Menu Menu
Communique

Weekly Communique # 19

20 August, 2020

WEEK IN REVIEW

New recommendations for Child and Adolescent Care
It has been a busy week for the Child and Adolescent Care Panel with two new consensus recommendations for:

  • Respiratory management of the deteriorating child
  • Extracorporeal membrane oxygenation for children

A new information box and an updated table of PIMS-TS definitions has also been added for ease of reading (further details below).

Update from the Care of Older People and Palliative Care Panel
The Care of Older People and Palliative Care Panel have reviewed each of the Taskforce’s existing recommendations to ensure specific considerations for the clinical care of COVID-19 in these patient populations have been discussed and captured, including for disease-modifying treatments (see the ‘key info’ section within each of the recommendations in MAGICapp).

The panel is currently developing new flowcharts for the management of people with COVID-19 who are older and living with frailty or cognitive impairment, and the management of people with COVID-19 receiving palliative care.

Participation in NHMRC/AHEC workshops on ethics framework for COVID-19 
This week the NHMRC’s Australian Health Ethics Committee (AHEC) invited health consumers to participate in the next phase of the development of national framework for ethical decision-making when establishing health policies and practices to address pandemics such as COVID-19.

Our community partner, the Consumers Health Forum of Australia submitted Consumer Position Statement: Ethical Issues Arising from the COVID-19 PandemicOne of the key ethical issues particularly relevant to the ongoing work off the Taskforce that was highlighted by CHF is that ‘Inaccurate information and misleading statements about treatments for COVID-19 should be widely corrected and rebutted to protect consumers.’

Several of our Taskforce Consumer Panel members attend workshops to develop case studies in public health ethics, clinical ethics and research ethics to illustrate the draft framework. The NHMRC will use these case studies in a broader online consultation to inform the next phase of framework development.

Thank you for your insights
The Taskforce is grateful to all clinicians who completed our recent survey to help improve and shape our clinical guideline recommendations and flowcharts.  We look forward to sharing the results shortly.

 


QUICK STATISTICS

COVID-19 research pipeline:

  • 16,799 studies published or registered in Cochrane COVID-19 Study Register, 853 added this week
  • 1,574 randomised controlled trials registered (data from Covid-nma site), 20 added this week
  • 1,969 systematic reviews registered in PROSPERO, 57 added this week
  • 40 randomised controlled trials published (data from Covid-nma site), added this week

 

NEW OR UPDATED RECOMMENDATIONS

Version 18.0

Respiratory management of the deteriorating child
New consensus recommendation

Consider endotracheal intubation and mechanical ventilation in children and adolescents with COVID-19 who are deteriorating despite optimised, non-invasive respiratory support.

Extracorporeal membrane oxygenation for children
New consensus recommendation

Consider early referral to an ECMO centre for venovenous or venoarterial ECMO in mechanically ventilated children and adolescents with COVID-19 with refractory respiratory or cardiovascular failure despite optimising other critical care interventions.

Therapies for pre-existing conditions in patients with COVID-19
A new section has been added to house the existing recommendations on therapies for pre-existing conditions in patients with COVID-19.

Delayed umbilical cord clamping
New consensus recommendation

Delayed umbilical cord clamping is supported as part of standard care, independent of the presence of COVID-19.

Child and adolescent care

  • New information box has been added to point readers to other recommendations throughout the guideline that also relate to children and adolescents.
  • The table of Paediatric Multisystem Inflammatory Syndrome (PIMS-TS) definitions has been updated for ease of reading.

The Taskforce is continually monitoring research to update recommendations weekly as new evidence accumulates.

 


CLINICAL FLOWCHARTS

Five clinical flowcharts have been developed by the Taskforce to cover:

  • Assessment for suspected COVID-19
  • Management of adults with mild COVID-19
  • Management of adults with moderate to severe COVID-19
  • Management of adults with severe to critical COVID-19
  • Respiratory support for adults with severe to critical COVID-19

There are no changes to flowcharts this week.

 


 EVIDENCE UNDER REVIEW

We are currently reviewing evidence to develop recommendations and flowcharts to guide practice in areas including:

  • Disease modifying treatments NEW
  • Antenatal corticosteroids NEW
  • ACE-I/ARBs in pregnant women NEW
  • Anticoagulants for pregnant women
  • Respiratory support for children and adolescents
  • Paediatric Multisystem Inflammatory Syndrome (PIMS-TS)
  • Overarching principles of care for older people and for people who are receiving palliative care
  • Cardiac arrest
  • Prone positioning
  • Non-invasive ventilation

 


NEWS & EVENTS

Cochrane
A Cochrane Rapid Review on the effectiveness of digital contact tracing technologies was published in the Cochrane Library this week. The authors investigated whether digital contact tracing, compared to manual contact tracing, is effective in reducing the spread of infection, as measured by secondary infections, identifying close contacts, tracing a complete set of contacts, and identifying the context of infection. Read here

 


NEW TOPICS & QUESTIONS

It is a core mission of the Taskforce to engage with frontline clinicians to rapidly identify and address priority clinical questions.

Each week we collect suggestions for new clinical questions or topics for consideration by the Taskforce. A document that lists all of the suggested questions, topics and new patient groups that we have received to date is available here.

Please encourage your clinical colleagues to provide their insights via the website.

 


 

Topics