Editors’ Note: This article was accepted on Sept. 7, 2021, and was accurate at that time. Because information about COVID-19 is evolving rapidly, please verify these recommendations and information.
Explore This IssueACEP Now: Vol 40 – No 11 – November 2021
The COVID-19 pandemic continues to affect billions throughout the world. The rapidly growing evidence base creates a challenge for clinicians worldwide. The dynamic nature of this evidence further makes it difficult to create timely clinical guidelines, which are normally created on the scale of months to years. Thus, professional societies have adjusted their methods on how to develop guidelines during the pandemic.
The ACEP Clinical Policies Committee regularly assesses the guidelines produced by other medical specialty societies facilitated by a presentation and discussion led by the Emergency Medicine Residents’ Association (EMRA) representative to the Clinical Policies Committee. In light of the pandemic, the Surviving Sepsis Campaign created a dedicated panel, the Surviving Sepsis Campaign (SCC) COVID-19 panel, to establish and maintain guidelines to address the ever-growing body of evidence. Here we will briefly examine the “Surviving sepsis campaign guidelines on the management of adults with coronavirus disease 2019 (COVID-19) in the ICU.”
The SSC implemented a living guideline model to provide continually updated guidance on the treatment of COVID-19. The panel released its original guideline on the management of COVID-19 in June 2020 with a subsequent update published in March 2021.1,2 The SSC COVID-19 panel includes a diverse range of experts from guideline development, infection control, infectious diseases and microbiology, critical care, hematology and thrombosis, surgery, emergency medicine, nursing, pharmacy, and public health. Eight new members were added to the panel from the prior iteration. All members had to disclose their conflict of interests (COI) and were not able to vote if they had a COI related to the guideline question. The panel utilized the GRADE methodology and the Evidence to Decision (EtD) Framework to develop the recommendations.3,4 The EtD Framework provides a structured approach that helps make the assessment and integration of the evidence, and other patient-centered considerations more systematic and explicit to generate rigorous recommendations.
Professional medical librarians performed a literature search through Cochrane Central Register of Controlled Trials and the National Library of Medicine’s MEDLINE databases. Trained reviewers screened the literature search and removed duplicates. Random-effects meta-analysis was done when applicable, based upon the data. The GRADE approach was utilized to assess the quality of evidence.3 Only direct evidence (evidence generated from studies on COVID-19) was included in the March 2021 update, as opposed to the prior guideline which included indirect evidence (evidence from more general disease process such as acute respiratory distress syndrome). The exception to this is questions regarding anticoagulation, as direct evidence was not available.