Anesthesia departments’ readiness for the COVID-19 pandemic; a nationwide cross-sectional study in Israel

Abstract

Background The Coronavirus infectious disease 2019 (COVID-19) brings anesthesiologists and intensive care physicians to the mainstay of clinical workload and healthcare managements’ focus. There are approximately 900 anesthesiologists in Israel, working in non-private hospitals. This nationwide cross-sectional study evaluated the readiness and involvement of anesthesia departments in Israel in management of the COVID-19 pandemic. The impact on anesthesiologists’ health, workload, and clinical practices were also evaluated. Methods An online questionnaire was distributed to all of anesthesia department chairs in Israel on April 14th. Each response was identifiable on the hospital level only. Informed consent was waived since no patient data were collected. Results Response rate was 100%. A decrease of at least 40% in operating-room activity was reported by two-thirds of the departments. Anesthesiologists are leading the treatment of COVID-19 patients in 19/28 (68%) Israeli hospitals. Israel Society of Anesthesiologists’ recommendations regarding intubation of COVID-19 patients were strictly followed (intubations performed by the most experienced available physician, by rapid-sequence induction utilizing video-laryngoscopy, while minimizing the number of people in the room - about 90% compliance for each). Anesthesiologists in most departments use standard personal protective equipment when caring for COVID-19 patients, including N95 masks, face shields, and water-proof gowns. Only one anesthesiologist across Israel was diagnosed with COVID-19 (unknown source of transmission). All department chairs reported emerging opportunities that advance the anesthesia profession: implementation of new technologies and improvement in caregivers’ clinical capabilities (68% each), purchase of new equipment (96%), and increase in research activity (36%). Conclusions This nationwide cross-sectional study had a complete response rate and therefore well-represents the anesthesia practice in Israel. We found that Israeli anesthesia departments are generally highly involved in the health system efforts to cope with the COVID-19 pandemic. Anesthesia and airway management are performed in a remarkably comparable manner and with proper protection of caregivers. Ambulatory anesthesia activity has dramatically decreased, but many departments find opportunities for improvement even in these challenging times.

Croatian national audit on videolaryngoscopes and alternative intubation devices in the era of COVID-19 pandemic

“…Despite current guidelines that encourage using VL, only 21% of Croatian hospitals use VL always, in routine intubation of COVID-19 patients. Compared to our results, Cohen et al reported that VL was the default device used in intubation of COVID-19 patients in 93% of anesthesia departments in Israel [ 36 ]. Single-center study from the UK found that 79% of all intubations of COVID-19 patients were done with VL [ 37 ].…”

Manejo anestésico de pacientes con covid-19: prevención y control quirúrgico

“…Un informe reciente enfatiza la amenaza inminente de la infección por COVID-19 para complicar el curso de los pacientes sometidos a cirugía. Al mismo tiempo, el riesgo de que los miembros del equipo quirúrgico infecten a los pacientes y al resto del personal es alto (11). La protección respiratoria es obligatoria durante la pandemia de COVID-19, incluso si la evidencia sobre la efectividad del EPP sigue siendo baja.…”

“…La extubación profunda puede ayudar a atenuar la respuesta de las vías respiratorias, pero deja el problema de un paciente anestesiado y una vía respiratoria desprotegida. Las guías de consenso recientes sobre este tema no sugieren el intercambio de vía aérea supraglótica segunda generación como una opción de primera línea en vista de la necesidad de un segundo procedimiento y la probabilidad de dificultad de la vía aérea después de su inserción (11,12).…”

Recommendations for developing clinical care protocols during pandemics: From theory and practice

“…It has been shown that anesthesiologists were at the leading front in the treatment of COVID-19 patients. 2 , 3 Initially, anyone caring for a COVID-19 suspected or confirmed patients were asked to comply with standard, contact, droplet and airborne precautions.…”