Evidence from the Cochrane Anaesthesia Review Group for anaesthesia and critical care during the COVID-19 pandemic

The COVID-19 outbreak has posed many challenges for anaesthesia and critical care. Apart from the clinical burden, one of the biggest problems is getting hold of accurate information. There are many infuriating social media experiences of information from untrusted, and occasionally unnamed, sources being shared widely. Even though these might not be enough to persuade us clinicians to change our current practice, they can create anxiety about how we manage our patients. To combat this, Cochrane has put together some resources that bring together the best evidence-based practice.

The significant rise in the number of patients requiring critical care admission has caused an increased demand for medications used in both anaesthesia and critical care. This issue was flagged up by the RCoA, the Association of Anaesthetists and the Chief Pharmaceutical Officer at NHS England, who have produced guidance on making the most of available supplies [1]. Local and regional anaesthetic techniques are recommended, when practical and safe [1]. Regional anaesthesia is also the preferred approach for the peri-operative management of people with fragility fractures during the COVID-19 pandemic; with its known advantages in this particular patient group it will help to reduce staff workload, and thus in turn have a positive impact on the theatre department [2].

The safe and evidence-based practice of regional anaesthesia is increasingly vital to maintain reliable anaesthetic services and will help limit the exposure of healthcare workers to COVID-19. The Cochrane Anaesthesia Review Group have collated their available evidence for regional anaesthesia in a new Special Collection [3]. Click on the link below to see the collection.

Cochrane has also produced a COVID-19 Special Collection with the latest evidence to guide the management of people hospitalised with severe acute respiratory infections [4].

We encourage readers to read, use, and share the reviews as widely as possible. Cochrane systematic reviews are usually free to access in the UK, but have been made available free-of-charge for the whole world during the pandemic.

Muataz Amare
Mike McEvoy
Cochrane Anaesthesia dissemination fellows
ST7 Specialist Registrars in Anaesthesia / Intensive Care
Wythenshawe Hospital, Manchester

Professor Andrew Smith
Co-ordinating Editor for Cochrane Anaesthesia
Consultant Anaesthetist
Royal Lancaster Infirmary and Lancaster University, Lancaster

Twitter: @dramare85, @m_i_mcevoy

References

1. Royal College of Anaesthetists / Association of Anaesthetists. Guidance on potential changes to anaesthetic drug usage and administration during pandemic emergency pressures, 2 April 2020. https://icmanaesthesiacovid-19.org/drug-demand-supply-anaesthetic-drug-usage-and-administration (accessed 6/5/2020).

2. NHS England. Clinical guide for the perioperative care of people with fragility fractures during the coronavirus pandemic, 25 March 2020. https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/C0086_Specialty-guide-_Fragility-Fractures-and-Coronavirus-v1-26-March.pdf (accessed 6/5/2020).

3. Cochrane Library. Cochrane Special Collections: Coronavirus (COVID-19): regional anaesthesia to reduce drug use in anaesthesia and avoid aerosol generation, 29 April 2020. https://www.cochranelibrary.com/collections/doi/SC000041/full (accessed 6/5/2020).

4. Cochrane. Special Collection: Coronavirus (COVID-19): evidence relevant to critical care, 2020. https://www.cochrane.org/news/special-collection-coronavirus-covid-19-evidence-relevant-critical-care (accessed 6/5/2020).