Table 2.

Emergency surgery for critically ill COVID-19 positive or suspected patients—preoperative planning and case selection

Care should be taken to limit delay of interventions and to maintain quality of interventions

Cases should be reviewed by two surgeons (attendings/consultants), when available to confirm necessity and to weigh role for alternate interventions

If time permits, pre-operative risk stratification tools, such as p-POSSUM, POTTER and NELA, may guide recommendations regarding prognosis and hence appropriate goals of care [11]

Should delay to surgery not compromise care, cases should preferentially be performed at times of day when staffing and resources are optimal, and the test result or CT scan is available. This may preserve resources in cases that tested negative or a free of pulmonary infiltrates

Patients and families (by phone) should be engaged in robust goals of care conversations. (The recommendations below may not apply to certain countries)

Prior to operative intervention, document communication that delineates prognosis, goals of care, recommendations regarding interventions, and code status

All admitted patients, and particularly patients proceeding to OR should have consideration to code status and for those with anticipated poor prognosis, “Do Not Resuscitate” status should be considered preoperatively to limit the possibility of CPR in the OR

The use of vasopressors, in general, are used routinely as standard of care in anesthesia management, in general, and should be permitted following the standard of care

Trauma cases should be excluded from discussions regarding goals of care only if immediate surgery is required. Any advanced directives should be respected and reviewed