Management Protocol for Emergency Aneurysm Craniotomy Clipping in Non-Major COVID-19 Epidemic Areas in Beijing, China

Abstract

Background: An epidemic of COVID-19 outbroke in Wuhan, China since December 2019. The ordinary medical service were hindered, however, the emergency cases including aneurysmal subarachnoid hemorrhage (aSAH) still required timely intervention and provoked challenges to the management protocol. In this study, we summarized our experience in the emergency management of aSAH (Beijing Tiantan Protocol, BTP) in Beijing, China.Methods: Demographic, clinical and imaging data of consecutive emergency aSAH patients who underwent craniotomy clipping during the COVID-19 epidemic season were reviewed and compared with the retrospective period last year. Subgroup analysis was further performed to assess the outcomes of different screening results and different detail protocols. Neurological outcome was assessed with the modified Rankin Scale (mRS).Results: A total of 127 aSAH referred to our emergency department and 42 (33.1%) underwent craniotomy clipping between January 20, 2020 and March 25, 2020. Compared with the retrospective period last year, the incidence of preoperative hospitalized adverse events and postoperative outcomes were similar (0.1, 95% CI 1.0 to 0.8, P = 0.779). In the subgroup analysis, 8 (19.0%) were initially screened as preliminary undetermined COVID-19 and 2 of them underwent craniotomy clipping in the negative pressure operating room (OR), the prognosis of patients with varied COVID-19 screening results was similar (F(2, 39) = 0.393, P = 0.678). Since February 28, 12 cases (28.6%) received COVID-19 nucleic acid testing (NAT) upon admission and all showed negative, the false negative rate was 0.0%. The preoperative hospitalized adverse events and postoperative prognosis were still similar between patients with and without COVID-19 NAT (-0.3, 95% CI -1.4 to 0.9, P = 0.653).Conclusions: Our emergency surgery management protocol (BTP) is reliable for scheduling emergency aneurysm craniotomy clipping in non-major epidemic areas.