In the first week of April 2020, the National COVID-19 Clinical Evidence Taskforce launched new 'living guidelines' to provide world-first, continually updated evidence-based guidance to clinicians caring for people with COVID-19. Each week the Taskforce publishes an update summarising the latest developments.
What’s new this week?
This week the Taskforce welcomed the Australian College of Midwives as a new member. There were also a number of new topics of discussion across the panels this week including:
- 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.
- Emphasizing that studies that enrol patients to test experimental therapies must be high quality randomised trials.
Guideline updates, flowcharts and evidence under review:
- 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. The Taskforce makes a consensus recommendation for the use prophylactic (preventive) doses of anticoagulants in adults with moderate COVID-19 illness or other indications, unless there is a contraindication such as risk for major bleeding.
- The Taskforce is also 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).
Updates to clinical flowcharts this week include:
- A dedicated flowchart for respiratory support for patients with severe to critical COVID-19
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
The guidelines now form a key part of Australia’s response to COVID-19. They are updated weekly and are available on the Taskforce website at www.covid19evidence.net.au
Published: 12 May 2020