Preventing exposure to COVID-19 in the operation theatre and intensive care unit

Successful Extracorporeal Cytokine Hemoadsorption in a Marfan Syndrome Patient with COVID-19 Undergoing Redo Bentall Procedure

BACKGROUND Patients with COVID-19 undergoing emergency or complex surgical procedures are at increased risk of developing perioperative complications. CytoSorb is a blood purification therapy used to remove circulating cytokines in conditions of hyperinflammation. This report is of a patient with COVID-19 requiring redo replacement of the aortic valve and aorta due to aortic aneurysm of the ascending aorta (Bentall procedure) associated with Marfan syndrome. The patient was successfully treated with extracorporeal cytokine hemoadsorption. CASE REPORT A 34-year-old man with Marfan syndrome, who had undergone a Bentall procedure in 2018, was admitted with symptoms of worsening dyspnea, tachycardia, fever, and confirmed COVID-19. Further diagnostic workup revealed dehiscence of the aortic root as well as moderate aortic regurgitation, in the context of a hyperinflammatory state. Anti-infective treatment was initiated. Given the severity of symptoms, COVID-19, echocardiography findings, and risk of aortic rupture, urgent Bentall surgery was performed. Additionally, a CytoSorb hemoadsorber was integrated into the cardiopulmonary bypass circuit to attenuate the anticipated systemic hyperinflammation. Intraoperatively, several blood products were administered due to excessive bleeding from the friable tissues and the pre-existing anemia and thrombocytopenia. Treatment was associated with marked improvements in vital parameters and inflammatory markers, and weaning from the ventilator and inotropes was possible after 48 hours. The remaining time in hospital was uneventful. CONCLUSIONS This report supports the findings from recent studies and reports that extracorporeal cytokine hemoadsorption has a role to play in reducing the systemic effects of cytokine storm associated with complex surgery involving cardiopulmonary bypass alongside severe infections, including COVID-19.

Strengthening the ICUs' human resource-related responses to Covid-19: A rapid review of the experience during the first year of public health emergency

By drawing on macro-categories of key human resource (HR) management interventions recommended by the Organization for Economic Co-operation and Development (OECD) during the Covid-19 pandemic, this study aimed to explore whether and how Intensive Care Units (ICU) have strengthened their HRs during the first year of Covid-19 emergency. A rapid review was conducted to provide a quick synthesis of the literature in English identified in the Web of Science Core Collection (WoS), PubMed, and Scopus databases. A total of 68 articles qualified for the final analysis. The findings illustrated that health organisations were often guided by staffing ratios to estimate capacity to care, aimed to modify the scope of practice of providers, redeployed both internal and external staff to ICUs, created and adapted the Covid-19-specific staffing models, and implemented technological innovations to provide services to the unprecedented number of patients while protecting the physical and mental health of their staff. The insights of this research should be helpful for health leaders, HR Managers, and policymakers who have faced unprecedented challenges and tough decisions during this emergency. The findings could also inform beyond-Covid-19 ICU policies and guide future research.

Procedural Dermatology during COVID-19 Pandemic

The Corona virus disease of 2019 (COVID-19) pandemic has imposed unprecedented challenges on the healthcare system including the specialty of dermatology. Procedural dermatology being an integral part of the specialty has also been profoundly affected where all elective and cosmetic procedures are presently being deferred, giving priority only to urgent and inescapable dermatologic procedures to curb down the risk of SARS-CoV-2 transmission in hospitals. With no certainty as to when the pandemic is going to end, procedural dermatology will be resumed in times to come, which must be taken up with cautious precautions. Dermatosurgeons must formulate protocols, restructure their facilities, and implement stringent measures with the aim to limit the spread of SARS-CoV-2, providing, at the same time, essential surgical care to patients. This review highlights the salient precautions to be observed in a dermatosurgery facility based on the current recommendations. The situation, however, remains fluid and as the pandemic is evolving, dermatosurgeons should remain vigilant and acquaint themselves with the latest guidelines.