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Communique

Weekly Communique # 28

22 October, 2020

WEEK IN REVIEW

SAVING LIVES SAFELY: New CPR flowcharts published today

The Taskforce, in partnership with the Infection Control Expert Group (ICEG), has published new clinical flowcharts to guide clinicians and trained first aid responders in delivering potentially lifesaving CPR as safely as possible.

Adjunct Clinical Professor Simon Craig, a member of the Cardiac Arrest Working Group assembled to develop the recommendations said the Taskforce recognised a need to provide healthcare providers, healthcare workers and members of the community with clear guidance on resuscitation principles during the COVID-19 pandemic.

“We understand the pandemic has caused much confusion and concern for many clinicians about the safety of normal life-saving procedures both within healthcare settings and out.

“The flowcharts reinforce the importance of first maximising staff safety and then commencing chest compressions as soon as possible.”

Australian Resuscitation Council Chair and working group member Professor Peter Morley said it was also vital that trained first aid responders feel confident to perform ‘compression only’ CPR.

“Lives can be saved by starting basic life support and calling for help early. We know that delays can result in worse outcomes for patients.”

Further resources are available on the website including an explainer and video interviews with Simon and Peter (links below).

On behalf of the Taskforce Steering Committee, our deepest gratitude to everyone involved in the development of these flowcharts. This was a major project of critical importance to both patients and clinicians, and the first joint guidance issued by the Taskforce and ICEG.

New living guideline recommendations

Two new recommendations have been published this covering:

  • Hydroxychloroquine for pre-exposure prophylaxis
  • Corticosteroids (PIMS-T)

Consumer Panel statement on preferences and values regarding hydroxychloroquine as a treatment for COVID-19

The Consumer Panel has reviewed the evidence informing the Taskforce’s recommendation against the use of hydroxychloroquine as a treatment for COVID-19, concluding that:

“The NC19CET Consumer Panel believes that as there is substantial evidence demonstrating well-known harms of hydroxychloroquine, informed patients would not choose this treatment.”

This is consistent with the panel’s initial assessment of preferences and values likely to important to patients, and provides reassurance that the current recommendation against the use of this treatment aligns wth the views of the Consumer Panel.

As currently stated in the guideline, the use of hydroxychloroquine may still be considered in the context of randomised trials with appropriate ethical approval, such as combination therapies that include hydroxychloroquine, or for pre or post-exposure prophylaxis.

New trial results under review

The Taskforce notes the publication of:

  • interim results of WHO SOLIDARITY trial (study drugs Remdesivir, Hydroxychloroquine, Lopinavir (fixed-dose combination with Ritonavir) and Interferon-β1) in medRxiv on 15 October
  • final report of the ACTT-1 trial  (Remdesivir) in the NEJM on 8 October

These studies are currently under review and the relevant recommendations will be updated in a future version of the guideline.

Have you used the Australian guidelines for care of people with COVID-19?

The Taskforce is interested in understanding how our guidance is being used.

We are keen to talk to people who have used guidance developed by the Taskforce, either individually or in their organisations, or who have developed materials adapted from the guidance.

If you have recommendations of good examples of the use of our guidance, or people we should talk to about how our guidance is being used, please contact Dr Tari Turner at [email protected]

 


QUICK STATISTICS

COVID-19 research pipeline

  • 25,817 studies published or registered in Cochrane COVID-19 Study Register, 1,433 added this week
  • 1,977 randomised controlled trials registered (data from Covid-nma site), 72 added this week
  • 2,388 systematic reviews registered in PROSPERO, 44 added this week
  • 93 randomised controlled trials published (data from Covid-nma site), added this week

 


LIVING GUIDELINES

Australian guidelines for the clinical care of people with COVID-19: Version 26.0

NEW RECOMMENDATIONS

  • Hydroxychloroquine for pre-exposure prophylaxis

For healthcare workers with no active or prior COVID-19, do not use hydroxychloroquine for pre-exposure prophylaxis outside of randomised trials with appropriate ethical approval.

  • Corticosteroids (PIMS-TS)

Consider using corticosteroids (irrespective of oxygen status) as a second-line agent or as adjuvant therapy for children and adolescents diagnosed with PIMS-TS.

UPDATES TO EXISTING GUIDANCE

  • Corticosteroids for children or adolescents

The remark under corticosteroids for treatment of COVID-19 in children or adolescents has been updated, alerting the reader to the PIMS-TS section.

  • Hydroxychloroquine

The key information on preferences and values has been updated with a statement from the Consumer Panel, with no changes to the strength or directions of the recommendation.

  • Lopinavir-ritonavir

The evidence base has been updated and the recommendation has been
strengthened from “do not use outside of randomised trials with appropriate ethical approval” to “do not use”.

  • Colchicine

The evidence base has been updated with no change to the the strength or direction of the recommendation.

  • ECMO for adults

The evidence base has been updated and the wording has been updated from being a consensus based recommendation to a conditional recommendation with no change to the direction of the recommendation.

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

 


CLINICAL FLOWCHARTS

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

  • Assessment for suspected COVID-19
  • Management of adults with mild COVID-19 UPDATED
  • Management of adults with moderate to severe COVID-19 UPDATED
  • Management of adults with severe to critical COVID-19 UPDATED
  • Respiratory support for adults with severe to critical COVID-19 UPDATED
  • Management of people with COVID-19 who are older and living with frailty and/or cognitive impairment
  • Management of people with COVID-19 who are receiving palliative care
  • Preparedness for CPR during the COVID-19 pandemic NEW
  • CPR for adults with COVID-19 in healthcare settings NEW
  • Basic life support for adults in the community during the pandemic NEW

Changes to the flowcharts this week include:

  •  Addition of new CPR flowcharts
  •  Updated ECMO recommendation
  •  ‘Do not use’ medications updated to include Lopinavir-ritonavir

 


EVIDENCE UNDER REVIEW

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

  • Bromhexine hydrochloride
  • Enoxaparin (therapeutic vs prophylactic)
  • Care of people recovering from COVID-19/Post-viral syndrome
  • Oestrogen-containing therapies
  • Paediatric Multisystem Inflammatory Syndrome (PIMS-TS)

 


NEWS & EVENTS

Cochrane

Cochrane has a new podcast on a recent review looking at whether plasma from people who have recovered from COVID-19 is an effective treatment for people with COVID-19, and whether this treatment causes any unwanted effects. Lead author Khai Li Chai from Monash University explains the findings on the latest Cochrane Library podcast.

The full list of Cochrane Reviews and related content from the Cochrane Library relating to the COVID-19 pandemic can be found here.

NPS MedicineWise
The latest podcast from NPS MedicineWise looks at why it’s important for healthcare workers to proactively look after their own mental health, when to seek professional help, some simple ways to manage stress, and some of the resources available from The Black Dog Institute including The Essential Network (TEN), an e-health hub for healthcare workers. Listen 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