A group of surgical leaders from affected countries have joined to discuss what they are learning during this Covid-19 Global crisis. The following is a brief summary of what they feel may be useful information to disseminate to the surgical community from the week of March 22-29
Aerosolization of virus during laparoscopic surgery
Concerns for aerosolization of Covid-19 during laparoscopic surgery has created significant confusion. Even though there is no Level 1 evidence to prove its occurrence or lack thereof, SAGES and EAES have joined efforts resulting on a guiding statement based on valuable expert opinion and review of related literature:
SAGES and EAES Recommendations Regarding Surgical Response to COVID-19 Crisis:
https://www.sages.org/recommendations-surgical-response-covid-19/ There is also an infographic:
Click image to see full size. The publication is accompanied by a very useful summary entitled:
Resources on Smoke & Gas Evacuation During Open, Laparoscopic and Endoscopic Procedures
https://www.sages.org/resources-smoke-gas-evacuation-during-open-laparoscopic-endoscopic-procedures/.Testing for all patients undergoing surgery
Based on the experience gained on the field, CVGSC recommends that in areas/institutions seeing high volumes of COVID-19 patients, all patients undergoing a surgical or interventional endoscopic procedure, receive some type of screening test, even if asymptomatic and without risk factors. When feasible and available, direct testing for COVID-19 is preferred. Alternatively, a chest ultrasound or a CT of the chest is advised. However cross contamination of CT equipment and patients is to be considered depending on the institutional availability of dedicated CT’s. Please see: https://www.sages.org/the-corona-virus-global-surgical-collaborative-cvgsc/ for more information and video.
COVID plasma trial
As the number of patients that recover from the disease is increasing, the FDA has approved the emergency use of investigational COVID-19 convalescent plasma to treat severely ill COVID-19 patients. While it will take months to years to develop an effective vaccine, convalescent plasma from recovered COVID-19 patients rich in antibodies may soon be available to boost immunity against the virus, theoretically reducing viral load and lowering mortality. A trial has been started at Mt Sinai, New York and is expanding to other centers. If results appear encouraging, SAGES will keep a list of sites that are actively screening volunteers for possible plasma donation.
3D printing of needed ventilation system parts
As the number of patients requiring prolonged ventilator support increases, institutions have seen a shortage of ventilator parts contributing to the shortage when there is otherwise a functioning ventilator available. A document entitled Production of 3D printed components for ventilation systems: practical hints is kindly shared by San Matteo Hospital, Pavia. 3D printing for COVID-19
Potential good news from Italy
Despite that devastation from the disease still continues, and being too early to draw any definitive conclusions, there are some signs that the slope of COVID-19 new cases in Italy may be starting to slow down. Italian epidemiologists feel it is the result of the strict physical distancing measures. As health care provides, this appears to be the best preventive measure to emphasize and possibly the only intervention currently available to overcome this epidemic.
Participants:
Drs. Horacio Asbun (Lead), Mohammed Abu Hilal, Jaap Bonjer, Nicolas Demartines, Nader Francis, Ho-Seong Han, Salvador Morales, Andrea Pietrabissa, Aurora Pryor, Christopher Schlachta, Patricia Sylla, Eduardo Targarona
Other Surgical Societies/leaders are welcome to participate in future discussions. Please contact SAGES Executive Director, Sallie Matthews at sallie@sages.org if interested in being considered for participation.
GENERAL DISCLAIMER
The following is intended to provide our members with information arising from the experience of our colleagues from Europe and Asia who experienced the pandemic first. While the information provided is from very reliable sources, it is NOT evidence based data, since there was no time to test its validity on scientific grounds. It is merely an attempt to share practical advice based upon prior experience and current knowledge.