endocarditis during COVID-19 pandemic
Breaking News:
April 22nd 2020.
ieQ COVID -19 Echocardiography recommendations document finalised!
Thank you to all involved; a mutidisciplinary multi-state (QLD, Victoria and Tasmania) collaboration!
Special thanks to the editing team (in alphabetical order) Alaa Alghamry (Internal medicine/stroke medicine), Alan Appelbe (Cardiology) Eugene Athan (ID), Andrew Burke (ID/respiratory) Darryl Burstow (Cardiology), Nathan Dwyer (Cardiology), Dionne Essenstam (ieQ project manager), Janice Geary (Infection control CNC), Robert Horvath (ID/micro), Joseph Lee (Medical imaging), Rishen Naidoo (Cardio-thoracic surgery), Kim Oman (ID), Ivan Rapchuk (Anaesthetics), John Sedgwick (Cardiology), Lauren Shearer (Cardiology).
Document viewable/downloadable via this link:
COVID-19 ieQ Echocardiography recommendations (PDF, 354.8 KB)
This document edited April 23rd, TTE section temporarily removed pending further discussions.
Please note: these recommendations are those of ieQ only, they have not been endorsed by ASID or CSANZ.
Further guidelines and discussion documents are below on this page.
March 31st, 2020 (amended April 23rd).
With COVID-19, the world is experiencing a pandemic.
The impact on health resources is unprecedented.
In terms of endocarditis, the ability to treat patients like “business as usual” is in many regions may no longer be possible.
Transoesophageal Echocardiography (TOE) may potentially be aerosol generating procedures, access to surgery/ICU may be limited due to lack of ICU beds, access to CTS hospitals may be limited due to transport as well as bed issues, access to things we take for granted like investigations or face-to-face appointments may be limited at times as the pandemic evolves.
We will endeavour to provide advice on IE management during this pandemic.
Please note that the situation is rapidly evolving and guidelines may change rapidly/ without notice.
We have assembled the current guidelines from ASE, GESA, CSANZ and ANZCA for your convenience.
CSANZ guidelines
https://www.csanz.edu.au/covid-19/
ASE guidelines
ANZCA guidelines
ANZCA-COVID-PPE-statement-v24 (PDF, 429.7 KB)
Further discussion documents are available below on this page.
Abbreviated ieQ TOE Statement:
We may be in a temporary era of patients being managed remotely (telehealth) with minimal investigations and minimal procedures whilst virus transmission is significant.
As IE is a very complicated condition, IEQ’s advice is “treat each individual endocarditis case as a unique case - the importance of MDTs to guide a management plan during this pandemic is more important than ever, with decisions based on current logistics as well as COVID- 19 activity”.
In Queensland, ieQ has already inaugurated a state-wide IE MDT advisory service, to provide advice to anyone in the state with an IE case.
This meeting is in a virtual format, allowing COVID- 19 safe social distancing.
For those Centres with significant numbers of IE cases, without current MDTs, the time is NOW to form your MDTs. Zoom or other virtual format for social distancing. Perhaps form networks between centres.
The first consideration during this pandemic is whether a TOE is really required. We may have to reconsider serial TTEs in selected patients as an alternative (and indeed be flexible with the timing). Alternative imaging to consider may include CT/MRI especially for peri-valvular complications, nuclear medicine (especially PET scans). If the purpose of the TOE is to forshorten intravenous therapy, the risk-benefit ratio of HITH/OPAT versus imaging may need to be individually considered.
A Checklist of symptoms/risk factors for COVID-19 should be asked of the patient at time of TOE booking as answers may influence whether a TOE proceeds or needs to be revised, and also immediately prior to procedure. This checklist is incorporated in our recommendations document above and also viewable separately as one of the discussion documents below.
The decision whether to proceed with a TOE in the above patients should be made by an MDT including an infectious diseases physician or microbiologist, cardiologist, TOE anaesthetist and perhaps cardiothoracic surgeon. If proceeding to surgery intra-operative TOE may be a consideration.
Staffing should be kept to a minimum.
Please check public health/ government health/ your institutions health notices at least daily as recommendations /situations may differ between regions and may be updated on a daily basis.”
COVID-19 Discussion documents.
ieQ pre-TOE checklist (April 22nd 2020)
pre TOE checklist (PDF, 130.3 KB)
Adult Congenital Heart Disease (ACHD) perspectives which Dr Lauren Shearer has kindly prepared.
COVID ACHD perspective (PDF, 192.9 KB)
Townsville University Hospital discussion paper which Dr Kim Oman has graciously submitted.
2020-3 IE TOE considerations Townsville 4 (DOCX, 23.9 KB)
We welcome discussions/suggestions about these topical and important statements.
Please email us on ieq@health.qld.gov.au