key: cord-1005590-70qp75t3 authors: Zeng, Min; Li, Shu; Li, Muhan; Yan, Xiang; Li, Ruowen; Dong, Jia; zhang, Yuewei; Miao, Zhongrong; Wang, Shuo; Peng, Yuming; Han, Ruquan title: The perioperative management of subarachnoid hemorrhage during Coronavirus disease 2019 pandemic in CHINA: case series report date: 2020-08-07 journal: World Neurosurg DOI: 10.1016/j.wneu.2020.08.007 sha: d73a0339b38a9fd2e6f58e0ac31ef5e40d6eabf3 doc_id: 1005590 cord_uid: 70qp75t3 Abstract Background For most of the international community out of the epicenter, Coronavirus disease 2019 (COVID-19) containment is normalizing, and daily medical practice is paralleling with preventing and treating COVID-19. The experience of simultaneously conducting emergent surgery and infection control for COVID-19 disease is needed during the pandemic from the outside of epicenter. Methods In this single-center, retrospective, and observational study, we enrolled patients with subarachnoid haemorrhage (SAH) who were emergently admitted from January 23 to April 8, 2020. Based on the COVID-19 triage, SAH patients were divided into three categories: positive, negative, and under investigation. Results During 77 days, a total of 90 SAH patients were admitted at the center. The median age was 55 years (range: 18 to 80) and 40 (44.4%) patients were male. None was positive, 42 patients were negative and 48 patients were under investigation for COVID-19 before surgery. During the same period, nine patients diagnosed COVID-19 without nosocomial infection. Conclusions Rescuing SAH patients and containment of COVID-19 benefit from joint prevention and control, centralized system of equipment distribution and personnel assignment, and quick workflow establishment. The outbreak of a novel coronavirus has led to a public health emergency with international concern. Despite rigorous global containment and quarantine efforts, the total number of Coronavirus Disease 2019 (COVID-19) cases worldwide continues to increase. At the time of writing, the cases of COVID-19 were rising to 7,690,708 with 427,630 deaths (mortality: 5.6%). 1 In China, 83,181 cases had been confirmed, and 4634 individuals had died (mortality: 5.6%). During the ongoing COVID-19 pandemic, most hospitals have postponed or even canceled elective surgery in order to divert medical resources on patients with COVID-19. However, some emergent surgeries are inevitable for life-threatening conditions. Subarachnoid hemorrhage (SAH) is a prevalent emergent disease of the central nervous system. 2 Early and aggressive surgery or intervention reduces morbidity and mortality. 3 In addition, SAH also complicated with fever and pulmonary changes, 4, 5 which need to be differentiated from COVID-19. More and more medical institutions out of the epicenter are facing the dilemma of launching routine clinical practice and preventing COVID-19. 6 Therefore, the report of SAH cases from Beijing, China might be helpful during the pandemic. Normally distributed variables were described as means with standard deviation (SD) and compared by using independent t-tests. Non-normally distributed variables were summarized as medians with interquartile range (IQR) and compared by using Mann-Whitney U tests. Categorical variables were described as count and percentage Table 1) . Through the preoperative evaluation, most cases had mild to moderate SAH. (Table 2 ). In the bundle of COVID-19 triage, 45 patients (50.0%) were Beijing local and none had a traveling history of Wuhan. Preoperative-abnormal results in temperature, lymphocyte count, and pulmonary presentation on CXR or pulmonary CT were observed in 6 (6.7%), 30 (33.3%) and 26 (28.9%) patients, respectively. Based on the screening for COVID-19, none were positive, 48 cases were under investigation and 42 cases were negative. Thirty-nine (43.3%) patients completed the first pharyngeal sampling before surgery ( Table 3 ). The demographics, baseline characteristics, diagnosis, SAH severity and comorbidity, and surgical approach were similar between patients from the negative and under-investigation group (Table 1) The abnormal body temperature and white blood cells in patients with SAH should be differentiated from those with COVID-19. Fever is the primary sign (88.7%) of COVID-19 and progressive decrease in peripheral blood lymphocytes was present in 83.2% patients. 13, 14 Fever after SAH is common due to systemic inflammatory reaction, basal cisterns irritation and loss of central temperature control. 15, 16 Pneumonia is the most common reason for infectious fever. 5, 17 Lung injuries were exacerbated by the elevated intracranial pressure through brain-lung crosstalk mechanism. 18 In order to control the spread of COVID-19, multiple measures were imposed along with emergent public health policy. Firstly, the comprehensive and effective preoperative evaluation and preparation were completed in a limited timeframe. The Anesthesiologists were implemented level-three protection for high-risk surgical patient. 20 Lastly, joint prevention and control were well embodied in our clinical practice since the beginning of pandemic. We established a special task force in conducting the nucleic acid test for COVID-19. Physicians from the diverse departments were designated for pharyngeal swab sampling. Researchers from the laboratory were diverted in the clinical nucleic acid test. The overall management was established on the prevention resources and preferentially allocated to the healthcare staff with a high risk of infection. The prevention and control office rapidly formulated the prevention and control workflow and updated it in time. At the time of writing, a total of 62 documents has been released and effectively ensured the safe and well-organized medical service during the entire pandemic period. In summary, the successful experience of rescuing SAH patients and containment of COVID-19 help to overcome the hard period outside the epicenter, and will hopefully provide references for other national areas. Hospital, Capital Medical University for their support and cooperation. Beijing J o u r n a l P r e -p r o o f Table captions and figure legends Table 1 . Demographics and baseline information. Table 2 . Surgical-and anesthetic-information and outcomes. J o u r n a l P r e -p r o o f Table 3 Under investigation Group Coronavirus disease (COVID-19) Situation Report -146 Subarachnoid Hemorrhage Variation of patient characteristics, management, and outcome with timing of surgery for aneurysmal subarachnoid hemorrhage A multicenter prospective cohort study of volume management after subarachnoid hemorrhage: circulatory characteristics of pulmonary edema after subarachnoid hemorrhage Participants in the International Multi-Disciplinary Consensus Conference on the Critical Care Management of Subarachnoid H. Fever management in SAH Preventing Infection of Patients and Healthcare Workers Should Be the New Normal in the Era of Novel Coronavirus Epidemics Surgical risk as related to time of intervention in the repair of intracranial aneurysms Report of World Federation of Neurological Surgeons Committee on a Universal Subarachnoid Hemorrhage Grading Scale Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning National Health Commission and National Administrative Office of Chinese Tradition Medicine: National Recommendations for Diagnosis and Treatment of Pneumonia Caused by 2019-nCoV Chinese Society of Anesthesiology Expert Consensus on Anesthetic Management of Cardiac Surgical Patients With Suspected or Confirmed Coronavirus Disease Anesthesia Considerations and Infection Precautions for Trauma and Acute Care Cases During the COVID-19 Pandemic Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis Clinical Characteristics of Coronavirus Disease 2019 in China Rectal temperature and prostaglandin E2 increase in cerebrospinal fluid of conscious rabbits after intracerebroventricular injection of hemoglobin Concepts of fever Fever Burden in Patients With Subarachnoid Hemorrhage and the Increased Use of Antibiotics Brain-lung crosstalk: Implications for neurocritical care patients Role of anaesthesiologists during the COVID-19 outbreak in China Perioperative Management of Patients Infected with the Novel Coronavirus: Recommendation from the Joint Task Force of the Chinese Society of Anesthesiology and the Chinese Association of Anesthesiologists