key: cord-0716228-pa3dkz2f authors: Wang, Jinsong; Kuang, Ming; Chen, Lingwu; Lian, Chong; Zhao, Lei; Wang, Shenming title: Strategy for treating vascular emergencies during the COVID-19 pandemic in China date: 2020-06-01 journal: J Vasc Surg DOI: 10.1016/j.jvs.2020.05.049 sha: 8d7af1b5e9c3b94799ecf844120a85a3d2ea8e63 doc_id: 716228 cord_uid: pa3dkz2f Coronavirus-caused pneumonia (COVID-19) broke out in Dec 2019. The virus soon proved to be extremely contagious and caused an international pandemic. Clinicians treating COVID-19 patients face considerable danger of occupational exposure due to the highly infectious nature of the virus and precautions must be taken to prevent medical staff infections. This article lists important measures that may save the lives of patients and medical staff during the COVID-19 pandemic and help to stop the transmission of COVID-19 on hospital grounds. The suggestions include: 1. Establishing detailed Infection Control and Prevention Protocols in the operating room; 2. Expediting testing procedures and patient screening for COVID-19; 3. Utilizing case-specific treatment planning for vascular patients with COVID-19, favoring minimally invasive methods; 4. Establishing and reinforcing protective awareness within medical personnel. contagious characteristics of this disease, frontline medical staff is at high risk for occupational 16 exposure and infection 1, 2 . Therefore, preventing nosocomial infections is a particularly 17 important and challenging task during this pandemic. 18 The special conditions warranted by the COVID-19 pandemic may have certain negative 19 impacts on the diagnosis, treatment, and relocation of patients with emergency vascular cases, 20 such as acute aortic dissection, ruptured thoracoabdominal aortic aneurysms, acute arterial 21 embolism, deep venous thrombosis of the lower extremities, or other high-mortality vascular 22 diseases that have a short rescue window. Nosocomial infections are most likely to occur from 1 contact during patient transport and management. 2 To prevent frontline medical staff members from being infected, The First Affiliated Given that the pandemic has spread worldwide and many international colleagues deal now 8 with similar, highly challenging and dangerous scenarios, we are pleased to share these 9 guidelines and strategies for everyone's benefit. 10 General principles 11 Under the provision and regulation of a medical task force, the Infection Prevention and 12 Control Protocols (IPCP) are formulated and carried out by the OC. The IPCP is to reinforce 13 and ensure the protection of medical personnel, the implementation of preoperative evaluations 14 and preventive measures, the use of protective strategies for patients pre-and postoperatively, 15 the use of isolated operating rooms, and the rehearsal of these procedures. 16 Blood availability for transfusions is often a challenge during epidemics; hospitals need to 17 communicate closely with their local blood banks and keep track of blood available for 18 planning operations. Hospitals should initiate as many blood donations as possible. To avoid cross-infections and prevent further spread of the epidemic, elective and nonurgent Suspected or confirmed COVID-19 patients with unstable vital signs caused by vascular 12 emergencies should be resuscitated in an isolated area. A multidisciplinary team performs a 13 rapid assessment of the risk/benefit ratio. If the benefit is greater than the risk, a surgical 14 treatment plan is quickly formulated. The operation is performed in an isolated digital 15 subtraction angiography (DSA) or hybrid operating room. After surgery, patients are 16 transported to an isolation ward that actively treats COVID-19. If the risk is greater than the 17 benefit, the patient should be isolated for conservative treatment following the same isolation 18 procedures as above until his or her condition is stable enough for surgery. Patients who have unstable vital signs and cannot be screened should be treated as if they 20 were confirmed COVID-19 patients. Testing can be conducted later if the patient stabilizes. 2. Treatment of non-COVID-19 patients with acute vascular surgical disease 1 Patients who screen negative for COVID-19 should be treated as usual following the process 2 for diagnosing and treating vascular emergencies. 3. Surgical protective wear and intraoperative precautions 12 All operative personnel must enter the potential buffer room from the cleanroom. Surgical 13 personnel in buffer rooms need to disinfect their hands 5 and put on protective clothing, 14 protective masks, trouser covers, shoe covers, two layers of sterile gloves, and sterile 15 disposable surgical clothing before entering. The surgeon may use positive-pressure headgear 16 if available. The type of anesthesia is basically determined by the type of emergency vascular case. Any blood or secretions should be wiped off the patient's body. Surgical wounds must be 20 adequately covered. The patient is extubated in the isolated ICU ward. A disposable sheet is used to cover the patient during transfer. The surgeon and anesthesiologist, while adhering to 1 level three protective measures transport the patient to the isolation ICU ward. 8 The following sequence should be performed to sanitize reusable surgical instruments: 9 disinfection, cleaning, and sterilization. Subjected items should be soaked in chlorine 10 disinfectant 5000 mg/L-10000 mg/L for ≥60 minutes in the operating room. is sterilized, filters need to be removed and treated according to the medical waste protocols. 20 The operating room can be used only after two samples have tested negative for contamination. With proper training, information, and study regarding the routes and mechanisms of 1 transmission of the COVID-19 coronavirus, infection and mortality rates in medical personnel 2 will gradually decrease. It is critical to identify ways to optimize relevant treatment strategies 3 from vascular emergencies during the COVID-19 outbreak. Additionally, we look forward to 4 receiving the latest guidance on COVID-19 from public health experts. The provision of PPE to patients and staff when needed is also crucial. Governmental/third-party assistance to enhance PPE manufacturing is vital to guarantee that a 7 steady and reasonable amount of PPE is consistently available. As an example of how 8 governmental or third-party assistance can benefit the situation, such assistance turned the city 9 of Qingyuan, China, with only a single PPE manufacturing company, into a PPE 10 manufacturing center with over 20 factories 8 . This article is based on our hospital's medical, surgical, and protective protocols along with 12 related management processes that were developed based on our hospital's experience in the 13 treatment of vascular diseases and emergencies. There are inevitably deficiencies and 14 omissions in these guidelines and constructive criticism and corrections are always welcome. Epidemiology Group of New Coronavirus Pneumonia Emergency Response Mechanism 10 of Chinese Center for Disease Control and Prevention.The epidemiological 11 characteristics of an outbreak of Hospitalized Patients With 2019Novel Coronavirus-Infected Pneumonia in 15 National Health Commission of the People's Republic of China.Diagnosis and treatment 17 plan of COVID-19 pneumonia (trial version 7) 2020 National Health Commission of the People's Republic of China.WST 367-2012,Medical 1 institution disinfection technical specifications National Health Commission of the People's Republic of China National Health Commission of the People's Republic of China.WST512-2016,Code of 5 management for cleaning and disinfection of environmental surface of medical 6 institutions National Health Commission of the People's Republic of Technical specification for construction of clean operation 9 department in hospital More than 1.3 million masks are produced every day, and an 11 industrial chain of masks has been established in qingyuan