International alliance and AGREE-ment of 71 clinical practice guidelines on the management of critical care patients with COVID-19: a living systematic review.

OBJECTIVE: We aimed to systematically identify and critically assess the clinical practice guidelines (CPGs) for the management of critically ill patients with COVID-19 with the AGREE II instrument. STUDY DESIGN AND SETTING: We searched Medline, CINAHL, EMBASE, CNKI, CBM, WanFang, and grey literature from November 2019 - November 2020. We did not apply language restrictions. One reviewer independently screened the retrieved titles and abstracts, and a second reviewer confirmed the decisions. Full texts were assessed independently and in duplicate. Disagreements were resolved by consensus. We included any guideline that provided recommendations on the management of critically ill patients with COVID-19. Data extraction was performed independently and in duplicate by two reviewers. We descriptively summarized CPGs characteristics. We assessed the quality with the AGREE II instrument and we summarized relevant therapeutic interventions. RESULTS: We retrieved 3,907 records and 71 CPGs were included. Means (Standard Deviations) of the scores for the 6 domains of the AGREE II instrument were 65%(SD19.56%), 39%(SD19.64%), 27%(SD19.48%), 70%(SD15.74%), 26%(SD18.49%), 42%(SD34.91) for the scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, editorial independence domains, respectively. Most of the CPGs showed a low overall quality (less than 40%). CONCLUSION: Future CPGs for COVID-19 need to rely, for their development, on standard evidence-based methods and tools.

Caracterización del funcionamiento de los servicios de cirugía cardiovascular en Colombia durante la pandemia de COVID-19 / Performance of cardiovascular surgery services in Colombia during the COVID-19 pandemic

Resumen Introducción: La pandemia actual representa un reto para la atención hospitalaria, los servicios de cirugía cardiovascular han modificado su funcionamiento y están constantemente evaluando el riesgo cardiovascular frente al riesgo de la COVID-19. Objetivo: Caracterizar el funcionamiento de 23 centros cardiovasculares de Colombia, con el fin de generar información que permita optimizar los servicios y evitar muertes de causa cardiovascular prevenibles. Método: Estudio observacional transversal con fuente primaria de información. Muestra por conveniencia de 23 centros cardiovasculares de Colombia. Resultados: Se encontró que el 39.1% de los centros suspendieron la actividad en algún momento entre enero y mayo de 2020 y el 34.8% han tenido una disminución en la actividad del servicio del 76-100%; en los meses de abril y mayo se encontró una reducción de alrededor del 50% con referencia a los primeros 2 meses. De las 2258 intervenciones realizadas, solo el 0.17% fueron en pacientes con COVID-19. El estudio muestra que el 60.1% de los servicios han presentado problemas con la utilización de elementos de protección personal. El 17.4% de los centros realizan reacción en cadena de la polimerasa para el virus de forma sistemática en el prequirúrgico, y el 44% la realiza a pacientes con síntomas respiratorios. Conclusiones: Durante la pandemia se requiere una detección temprana de posibles infectados que vayan a cirugía, adaptar la programación y promocionar un adecuado uso de los equipos de protección personal. Urge aplicar estrategias dirigidas a pacientes que no pueden ser postergados para evitar segundas y terceras víctimas de la pandemia.

Abstract Introduction: The current pandemic represents a challenge at the hospital level, cardiovascular surgery services have modified their operation and are constantly evaluating cardiovascular risk vs. COVID-19 risk. Objective: To characterize the operation of 23 cardiovascular centers in Colombia, in order to obtain information that allows the optimization of services and to avoid preventable deaths from cardiovascular causes. Method: Cross sectional observational study with a primary source of information. A convenience sample of 23 cardiovascular centers in Colombia was used. Results: It was found that 39.1% of the centers suspended activity sometime between January to May 2020 and 34.8% had a decrease in service activity of 76-100%. In the months of April and May the reduction was around 50% compared to the first two months. Of the 2,258 interventions performed, only 0.17% were on positive COVID-19 patients. The study shows that 60.1% of the services have presented problems with the use of personal protection elements. 17.4% of the centers perform PCR to detect the virus in the preoperative routine, 44% perform it in respiratory symptomatic patients. Conclusions: During the pandemic, the need is to detect in early phases all the possible infected patients, that require surgical procedures, adapt the schedules and promote an adequate use of personal protective equipment. It is urgent to apply strategies aimed at patients in which surgical procedures cannot be postponed to avoid second and third victims of the pandemic.