Minimizing SARS-CoV-2 exposure when performing surgical interventions during the COVID-19 pandemic. (20th May 2020)

• Record Type: Journal Article
• Authors: Pandey, Aditya S; Ringer, Andrew J; Rai, Ansaar T; Kan, Peter; Jabbour, Pascal; Siddiqui, Adnan H; Levy, Elad I; Snyder, Kenneth V; Riina, Howard; Tanweer, Omar; Levitt, Michael R; Kim, Louis J; Veznedaroglu, Erol; Binning, Mandy J; Arthur, Adam S; Mocco, J; Schirmer, Clemens; Thompson, Byron Gregory; Langer, David
• Other Names: author non-byline.; Bain Mark author non-byline.; Bendock Bernard author non-byline.; Boulos Alan S. author non-byline.; Crowley Webster author non-byline.; Fessler Richard author non-byline.; Grande Andrew author non-byline.; Guterman Lee author non-byline.; Hanel Ricardo author non-byline.; Daniel Hoit; L author non-byline.; Hopkins Nelson author non-byline.; Howington Jay author non-byline.; James Robert author non-byline.; Jankowitz Brian author non-byline.; Khalessi Alex A author non-byline.; Lanzino Giuseppe author non-byline.; Lopes Demetrius author non-byline.; Mack William author non-byline.; Mericle Robert author non-byline.; Ogilvy Chris author non-byline.; Replogle Robert author non-byline.; Rodriguez Rafael author non-byline.; Saugaveau Eric author non-byline.; Spiotta Alex author non-byline.; Sultan Ali author non-byline.; Tawk Rabih author non-byline.; Thomas Ajith author non-byline.; Turner Raymond author non-byline.; Welch Babu author non-byline.; White Jonathan author non-byline.
• Is Part Of: Journal of neurointerventional surgery. Volume 12:Number 7(2020)
• Page Start: 643
• Page End: 647
• Publication Date: 2020-05-20
• Subjects: infection -- standards -- aneurysm -- arteriovenous malformation -- hemorrhage; Nervous system -- Surgery -- Periodicals; Cerebrovascular disease -- Surgery -- Periodicals; 617.48
• DOI: 10.1136/neurintsurg-2020-016161
• Languages: English
• ISSNs: 1759-8478

Abstract

Abstract : Background: Infection from the SARS-CoV-2 virus has led to the COVID-19 pandemic. Given the large number of patients affected, healthcare personnel and facility resources are stretched to the limit; however, the need for urgent and emergent neurosurgical care continues. This article describes best practices when performing neurosurgical procedures on patients with COVID-19 based on multi-institutional experiences. Methods: We assembled neurosurgical practitioners from 13 different health systems from across the USA, including those in hot spots, to describe their practices in managing neurosurgical emergencies within the COVID-19 environment. Results: Patients presenting with neurosurgical emergencies should be considered as persons under investigation (PUI) and thus maximal personal protective equipment (PPE) should be donned during interaction and transfer. Intubations and extubations should be done with only anesthesia staff donning maximal PPE in a negative pressure environment. Operating room (OR) staff should enter the room once the air has been cleared of particulate matter. Certain OR suites should be designated as covid ORs, thus allowing for all neurosurgical cases on covid/PUI patients to be performed in these rooms, which will require a terminal clean post procedure. Each COVID OR suite should be attached to an anteroom which is a negative pressure room with a HEPA filter, thus allowing for donning and doffing of PPE without risking contamination of clean areas. Conclusion: Based on a multi-institutional collaborative effort, we describe best practices when providing neurosurgical treatment for patients with COVID-19 in order to optimize clinical care and minimize the exposure of patients and staff.