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Novel Coronavirus: What Neuroradiologists Should Do

Novel Coronavirus: What Neuroradiologists Should Do LETTERS e read with great interest the article “Novel Coronavirus: environment with patients. Patients with known coronavirus dis- WWhat Neuroradiologists as Citizens of the World Need to ease 2019 (COVID-19) undergoing endovascular intervention Know,” published by the American Journal of Neuroradiology in should don appropriate PPE (including N95 masks). A minimal March 2020. The authors have discussed in detail the epidemiol- number of health care workers who also have adequate training for ogy; virulence of coronavirus causing the current pandemic sce- doffing and donning of PPE should scrub into procedures. Vendor nario with the pathogenesis, diagnosis and prognosis of the disease. access inside the catheterization laboratory and use of PPE should There is an increasing trend toward a high incidence of infection be limited when necessary. Because access to rapid testing for among health care workers, and certain infection control measures COVID-19 is limited, all patients with fever and cough should be have also been developed for health care workers in radiology evaluated clinically and screened with portable chest radiographs, departments. Thus,the authorshavediscussed theroleofneurora- andelectiveproceduresmustbedeferreduntil thesourceis diologists in disseminating knowledge and providing guidance to identified. the general public to effectively control the spread. The authors After every procedure, interventional laboratories should have discussed the contact and airborne precautions that must be undergo terminal cleaning using hot water, detergent, and 1% followed by neuroradiologists performing lumbar punctures, mye- freshly prepared hypochlorite solution, and at least 1 hour of air lograms, and spine procedures. However, many other distinct pro- exchange should be allowed between procedures. Patients with cedures performed by interventional neuroradiologists in the suspected or known COVID-19 should be treated at the end of emergency setting for active head and neck bleeding, ischemic the day, or a dedicated lab may be of value. stroke, and ruptured aneurysms require urgent endovascular atten- The authors have described very well what neuroradiologists tion. Such procedures often need urgent intubation/suctioning, and should know during this global pandemic; we suggest practice there is an increased risk of aerosolization of respiratory secretions guidelines for neurointerventional laboratories and what neurora- and human spread of Severe Acute Respiratory Syndrome–corona- diologists should actively do to constrain the pandemic. virus 2 (SARS-CoV-2) infection. Thus, an interventional laboratory protocol, which has not been discussed previously, must be insti- REFERENCES tuted to limit the spread of the disease and curb human-to-human 1. Mahajan A, Hirsch JA. Novel coronavirus: what neuroradiologists as transmission. citizens of the world need to know. AJNR Am J Neuroradiol Techniques like preintubation before arrival of the patient in 2020;41:552–54 CrossRef Medline the neurointervention lab, use of powered air-purifying respira- 2. Mossa-Basha M, Meltzer CC, Kim DC, et al. Radiology department tor (PAPR) systems by anesthetists, filter systems (eg, high-effi- preparedness for COVID-19: Radiology Scientific Expert Panel. ciency particulate air; HEPA) in the anesthesia circuit, and closed Radiology 2020 Mar 16. [Epub ahead of print] CrossRef Medline circuit bilevel positive airway pressure (BIPAP) machines (when 3. Welt FG, Shah PB, Aronow HD, et al; American College of Cardiology’s intubation is not done) pose less risk to health care workers (ACC) Interventional Council and the Society of Cardiovascular Angiography and Intervention (SCAI). Catheterization laboratory con- because ventilation is managed through a closed circuit. In ac- siderations during the coronavirus (COVID-19) pandemic: from cordance with considerations for catheterization laboratories 3 ACC’s Interventional Council and SCAI. J Am Coll Cardiol 2020 Mar published in the Journal of the American College of Cardiology, 16. [Epub ahead of print] CrossRef Medline we recommend the use of appropriate personal protective equip- ment (PPE), including gowns, gloves, goggles (shields), and 3-lay- C. Jain ered surgical masks for all health care workers who work in a close V. Bhatia A. Kumar Department of Radiodiagnosis and Imaging Postgraduate Institute of Medical Education and Research Indicates open access to non-subscribers at www.ajnr.org Chandigarh, India http://dx.doi.org/10.3174/ajnr.A6550 AJNR Am J Neuroradiol 41:E49 Jul 2020 www.ajnr.org E49 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Neuroradiology American Journal of Neuroradiology

Novel Coronavirus: What Neuroradiologists Should Do

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Publisher
American Journal of Neuroradiology
Copyright
© 2020 by American Journal of Neuroradiology. Indicates open access to non-subscribers at www.ajnr.org
ISSN
0195-6108
eISSN
1936-959X
DOI
10.3174/ajnr.A6550
Publisher site
See Article on Publisher Site

Abstract

LETTERS e read with great interest the article “Novel Coronavirus: environment with patients. Patients with known coronavirus dis- WWhat Neuroradiologists as Citizens of the World Need to ease 2019 (COVID-19) undergoing endovascular intervention Know,” published by the American Journal of Neuroradiology in should don appropriate PPE (including N95 masks). A minimal March 2020. The authors have discussed in detail the epidemiol- number of health care workers who also have adequate training for ogy; virulence of coronavirus causing the current pandemic sce- doffing and donning of PPE should scrub into procedures. Vendor nario with the pathogenesis, diagnosis and prognosis of the disease. access inside the catheterization laboratory and use of PPE should There is an increasing trend toward a high incidence of infection be limited when necessary. Because access to rapid testing for among health care workers, and certain infection control measures COVID-19 is limited, all patients with fever and cough should be have also been developed for health care workers in radiology evaluated clinically and screened with portable chest radiographs, departments. Thus,the authorshavediscussed theroleofneurora- andelectiveproceduresmustbedeferreduntil thesourceis diologists in disseminating knowledge and providing guidance to identified. the general public to effectively control the spread. The authors After every procedure, interventional laboratories should have discussed the contact and airborne precautions that must be undergo terminal cleaning using hot water, detergent, and 1% followed by neuroradiologists performing lumbar punctures, mye- freshly prepared hypochlorite solution, and at least 1 hour of air lograms, and spine procedures. However, many other distinct pro- exchange should be allowed between procedures. Patients with cedures performed by interventional neuroradiologists in the suspected or known COVID-19 should be treated at the end of emergency setting for active head and neck bleeding, ischemic the day, or a dedicated lab may be of value. stroke, and ruptured aneurysms require urgent endovascular atten- The authors have described very well what neuroradiologists tion. Such procedures often need urgent intubation/suctioning, and should know during this global pandemic; we suggest practice there is an increased risk of aerosolization of respiratory secretions guidelines for neurointerventional laboratories and what neurora- and human spread of Severe Acute Respiratory Syndrome–corona- diologists should actively do to constrain the pandemic. virus 2 (SARS-CoV-2) infection. Thus, an interventional laboratory protocol, which has not been discussed previously, must be insti- REFERENCES tuted to limit the spread of the disease and curb human-to-human 1. Mahajan A, Hirsch JA. Novel coronavirus: what neuroradiologists as transmission. citizens of the world need to know. AJNR Am J Neuroradiol Techniques like preintubation before arrival of the patient in 2020;41:552–54 CrossRef Medline the neurointervention lab, use of powered air-purifying respira- 2. Mossa-Basha M, Meltzer CC, Kim DC, et al. Radiology department tor (PAPR) systems by anesthetists, filter systems (eg, high-effi- preparedness for COVID-19: Radiology Scientific Expert Panel. ciency particulate air; HEPA) in the anesthesia circuit, and closed Radiology 2020 Mar 16. [Epub ahead of print] CrossRef Medline circuit bilevel positive airway pressure (BIPAP) machines (when 3. Welt FG, Shah PB, Aronow HD, et al; American College of Cardiology’s intubation is not done) pose less risk to health care workers (ACC) Interventional Council and the Society of Cardiovascular Angiography and Intervention (SCAI). Catheterization laboratory con- because ventilation is managed through a closed circuit. In ac- siderations during the coronavirus (COVID-19) pandemic: from cordance with considerations for catheterization laboratories 3 ACC’s Interventional Council and SCAI. J Am Coll Cardiol 2020 Mar published in the Journal of the American College of Cardiology, 16. [Epub ahead of print] CrossRef Medline we recommend the use of appropriate personal protective equip- ment (PPE), including gowns, gloves, goggles (shields), and 3-lay- C. Jain ered surgical masks for all health care workers who work in a close V. Bhatia A. Kumar Department of Radiodiagnosis and Imaging Postgraduate Institute of Medical Education and Research Indicates open access to non-subscribers at www.ajnr.org Chandigarh, India http://dx.doi.org/10.3174/ajnr.A6550 AJNR Am J Neuroradiol 41:E49 Jul 2020 www.ajnr.org E49

Journal

American Journal of NeuroradiologyAmerican Journal of Neuroradiology

Published: Jul 1, 2020

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