The WHO is distributing an Interim Guidance document for the “Clinical management of severe acute respiratory infection when Novel coronavirus (nCoV) infection is suspected.” The medical community is closely monitoring the outbreak. The WHO guidance document includes a statement to “consider referral patients with refractory hypoxemia despite lung-protective ventilation. . . in settings with access to expertise in ECLS.”
Where ECLS expertise is available, extracorporeal support should be considered according to the standard management algorithm for ARDS in supporting patients with viral lower respiratory tract infection. However, clearly at this time, there is little worldwide experience with using ECMO to support nCOV-infected patients. ELSO will continue to collect data through our member centers and provide recommendations as additional information becomes available.
Dr. Mark Ogino, ELSO – Extracorporeal Life Support Organization President.
The World Health Organization (WHO) Interim Guidance full text open access.
In this first report published on The Lancet, available data (to date) about the recent cluster of pneumonia cases caused by a novel betacoronavirus in Wuhan, China, with the epidemiological, clinical, laboratory, radiological characteristics of these patients, including treatment (n=2, 5% of all reported cases, 15% of the patients requiring ICU care, supported with ECMO) and clinical outcomes. Open access text
A second study on the same journal includes all confirmed cases of 2019-nCoV in Wuhan Jinyintan Hospital from Jan 1 to Jan 20, 2020. Cases were confirmed by real-time RT-PCR and were analysed for epidemiological, demographic, clinical, and radiological features and laboratory data, with outcomes followed up until Jan 25, 2020; 23% admitted to ICU, 17% developed ARDS, 3% treated with extracorporeal support, 11% worsened in a short period of time and died of multiple organ failure. Open access text
On The Lancet also a study reporting epidemiological, clinical, laboratory, radiological, and microbiological findings of 5 patients in a family cluster who presented with unexplained pneumonia after returning to Shenzhen, Guangdong province, China, after a visit to Wuhan, and an additional family member who did not travel to Wuhan, with findings consistent with person-to-person transmission of this novel coronavirus in hospital
and family settings, and the reports of infected travellers in other geographical regions. Open access text
… and some interesting comments:
About novel coronavirus outbreak of global health concern Open access text
on data sharing and outbreaks: best practice exemplified Open access text
… and emerging understandings of 2019-nCoV. Open access text
Consider reading this report on The New England Journal of Medicine, about 3 adult patients presented with severe pneumonia admitted to a hospital in Wuhan at the end of December, with details on detection, isolation and characterization of the Novel Coronavirus. Abstract
NEJM has also published an editorial, focusing on this zoonotic coronavirus, which (third time in 3 decades, after evere acute respiratory syndrome coronavirus [SARS-CoV] and Middle East respiratory syndrome coronavirus [MERS-CoV]) has crossed species to infect human populations. Open access text
Moreover, on same journal, a viewpoint on key questions for impact assessment of this new emerging Coronavirus. Open access text
NEJM published data on the first 425 confirmed cases of novel coronavirus infected pneumonia (NCIP) in Wuhan, reporting informations collected on demographic characteristics, exposure history, and illness timelines of laboratory-confirmed cases by January 22, 2020, with estimation of key epidemiologic time-delay distributions. Open access text
The report of a case of importation and human-to-human transmission of nCoV in Vietnam ia also available. Open access link
Moreover, a dedicated page has been created on New England Journal of Medicine, and a special set of practices that will be applied to all submitted manuscripts describing the 2019-nCoV outbreak, has been announced in this editorial, to promote fast publishing.
JAMA published another viewpoint highlighting the perpetual challenge of emerging infectious human diseases caused by pathogens from viral families (formerly thought to be relatively benign) and the importance of sustained preparedness. Open access text
Moreover, another editorial refers about control measures in China, and control measures by governments worldwide, nonpharmaceutical interventions, and role of WHO. Open access text
A dedicated page is available on Centers for Disease Control and Prevention (CDC) website, with outbreak of respiratory illness caused by the novel coronavirus reporting:
– situation news & summary;
– informations/interim guidance for healthcare professionals, including criteria to guide evaluation of patients under investigation (PUI) for 2019-nCoV; recommendations for reporting, testing, and specimen collection; healthcare infection prevention and control recommendations for PUI for 2019-nCoV, and checklists for HCPs/hospitals;
– interim guidance for laboratory professionals working with specimens from PUI for human infections with 2019-nCoV.
An online dashboard for tracking worldwide spread of novel Coronavirus has been built & is regularly updated by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University; the map is freely available! link
But how setting up an ICU to cope with novel Coronavirus infection? read about this experience from Sichuan region, China:
education & training of staff
protection of the staff
early recognition/classification of disease severity
restriction of patient contact
full text open access on ICM
The ELSO – Extracorporeal Life Support Organization will persist in publishing additional evidence and advices, as available, on all our social media channels and on our website, in order to actively contribute to the updating of our community about this topic.