[Status and recommendations for interventional radiological procedures in COVID-19 patients]. / Status und Empfehlungen zur interventionell-radiologischen Versorgung bei COVID-19-PatientInnen.

BACKGROUND: Particularly at the beginning, the COVID-19 (coronavirus disease 2019) pandemic caused a reduction in the number of interventions in interventional radiology. At the same time, interventional training became more challenging. Infectious patients and disease transmission within interventional radiology departments continue to pose significant challenges. OBJECTIVES: This article describes the status and recommendations for interventional radiological procedures in COVID-19 patients. MATERIALS AND METHODS: Guidelines and recommendations from international and national societies as well as original works and reviews were evaluated. RESULTS: Interventional radiological care of COVID-19 patients with complicated courses of infection has become established during the course of the pandemic. To protect patients and staff, interventions in COVID-19 patients should be prioritized, performed in separate procedure rooms if possible, and patients should be tested before interventions. Logistics, staff planning, and hygiene measures should be continuously optimized. CONCLUSIONS: Structured workflows within interventional radiology in dealing with COVID-19 patients appear necessary to minimize infection risks and to guarantee the staff's work capability and health. In order to develop concepts for the handling of COVID-19 patients and to be prepared for potential upcoming waves of infections, recommendations of the Robert Koch Institute (RKI) and (inter-)national professional societies are helpful.

Adaptation and development of IR services in response to the COVID-19 pandemic: preliminary results of a focused survey

Purpose: The cyclic nature of active and recovery phases of the COVID-19 pandemic, has demanded fast adaptations and preparation for health care workers world-wide. We aimed to assess how interventional radiologists are handling the pandemic during active and recovery phases with regard to work and team structures, as well as mental health and how the pandemic could have increased the awareness of minimally-invasive therapies as alternatives to postponements of non-urgent procedures. Material and methods: 7125 CIRSE members were invited to participate. For this interim report, responses were collected between 23 November 2021 and 17 December 2021. Results: 114 responses were obtained for this preliminary report, of which 102 were complete. 94% (n=99) of respondents were interventional radiology specialists. Most respondents reported having established a routine to handle different waves of the pandemic (89.5%;n=102). Compared to active phases, fewer respondents indicated at least one pandemic-associated measure in their department during recovery phases (46%-71% vs 13%). 56% reported an increase in ambulatory care patients either during active and/or recovery phases. 54% reported more referrals during active and/or recovery phases. 25% reported increased hours at the hospital during recovery phases, 52% indicated increased sick leave, care leave, quarantine, and burn-out of team members and only 39% reported to get enough time to rest during recovery phases. Conclusion: While the COVID-19 pandemic is continuing to burden IR departments and the mental health of IRs, more than half of respondents reported an increase in referrals for minimally-invasive therapies and ambulatory care.

The Impact of COVID-19 on Interventional Radiology Practice Worldwide: Results from a Global Survey.

BACKGROUND: The COVID-19 pandemic had an unprecedented impact on clinical practice and healthcare professionals. We aimed to assess how interventional radiology services (IR services) were impacted by the pandemic and describe adaptations to services and working patterns across the first two waves. METHODS: An anonymous six-part survey created using an online service was distributed as a single-use web link to 7125 members of the Cardiovascular and Interventional Radiological Society of Europe via email. Out of 450 respondents, 327 who completed the survey at least partially including 278 who completed the full survey were included into the analysis. RESULTS: Interventional radiologists (IRs) reported that the overall workload decreased a lot (18%) or mildly (36%) or remained stable (29%), and research activities were often delayed (30% in most/all projects, 33% in some projects). Extreme concerns about the health of families, patients and general public were reported by 43%, 34% and 40%, respectively, and 29% reported having experienced significant stress (25% quite a bit; 23% somewhat). Compared to the first wave, significant differences were seen regarding changes to working patterns, effect on emergency work, outpatient and day-case services in the second wave. A total of 59% of respondents felt that their organisation was better prepared for a third wave. A total of 19% and 39% reported that the changes implemented would be continued or potentially continued on a long-term basis. CONCLUSION: While the COVID-19 pandemic has negatively affected IR services in terms of workload, research activity and emotional burden, IRs seem to have improved the own perception of adaptation and preparation for further waves of the pandemic.

A pre-infection laboratory score identifies cancer patients at risk for severe COVID-19: An analysis of the ADHOK coronavirus tumor registry

Introduction: Cancer patients (pts.) are considered susceptible to severe COVID-19 after SARS-CoV-2 infection, however, represent a heterogeneous population with variable risk. Pts. with active tumor disease and hematological neoplasms are particularly vulnerable to the infection. In a retrospective analysis of the ADHOK coronavirus tumor registry, the absolute neutrophil count (ANC) determined prior to infection showed a strong and independent correlation with COVID-19 mortality (Kiani et al, Cancer Med, in press). Here, we present an extended analysis of pre-infection laboratory parameters and COVID-19 severity in the registry pts., with the aim to establish an objective and easy-to-obtain predictor of infection outcome. Methods: Pts. with malignant tumor disease and PCR-confirmed SARSCoV- 2 infection were included in the registry by 22 German clinical institutions. Detailed information about tumor disease and treatment was collected retrospectively. Results of routine laboratory testing, performed at least 10 days prior to infection, were obtained. The course of SARSCoV- 2 infection was graded according to the WHO. Results: By May 10, 2021, 268 pts. (68% with solid tumors, 32% with hematological neoplasms) were included in the registry. Pre-infection routine laboratory values were available from 166 pts., obtained at a median of 21 days before infection. The pre-infection ANC, the neutrophil-to-lymphocyte ratio, and serum levels of CRP and LDH significantly correlated with COVID-19 severity after infection. In multivariable analysis, the ANC was found to be the strongest prognostic predictor for COVID-19 mortality (ANC > 4,4 /nL: OR 10.5, p=0.02) and was independent of age, sex, tumor activity, and CRP. Combining ANC and CRP to a score of 0, 1, or 2 points allowed to separate three groups of pts. with significantly different COVID-19 mortality (2% vs. 29 % vs. 64%, p< 0.001). Significant association of the 'pre-infection COVID-19 score' with COVID-19-related mortality was consistently found in the first and second waves of the pandemic and, in multivariable analysis, was independent of pre-infection LDH, a surrogate marker for tumor activity. Conclusions: A combined score of pre-infection ANC and CRP, determined as part of routine clinical testing prior to SARS-CoV-2 infection, strongly and consistently correlates with COVID-19 severity in cancer pts. It may serve as an easy-to-obtain parameter for COVID-19 risk assessment of cancer pts. prior to infection.