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• W3132356972 abstract "The European Association of Cardiothoracic Anaesthesiology (EACTA) and the Society of Cardiovascular Anesthesiologists (SCA) aimed to create joint recommendations for the perioperative management of patients with suspected or proven severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection undergoing cardiac surgery or invasive cardiac procedures.To produce appropriate recommendations, the authors combined the evidence from the literature review, reevaluating the clinical experience of routine cardiac surgery in similar cases during the Middle East Respiratory Syndrome (MERS-CoV) outbreak and the current pandemic with suspected coronavirus disease 2019 (COVID-19) patients, and the expert opinions through broad discussions within the EACTA and SCA. The authors took into consideration the balance between established procedures and the feasibility during the present outbreak. The authors present an agreement between the European and US practices in managing patients during the COVID-19 pandemic.The recommendations take into consideration a broad spectrum of issues, with a focus on preoperative testing, safety concerns, overall approaches to general and specific aspects of preparation for anesthesia, airway management, transesophageal echocardiography, perioperative ventilation, coagulation, hemodynamic control, and postoperative care.As the COVID-19 pandemic is spreading, it will continue to present a challenge for the worldwide anesthesiology community. To allow these recommendations to be updated as long as possible, the authors provided weblinks to international public and academic sources providing timely updated data.This document should be the basis of future task forces to develop a more comprehensive consensus considering new evidence uncovered during the COVID-19 pandemic. The European Association of Cardiothoracic Anaesthesiology (EACTA) and the Society of Cardiovascular Anesthesiologists (SCA) aimed to create joint recommendations for the perioperative management of patients with suspected or proven severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection undergoing cardiac surgery or invasive cardiac procedures. To produce appropriate recommendations, the authors combined the evidence from the literature review, reevaluating the clinical experience of routine cardiac surgery in similar cases during the Middle East Respiratory Syndrome (MERS-CoV) outbreak and the current pandemic with suspected coronavirus disease 2019 (COVID-19) patients, and the expert opinions through broad discussions within the EACTA and SCA. The authors took into consideration the balance between established procedures and the feasibility during the present outbreak. The authors present an agreement between the European and US practices in managing patients during the COVID-19 pandemic. The recommendations take into consideration a broad spectrum of issues, with a focus on preoperative testing, safety concerns, overall approaches to general and specific aspects of preparation for anesthesia, airway management, transesophageal echocardiography, perioperative ventilation, coagulation, hemodynamic control, and postoperative care. As the COVID-19 pandemic is spreading, it will continue to present a challenge for the worldwide anesthesiology community. To allow these recommendations to be updated as long as possible, the authors provided weblinks to international public and academic sources providing timely updated data. This document should be the basis of future task forces to develop a more comprehensive consensus considering new evidence uncovered during the COVID-19 pandemic. IN DECEMBER 2019, a novel coronavirus-related disease outbreak was reported in the China province of Hubei, presenting most of the time as a “flu-like” illness. Twenty percent of the infected patients had mild symptoms such as fever or chills, headache, new loss of taste, nasal congestion, sore throat, nausea or vomiting, and diarrhea; and in severe cases, respiratory insufficiency occurred, and eventually acute respiratory distress syndrome (ARDS) necessitating respiratory support and invasive ventilation [click here]. The virus rapidly was identified and classified as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and the disease it causes is now called coronavirus disease 2019 (COVID-19), with a potential death rate of the infected currently monitored by the Johns Hopkins University [click here], mainly depending on age and underlying comorbidities. For its elevated contagiousness (R0, the reproduction number of transmitted infections to new people >two) and the fact that asymptomatic carriers played a crucial role in spreading, COVID-19 in late February 2020 rapidly proliferated to South Korea and Italy. Massive disruptions in public services forced the governments to impose drastic restrictions on social and economic life to prevent the collapse of healthcare systems and death. As of March 2020, the infection gained a new dark primacy as it was declared a pandemic by the World Health Organization, causing the infection of millions of people and hundreds of thousands of deaths worldwide.1Mahase E. Covid-19: WHO declares pandemic because of “alarming levels” of spread, severity, and inaction.BMJ. 2020; 368: m1036Crossref PubMed Scopus (415) Google Scholar The second surge of COVID-19 is affecting different worldwide countries, mainly in Europe and the United States. Imposed restrictions to prevent the spread of COVID-19 infection have resulted in delays in the perioperative care of patients requiring cardiovascular procedures, and healthcare units providing high levels of inpatient care (such as intensive care units [ICUs]) have been stretched beyond capacity in many places throughout the world. Because the virus is believed to disseminate through aerosolized droplets diffused in the environment by coughing, sneezing, or talking, many healthcare workers have become infected, especially during maneuvers leading to aerosol generation.2Lancet The COVID-19: Protecting health-care workers.Lancet. 2020; 395: 922Abstract Full Text Full Text PDF Scopus (797) Google Scholar,3Zhou F Yu T Du R et al.Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study.Lancet. 2020; 395: 1054-1062Abstract Full Text Full Text PDF PubMed Scopus (17670) Google Scholar There are several published consensus statements4Zheng H Hébert HL Chatziperi A et al.Perioperative management of patients with suspected or confirmed COVID-19: Review and recommendations for perioperative management from a retrospective cohort study.Br J Anaesth. 2020; 125: 895-911Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar, 5Zeng H Li G Weng J et al.The strategies of perioperative management in orthopedic department during the pandemic of COVID-19.J Orthop Surg Res. 2020; 15: 474Crossref PubMed Scopus (10) Google Scholar, 6Solanki SL Thota RS Garg R et al.Society of Onco-Anesthesia and Perioperative Care (SOAPC) advisory regarding perioperative management of onco-surgeries during COVID-19 pandemic.Indian J Anaesth. 2020; 64: S97-102PubMed Google Scholar and joint recommendations on the perioperative management of COVID-19 patients during different varieties of surgery.7Shaylor R Verenkin V Matot I. Anesthesia for patients undergoing anesthesia for elective thoracic surgery during the COVID-19 pandemic: A consensus statement from the Israeli Society of Anesthesiologists.J Cardiothorac Vasc Anesth. 2020; 34: 3211-3217Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar,8He Y Wei J Bian J et al.Chinese Society of Anesthesiology expert consensus on anesthetic management of cardiac surgical patients with suspected or confirmed coronavirus disease 2019.J Cardiothorac Vasc Anesth. 2020; 34: 1397-1401Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar EACTA and SCA believe that it was important to develop this joint consensus for the perioperative management of patients undergoing cardiac surgery and minimally invasive cardiac interventions during the COVID-19 pandemic, based on the best evidence available until now. First, this consensus could serve as a guide to cardiac anesthesiologists in light of continuing cardiovascular care delivery services during the evolving second and, perhaps, subsequent waves of COVID-19. Second, this document provided a foundation for future task forces to develop a more comprehensive consensus considering new evidence uncovered during the COVID-19 pandemic [click here]. The principal methodologies to produce these recommendations included expert opinions through broad discussions within EACTA and SCA, reevaluating the clinical experience of routine cardiac surgery in similar cases during the Middle East Respiratory Syndrome (MERS- CoV) outbreak and the current pandemic with suspected COVID-19 patients, and reviewing the literature and public institutional and academic sources. Because the COVID-19 situation is very fluid, the authors aimed to avoid this document being outdated in a short period by providing web links to the public sources so that the information herein provided could remain “live” for the anesthesiology community as long as the sources were updated. A complete list of the web links is provided in Supplemental Table 1. The authors performed a literature review for direct and indirect evidence on the management of COVID-19, SARS, MERS-CoV, and H1N1 patients. Major databases—MEDLINE, Embase, and Google Scholar—were explored to identify recent consensus recommendations, guidelines, relevant systematic reviews, randomized controlled trials, observational studies, and case series. These electronic searches were performed looking for studies published in English from inception to February 6, 2021. The authors used recently published articles to implement airway management recommendations and asked the expert panel to identify any new relevant studies. Publicly accessible sources relevant to the COVID-19 pandemic, such as WHO, universities, and scientific societies websites, were linked and displayed as a [click here] tag throughout the document. The authors realize that there are important variations in the healthcare system structure between European and US centers. Thus, the authors present an agreement between both the European and US practice in managing patients during the COVID-19 pandemic, and these recommendations were considered best practices as of the completion of this manuscript's writing on February 6, 2021. The group considered a broad spectrum of issues regarding cardiac anesthesia in patients who are suspected or diagnosed to have COVID-19 infection and decided to focus on overall approaches to general and specific aspects (Table 1) of preparation for cardiac anesthesia, airway management, perioperative ventilation, coagulation, and hemodynamic control and postoperative intensive care.Table 1Areas Covered by EACTA/SCA RecommendationsHospital and Pathway PlanningProtection of healthcare providersProtection of the patientTranscatheter approachesPostoperative managementAbbreviation: EACTA/SCA, European Association of Cardiothoracic Anaesthesiology/Society of Cardiovascular Anesthesiologists. Open table in a new tab Abbreviation: EACTA/SCA, European Association of Cardiothoracic Anaesthesiology/Society of Cardiovascular Anesthesiologists. To produce appropriate recommendations, the authors combined the evidence from the literature and expert opinions. The recommendations considered safety concerns for patients and healthcare providers, the balance between established procedures, and the feasibility during the present outbreak. As the goal was to make this preliminary consensus rapidly available to all cardiac surgical teams, the authors acknowledge the adopted methodology's limitations. Disclaimer: The information set forth herein is not intended to replace the considered judgment of a licensed professional with respect to patients, procedures, or practices. The information found in this document may not be appropriate for all patients, and neither the EACTA, the SCA, nor the individual contributors make any warranty, guarantee, or other representation, express or implied, with respect to their fitness for any particular purpose. All statements that are not specifically referenced are based on expert opinion. The hospital organization should provide separate perioperative pathways for non–COVID-19 and COVID-19–positive patients.9Donatelli F Miceli A Glauber M et al.Adult cardiovascular surgery and the coronavirus disease 2019 (COVID-19) pandemic: The Italian experience.Interact Cardiovasc Thorac Surg. 2020; 31: 755-762Crossref PubMed Scopus (8) Google Scholar These pathways apply also to patients transferred from other institutions.•Every patient should be screened clinically10Patel V Jimenez E Cornwell L et al.Cardiac surgery during the coronavirus disease 2019 pandemic: Perioperative considerations and triage recommendations.J Am Heart Assoc. 2020; 9e017042Crossref PubMed Scopus (55) Google Scholar and virologically for SARS-CoV-2 infection. The current practice is to collect a specimen from the pharyngeal or nasal mucosa with a swab to confirm the virus's presence with polymerase chain reaction (PCR) quantification to reveal the viral genome. [click here]. Testing should be performed as close to surgery as possible (preferably fewer than 48 hours) to decrease the risk that a patient becomes positive while waiting for the surgical procedure.11Engelman DT Lother S George I et al.Adult cardiac surgery and the COVID-19 pandemic: Aggressive infection mitigation strategies are necessary in the operating room and surgical recovery.J Thorac Cardiovasc Surg. 2020; 160: 447-451Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar•When dealing with positive-tested COVID-19 patients, hospital planning and organization should consider if surgery is emergent or elective [click here].•The authors recommend that in cardiac patients with clinical symptoms suggestive of infection with SARS-CoV-2 (eg, cough, fever) and a negative PCR test result, a computerized chest tomography (CT) is performed.12Shao JM Ayuso SA Deerenberg EB et al.A systematic review of CT chest in COVID-19 diagnosis and its potential application in a surgical setting.Colorectal Dis. 2020; 22: 993-1001Crossref PubMed Scopus (22) Google Scholar•Suppose surgery is urgent and necessary in a patient with suspected or confirmed infection found before proceeding to the operating room. In that case, providers should ensure that appropriate perioperative care units are notified and plans established to care safely for patients with known or suspected COVID.9Donatelli F Miceli A Glauber M et al.Adult cardiovascular surgery and the coronavirus disease 2019 (COVID-19) pandemic: The Italian experience.Interact Cardiovasc Thorac Surg. 2020; 31: 755-762Crossref PubMed Scopus (8) Google Scholar•Symptomatic patients with urgent or emergent indications for cardiac surgery and CT signs suspected for COVID-19 should be considered COVID-19-positive even in the presence of a negative PCR test result (Fig 1). [click here] In patients undergoing surgery after contracting coronavirus, the Centers for Disease Control and Prevention (CDC) advises that retesting patients is no longer a recommended approach, but a clinical evaluation based on time passed since symptom onset, last fever, and improvement of symptoms should be applied [click here].Fig 2Systematic approach for tracheal intubation. Abbreviations: BB, bronchial blocker; DLT, double-lumen endobronchial tube; ETT, endotracheal tube; FNAC, front neck access; OLV, one lung ventilation; RSI, rapid-sequence induction.View Large Image Figure ViewerDownload Hi-res image Download (PPT) •After a patient is transferred, the breathing circuit should be discarded.•The soda-lime canister and airway breathing system (ABS)/airway generation system (AGS) of the ventilator should be decontaminated according to the manufacturers’ recommendations.•All consumables should be discarded.•All reusable materials should be sent for decontamination according to the manufacturers’ recommendations.•A waiting period of 20 minutes is necessary to disinfect the operating room, all uncovered surfaces including the ABG, ACT, thrombelastography machines, TEE and CPB machines, and OR table using 3% - 5% chlorine solution, or plastic covers should be exchanged. •Ideally, a dedicated COVID-19 operating room with negative pressure and >12 air cycles/hour should be used for cardiac surgery.•In rooms with positive pressure, the pressure should be set at the lowest level assuring adequate air treatment. The doors should be kept closed so that the high exchange rate of air in operating rooms limits aerosols’ dispersion outside the room, despite the airflow directed from inward to outward.•During surgery, the operating room temperature level should be reduced to 18°-to-20°,13He H Zhao S Han L et al.Anesthetic management of patients undergoing aortic dissection repair with suspected severe acute respiratory syndrome COVID-19 Infection.J Cardiothorac Vasc Anesth. 2020; 34: 1402-1405Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar and humidity is kept between 40% and 60%.14Quraishi SA Berra L Nozari A. Indoor temperature and relative humidity in hospitals: Workplace considerations during the novel coronavirus pandemic.Occup Environ Med. 2020; 77: 508Crossref PubMed Scopus (12) Google Scholar•A closed system for tracheal suction should be used.•Transesophageal echocardiography and anesthesia machines, computers, ABG, ACT, bedside coagulation POC instruments, etc, could be covered with disposable transparent plastic sheets.•The breathing circuit should be checked as a standard practice. Antiviral filters, such as the high-efficiency particulate air (HEPA) or heat and moisture exchanger (HME) filters, should be attached between the face mask/tracheal tube and the Y-shaped connector and at the expiratory outlet of the breathing circuit. The CO2 sample line should remain near the Y-connector proximal to the ventilator to avoid contamination. Inside the room, preferably there might be three staff members, including the most experienced cardiac anesthesiologist to intubate the patient's trachea; a second doctor should be present for unanticipated difficulty, and a circulating nurse or anesthesia assistant/technician should help to administer drugs and monitor the patient.•There must be a “runner” available directly outside the room in case of need for handling any equipment or medicines.•Surgeons, perfusionists, and scrub nurses should wait outside the room until the airway has been secured, ventilation started, and the TEE and esophageal temperature probes have been inserted•There should be a dedicated area outside the operating room in which the operators can safely doff the personal protective equipment (PPE), and an observer has to be present to monitor the process.•The room turnover should be minimized (ie, the same anesthesia personnel should remain in the operating room for the entirety of the case, if possible).•Due to a higher risk for the infection to become fatal, practitioners with significant vulnerability, including those aged >60 years, immunosuppressed, pregnant, or having multiple comorbidities, as described according to the WHO criteria, [click here] should have personal discussions within their work units, ultimately with decisions whether being included in the team operating on suspected or diagnosed COVID-19 patients made by them and their respective institutions.•Strengthening effective communications should be agreed on in advance, as the PPE renders information exchange among practitioners very difficult.•In suspected or diagnosed patients, during aerosol-generating procedures (AGP); namely intubation, noninvasive ventilation (NIV) or continuous positive airway pressure (CPAP), bronchoscopy, and TEE, it is suggested to wear the following PPE, including: [click here]○Hair cover/hood○Well-fitted filtering mask (FFp3/N95/FFp2) or powered air-purifying respirator (PAPR) [click here]○Goggles and/or face shield○Long-sleeve, fluid-resistant gown or protective suit as directed by the local regulations and availability○Double gloves○Overshoes•Respecting the sequence for donning and especially doffing is crucial to avoid contamination. An example is shown in Table 2. This process can be challenging, especially for inexperienced care providers; the authors recommend hospital institutions to organize and run frequent donning/doffing courses or simulations for personnel directly involved in the care of COVID-19 patients. Moreover, donning and doffing should be assisted by cognitive aids.Table 2Donning and Doffing Sequences of PPEDonning PPEDoffing PPEHand hygieneRemove shoe coversInner glovesRemove gownHand hygieneRemove outer gloveHair covers /hoodHand hygieneShoe coversRemove eye protectionGownRemove maskMask fit checkRemove hair covers/hoodEye protection: fit check againRemove inner gloveHand hygiene + outer gloveHand hygieneNOTE. Modified from https://www.cdc.gov/hai/pdfs/ppe/ppe-sequence.pdf.Abbreviation: PPE, personal protective equipment. Open table in a new tab •It is recommended that experienced personnel supervise donning and doffing.•Airway management should be performed by the most experienced staff available [click here].•The staff not immediately involved in airway management should not enter the operating room until after the airway has been secured.•After securing the airway, the regular contact and droplet precautions (longsleeves, fluid-resistant gown, gloves, N95 or surgical mask in case of shortages of N95, and eye protection using goggles or face shield) around suspected or COVID-19-positive patients should be worn by both anesthesiologists and surgeons during the entire surgical procedure.•All staff including surgeons, perfusionists, and nurses, must don PPE for all suspected or COVID-19–positive patients including masks (N95, FFP2), eye protection, double nonsterile gloves, gowns, and hair and shoe covers15Tan L Kovoor JG Williamson P et al.Personal protective equipment and evidence-based advice for surgical departments during COVID-19.ANZ J Surg. 2020; 90: 1566-1572Crossref PubMed Scopus (22) Google Scholar or as per the regularly updated WHO recommendations [click here]. These recommendations are extended to interventions done under sedation without securing the airway NOTE. Modified from https://www.cdc.gov/hai/pdfs/ppe/ppe-sequence.pdf. Abbreviation: PPE, personal protective equipment. •Operating on COVID-19 patients is likely to be a long-lasting procedure and emotionally demanding. Psychological counseling should be available virtually, if possible16Muller AE Hafstad EV Himmels JPW et al.The mental health impact of the covid-19 pandemic on healthcare workers, and interventions to help them: A rapid systematic review.Psychiatry Res. 2020; 293113441Crossref PubMed Scopus (458) Google Scholar [click here].•Staff should consider their hydration and use of the toilet before starting the long cases.•Staff should be given appropriate break time before the next cases.•Urgent further cases may be best performed by a new team, if possible. •Patients with COVID-19 infection demonstrated a high number of arterial and venous thromboembolic events in 7.7% of hospitalized patients (cumulative rate of 21.0%) diagnosed within 24 hours of admission.17Lodigiani C Iapichino G Carenzo L et al.Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy.Thromb Res. 2020; 191: 9-14Abstract Full Text Full Text PDF PubMed Scopus (1421) Google Scholar Many institutions apply thrombosis prophylaxis with high prophylactic doses, eg, enoxaparin two times 40 mg/day under anti-Xa activity monitoring.18Klok FA Kruip MJHA van der Meer NJM et al.Incidence of thrombotic complications in critically ill ICU patients with COVID-19.Thromb Res. 2020; 191: 145-147Abstract Full Text Full Text PDF PubMed Scopus (3121) Google Scholar Currently, there is no consensus on the ideal anticoagulant or appropriate dose [click here].•Strict application of pharmacologic thrombosis prophylaxis is recommended for all suspected or diagnosed COVID-19 patients admitted to the ICU either preoperatively or after surgery in the absence of bleeding.•All doses of anticoagulants may need adjustments based on renal function, mainly in patients who experienced acute kidney injury during noninvasive ventilation during the preoperative period. Caution should be exercised when the platelets fall below than 30,000/μmL for prophylaxis or below 50,000/μmL for therapeutic heparin.•Bleeding events are observed in 7.8% of patients with COVID-19 infection, which are sensitive to the use of escalated doses of anticoagulants.19Jiménez D García-Sanchez A Rali P et al.Incidence of VTE and bleeding among hospitalized patients with coronavirus disease 2019: A systematic review and meta-analysis [e-pub ahead of print].Chest. 2021; (Accessed February 28)https://doi.org/10.1016/j.chest.2020.11.005Abstract Full Text Full Text PDF Scopus (292) Google Scholar Point-of-care monitoring of coagulation, including thromboelastography,20Guo Z Sun L Li B et al.Anticoagulation management in severe coronavirus disease 2019 patients on extracorporeal membrane oxygenation.J Cardiothorac Vasc Anesth. 2021; 35: 389-397Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar can be considered to manage hemostasis in the perioperative period. •Preparing a dedicated cart is recommended for tracheal intubation of the suspected or confirmed COVID-19-infected patient. Disposable devices (eg, single-use blades, single-use video laryngoscopes, laryngoscopes, video laryngoscopes with remote screens, front-of-neck airway/cricothyroidotomy access set, and disposable flexible bronchoscopes) should be preferred. Anesthesia induction and tracheal intubation in the COVID-19 patients undergoing cardiac surgery are high-risk procedures for the anesthetic team because of the risks of aerosol transmission of the infection during placement of the endotracheal tube.•The procedure should be safe for the operators and the patient and fast enough to minimize aerosol diffusion.•Before tracheal intubation, a complete evaluation of the airways and optimization of the patient's position, oxygenation, and hemodynamic status should be performed. •NIV or CPAP, reported being beneficial before intubation, especially in obese patients,21Gedeon M Gomes S Roy K et al.Use of noninvasive positive pressure ventilation in patients with severe obesity undergoing esophagogastroduodenoscopy: A randomized controlled trial.Surg Obes Relat Dis. 2019; 15: 1589-1594Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar can be considered to preoxygenate the patient only if the induction room is put in a negative-pressure environment.22Fogarty M Kuck K Orr J et al.A comparison of controlled ventilation with a noninvasive ventilator versus traditional mask ventilation.J Clin Monit Comput. 2020; 34: 771-777Crossref PubMed Scopus (4) Google Scholar The Italian Society of Anesthesiology and Intensive Care (SIAARTI) suggests using a helmet as a less aerosol-generating interface, if available.23Sorbello M El-Boghdadly K Di Giacinto I et al.The Italian coronavirus disease 2019 outbreak: Recommendations from clinical practice.Anaesthesia. 2020; 75: 724-732Crossref PubMed Scopus (252) Google Scholar•Face mask ventilation should be avoided unless needed. If necessary, a two-person, low-flow/low-pressure technique should be used. A two-person, two-handed mask ventilation should be performed to improve the seal.•Another measure of adequate pre-oxygenation is to assess the fraction of exhaled oxygen (measured from the patient's exhaled breath) that should exceed 80%. •Intubation preferably could be performed using a video laryngoscope with a remote screen to maximize the distance from the anesthesiologist and the patient's mouth and avoid aerosol transmission.23Sorbello M El-Boghdadly K Di Giacinto I et al.The Italian coronavirus disease 2019 outbreak: Recommendations from clinical practice.Anaesthesia. 2020; 75: 724-732Crossref PubMed Scopus (252) Google Scholar•The unanticipated difficult airway should be treated similarly to ordinary patients as per institution practice or internal guidelines. The authors recommend the suggested approach by SIAARTI and UK joint societies23Sorbello M El-Boghdadly K Di Giacinto I et al.The Italian coronavirus disease 2019 outbreak: Recommendations from clinical practice.Anaesthesia. 2020; 75: 724-732Crossref PubMed Scopus (252) Google Scholar,24Cook TM El-Boghdadly K McGuire B et al.Consensus guidelines for managing the airway in patients with COVID-19.Anaesthesia. 2020; 75: 785-799Crossref PubMed Scopus (633) Google Scholar as follows:○The first laryngoscopy attempt should be performed with an endotracheal tube preloaded on a stylet.○If it fails, a reoxygenation period can be needed, which has to be applied with a low-tidal- volume/pressure to avoid leakage of contaminated air.○If a third attempt is necessary, an early switch to a second-generation intubating supraglottic airway device should be considered.25Chae YJ Lee H Jun B et al.Conversion of I-gel to definitive airway in a cervical immobilized manikin: Aintree intubation catheter vs long endotracheal tube.BMC Anesthesiology. 2020; 20: 152Crossref PubMed Scopus (1) Google Scholar Intubation through this device should be performed wit" @default.
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• W3132356972 title "EACTA/SCA Recommendations for the Cardiac Anesthesia Management of Patients With Suspected or Confirmed COVID-19 Infection: An Expert Consensus From the European Association of Cardiothoracic Anesthesiology and Society of Cardiovascular Anesthesiologists With Endorsement From the Chinese Society of Cardiothoracic and Vascular Anesthesiology" @default.
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