Weekly Communique #4

WEEK IN REVIEW

We welcomed the following new members to the Taskforce:

• Australian College of Midwives

Key new topics of discussion across the panels this week included:

• Publication of a prominent media release around impending interim results of a trial of remdesivir in COVID-19 (noting that to date, no data have been published)
• Emerging observational data on increased incidence of venous thromboembolism and the use of anticoagulants in moderate, severe and critical COVID-19.
• Emphasising that studies that enrol patients to test experimental therapies must be high quality randomised trials.
• Formation of an observational data working group to identify large datasets capable of measuring the uptake and impact of COVID-19 guidelines in Australia and/or providing data to inform recommendations for clinical care.

NEW/UPDATED GUIDANCE THIS WEEK

Australian guidelines for the clinical care of people with COVID-19 (V3.0)

• The evidence base for recommendations on antivirals and other disease-modifying treatments has been reviewed and a recommendation specific to remdesivir has been added.

Following another week of continuous evidence surveillance there is still no evidence for the effectiveness for ANY treatments for COVID-19. The Taskforce has strengthened its recommendation that all experimental therapies should only be given in the context of randomised trials with appropriate ethical approval.

• A new recommendation has been added on the use of prone positioning in people who are not mechanically ventilated.

• A new recommendation has been added regarding the use of venous thromboembolism (VTE) prophylaxis in people with moderate COVID-19.

NB–The Taskforce is currently reviewing the evidence in order to make urgent recommendations on the use of high dose VTE prophylaxis in patients with severe and critical COVID-19. This is in response to emerging observational data indicating a high incidence of VTE among people with COVID-19 (including pulmonary embolism and deep vein thrombosis).

CLINICAL FLOWCHARTS

Updates to clinical flowcharts this week include:

• A dedicated flowchart for respiratory support for patients with severe to critical COVID-19

EVIDENCE UNDER REVIEW

New clinical questions prioritised this week for evidence review relate to:

• Concomitant use of ACE inhibitors and angiotensin receptor blockers
• The use of neuromuscular blocking agents
• The use of nitric oxide
• The use of corticosteroids
  Timing of mechanical ventilation
• Low versus high PEEP thresholds

NEW TOPICS & QUESTIONS

We continue to receive a steady stream of suggestions for priority guideline questions via the Taskforce website and broader clinical network. These are reviewed and prioritised each week via a formal process overseen by our evidence team, expert panels and Guidelines Leadership Group.

A summary of all of the topic areas for which we have received suggested questions is provided below.

Questions related to infection prevention and control/ (IPC) and personal protective equipment (PPE).

A large number of questions related to infection prevention and control (IPC) and the use of personal protective equipment (PPE) have been received and are clearly important issues for clinicians.While IPC-related guidance is beyond the initial scope of the Taskforce (to provide recommendations on clinical care), we have established representation from the Infection Control Expert Group (ICEG) which develops IPC and PPE guidance for the Australian Health Protection Principal Committee (AHPPC).

Current guidance developed by ICEG is available at https://www.health.gov.au/committees-and-groups/infection-control-expert-group-iceg

We are currently working to explore ways we can provide support to ICEG to understand and address the priority questions being brought to the Taskforce.

Please encourage your clinical colleagues to visit the Taskforce website to provide their valuable feedback and insights www.livingevidence.org.au