been postponed or rescheduled in many centres
- Preoperative routine screening for COVID-19 infection using a checklist, RT-PCR, CT, or antibodies should be considered.
- Golden measures to be prepared include planning ahead, increasing ICU capacity, the proper team preparing and training, floor and hospital planning, using schematic checklists, preparing equipment and medicines needed, briefing and debriefing and ensuring staff wellbeing.
- Perioperative management should be provided by the most experienced staff.
- Limit the number of staff involved.
- Negative rooms, if available, should be considered particularly during the aerosol-generating procedures.
- Nonintubated cardiac or thoracic procedures would leave the airway open to the atmosphere with risks for aerosol transmission.
- Elective intubation should be considered in all COVID-19 patients.
- Innovative and untrusted PPE measures should be validated before use.
- Identify the indications for using the BB or DLT if lung separation/isolation is required.
- One lung ventilation is challenging particularly in the light of two phenotypes of COVID-19.
- A focused TOE exam should be limited to the selected cases.
- The decision on extubation should be individualized based on the infectivity status, patient’s conditions and available resources.
- Caution should be exercised after surgery for patient transferring and decontamination procedures.
- Maintain healthy non-clinical environment far away from the caring of the patients during the COVID-19 pandemic.
- Finally, we hope these recommendations would be helpful in everyday practice during the era of COVID-19 outbreak.
Summary: EACTA webinar on Perioperative Management of Patients with COVID-19
Dr. Hans-Christian Zaun, Ph.D. Scientific Advisor, MULTILEARNING GROUP.
Moderated by Dr. Mohamed El Tahan of Mansoura University, Egypt, and the University of Damman, Saudi Arabia.
The speakers include Dr. Massimiliano Sorbello of San Marco University, Catania, Italy; Dr. Fabio Guarracino, Pisa University Hospital, Italy; Dr. Mert Senturk, İstanbul University-Cerrahpaşa, Istanbul, Turkey; Dr. Irene Ovira, from Barcelona, Spain.
Dr. Sorbello began the webinar on the lessons learned from airway management of COVID-19 patients, and his experiences in Italy. He starts with a brief recap of the COVID-19 outbreak in Italy and a remembrance of the 150 health care workers who died. Dr. Sorbello notes that there is still a lot that is unknown about COVID-19, particularly about its transmission by way of aerosols and how this affects the necessary steps in preventing infection of medical staff in the clinical setting. He reviews numerous studies looking at personal protective equipment (PPEs) and stresses that the prevention of aerosol-based infection is imperative in airway management and anesthesiology. He further emphasizes the importance of proper donning and doffing of PPEs, especially as doffing results in an increased risk of self-contamination. Dr. Sorbello continues by discussing the differences in clinical manifestations of COVID-19 from other respiratory diseases. He reviews recommendations on the numerous procedures such as pre-oxygenation, intubation and extubation that includes informative videos.
Then Dr. Guarracino discusses proper preparedness for the Cardiac Anaesthetist. He reviews the importance of both screening patients before surgery and protective measures needed in the operating theatre. He reiterates Dr. Sorbello`s position on the importance of proper PPE management, particularly the donning and doffing and recommends that teams run simulations with the most experienced staff supervising. He continues his discussion by presenting recommendations for various procedures that include intubation, extubation, non-intubation surgeries, among others. Dr. Guarracino concludes his presentation by reminding viewers that COVID-19 is still spreading and that all anesthesiologists will most likely have to deal with these issues in the future.
Dr. Mert Senturk continues by discussing the proper preparation of staff for thoracic surgeries. He gives recommendations both on the appropriate set up of the operating theatre and preparation for the airway management team. He also discusses the importance of testing and recommends that the CT scan should be a part of the diagnosis due to the problem of false-negative results of the swab tests. He stresses that while waiting for diagnostic results to confirm COVID-19, we must treat all patients as potentially COVID-19 positive. Dr. Senturk continues his discussion by reviewing numerous recommendations for preparing both operating theatres as well as the patient. The remainder of Dr. Senturk’s presentation reviews multiple procedures that include algorithms for thoracic intubation and general indicators for bronchial blockers.
Finally, Dr. Irene Rovira discusses the situation in Spain and the numerous preparations of her hospital in Barcelona undertook in preparing for the influx of COVID-19 patients. These preparations included freeing up ICU beds, coordinating multidisciplinary teams, preparing equipment and reviewing various recommendations including checklists for the donning and doffing of PPEs, ventilation procedures, and COVID-19 patients.
After several questions about screening recommendations and heparinization issues, Dr. El Tahan concluded by briefly reviewed the guidance given by the speakers.
After joining this webinar you will better understand:
- Essentials of airway management in patients with COVID-19 infection;
- Preparations for perioperative care of patients with suspected or confirmed COVID-19 infection who undergoes cardiac or thoracic surgery;
- Principles of care of the critically ill COVID-19 patients.
Cardiac, thoracic and vascular anaesthetists, intensivists, perfusionists, general anaesthetists, anaesthesia certified nurses, nurses, interns and medical students.
The webinar is free of charge.
To join it, you should be registered in the EACTA database in order to have access to the e-academy (no need to pay the members’ fee, as the content is available for free). Please click here and then on ‘create account’ in order to gain your credentials.
EACTA members can directly access with their own credentials.
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Certificates of attendance have been sent to all the participants by email after the event.
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Click here to see the recordings of the webinar, published in open access
Check below the programme, the speakers and replies to questions not adressed during the live event