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ASA has partnered with the Association of University Anesthesiologists (AUA) to create a central listing of anesthesia research investigations related to the COVID-19 pandemic. ASA and AUA feel strongly that during this time we should be highlighting the leadership role of anesthesiologists, the clinical impact of anesthesiologists, and the research work of anesthesiologists.
intubateCOVID Global Registry
Department of Anesthesiology and Perioperative Medicine at Penn State University College of Medicine, Hershey, PA
"intubateCOVID" is a global registry of occupational exposure and health outcomes for providers performing airway management procedures in patients with COVID-19.
Barrier Enclosure during Endotracheal Intubation
Boston Medical Center, Boston, MA
Brigham and Women’s Hospital, Boston, MA
Clinicians with inadequate access to standard personal protective equipment (PPE) have been compelled to improvise protective barrier enclosures for use during endotracheal intubation. We describe one such barrier that is easily fabricated and may help protect clinicians during this procedure. Access the original letter and supplemental material and video.
Concept Paper: Modulation of Immune Response to SARS-CoV-2 by Sevoflurane Anesthetic
VA Western New York Healthcare System, Buffalo, NY
University of Buffalo, Buffalo, NY
We will test the hypothesis that administration of sevoflurane, a commonly used volatile anesthetic, for 4 hours after intubation and starting mechanical ventilation will decrease the severity of ARDS and subsequently decrease the mortality due to SARS-CoV-2. Download the Concept Paper (PDF).
Collaborative, rapid innovations to meet the clinical and health system demands of the COVID-19 pandemic
Northwestern University Feinberg School of Medicine, Chicago, IL
The Etemadi Research Group is an interdisciplinary group of engineers, nurses, and business professionals that until right before COVID-19, was based inside one of the ICUs at Northwestern Memorial as well as one of the perioperative areas. Being in this collaborative, immersive environment for years led them to be able to act quickly to develop tools to help clinicians and the health system. Through the immense help of collaborators across the health system, the university, and industry, projects include: remote, touchless management of ventilators, 3D printing of viral culture swabs, building of a rapidly-manufacturable emergency ventilator, repurposing of existing home-use vitals monitors for rapid creation of step-down beds, and solving to other needs as they arise.
The Ohio State University Wexner Medical Center Department of Anesthesiology COVID-19 Research Activities (PDF)
The Ohio State University Wexner Medical Center, Columbus, OH
Improving outcomes in mechanically-ventilated COVID-19 patients with hyperinflammatory response
University of California San Francisco Researchers: Mervyn Maze, Shantel Weinsheimer, Sarah Saxena, Lauren Meyer, Andres Alvarez Pinzon, Jeff Nelson
Acute respiratory distress syndrome (ARDS) has emerged as the most common cause of mortality in patients with COVID-19. Previous non-COVID-19 studies have demonstrated that patients with a hyperinflammatory subtype of ARDS have worse clinical outcomes, and emerging studies in patients with COVID-19 have revealed that a significant percentage of patients are developing severe hyperinflammation resembling a syndrome known as secondary hemophagocytic lymphohistiocytosis (sHLH). We hypothesize that, in COVID-19 positive patients with ARDS who require intubation and mechanical ventilation, those who receive dexmedetomidine as part of their sedation regimen will have improved outcomes, and that this effect will be most pronounced in the subset of patients with hyperinflammation owing to the inflammation-resolving properties of dexmedetomidine.
Phase I is a retrospective review of existing COVID-19 databases to determine the size of any effect.
Phase II is a randomized controlled trial of dexmedetomidine vs propofol for ARDS patients with a hyperinflammatory phenotype.
COVID-19 Research Projects from the Department of Anesthesiology at SUNY@Buffalo
The State University of New York, Buffalo, NY
Project title: A novel platform for development of a COVID-19 vaccine (cobalt-porphyrin-phospholipid nanoliposomes).
Personnel
Principal Investigator: Bruce Davidson, PhD, Research Professor, Dept. of Anesthesiology, SUNY@Buffalo
Co-I: Jonathan Lovell, PhD, Associate Professor, Dept. of Biomedical Engineering, SUNY@Buffalo
Co-I: Amy Jacobs, PhD, Research Associate Professor, Dept. of Microbiology & Immunol., SUNY@Buffalo
Co-I: Paul Knight, MD, PhD, SUNY Distinguished Professor, Dept. of Anesthesiology, SUNY@Buffalo
Summary of research
Our laboratory has developed cobalt-porphyrin-phospholipid (CoPoP) nanoliposomes (approximately 100 nm in diameter) that spontaneously bind his-tagged molecules due to the immobilized cobalt in the phospholipid bilayer, thus, decorating the surface with the molecule. This technology has been successfully utilized as a vaccine platform by attaching peptides or proteins (immunogens) that elicit immune responses targeting a growing list of pathogens. We have demonstrated successful immunizations in mice against HIV, influenza (mice and ferrets), Lyme disease and malaria utilizing this technique. Additionally, we have shown that our approach allows for antigen-sparing when compared to other influenza vaccine formulations and also provides for the capability of incorporating numerous viral immunogens on the same particle (multiplexing).
The goal of this research project is to test the effectiveness of the CoPoP vaccination formulation in providing protection from SARS-CoV-2 infection. The general approach is to produce a range of His-tagged SARS-CoV-2 receptor binding domain (RBD) peptides in HEK293T cells. RBD is the portion of the virus's S protein that is used to attach to angiotensin converting enzyme 2 (ACE2) on respiratory epithelial type II cells initiating the infection. We will test for RBD-ACE2 binding using a dot blot and/or surface plasmon resonance (SPR) technology. Next, we will generate CoPoP-RBD and vaccinate mice with it. Following a prime-boost strategy, immune serum will be collected and tested for inhibition of viral entry into Vero E6 cells using a pseudotyped reporter virus constructed on an inactive HIV core decorated with SARS-CoV-2 envelop proteins.
The procedures described above are BSL-2 or less. However, once we have confirmed that our formulations are efficacious in the experiments above, we will initiate in vitro and in vivo studies with wild-type SARS-CoV-2, a BSL-3 pathogen. A SARS-CoV-2-susceptible transgenic mouse strain, B6.Cg-Tg(K18-ACE2)2Primn/J, that expresses human ACE2 on the respiratory epithelium, will be used in the in vivo studies.
Project title: A novel nanoparticle for COVID-19 treatment (chitosan-5’PPPshRNA).
Personnel
Principal Investigator: Bruce Davidson, PhD, Research Professor, Dept. of Anesthesiology, SUNY@Buffalo
Co-I: Paul Knight, MD, PhD, SUNY Distinguished Professor, Dept. of Anesthesiology, SUNY@Buffalo
Co-I: Siavash Sedghi, MD, Anesthesiology Resident, Dept. of Anesthesiology, SUNY@Buffalo
Co-I: Prince Bonsu, MD, Anesthesiology Resident, Dept. of Anesthesiology, SUNY@Buffalo
Co-I: Hilliard Kutscher, PhD, Post-Doctoral Associate, Dept. of Anesthesiology, SUNY@Buffalo
Co-I: John Sullivan, MD, PhD, Professor, Dept. of Ophthalmology, SUNY@Buffalo
Co-I: Suryaprakash Sambhara, DVM, PhD, Chief Immunology Section, Influenza Division, CDC
Co-I: Amy Jacobs, PhD, Research Associate Professor, Dept. of Microbiology & Immunol., SUNY@Buffalo
Summary of research
The goal of this project is to develop a nanoparticle platform for delivering 5’PPP-shRNA to the respiratory epithelium as a treatment to initiate the RIG-I antiviral host response, as well as directly targeting specific SARS-CoV-2 gene products to disrupt replication. We have constructed such a compound targeting influenza infection using chitosan-tripolyphosphate-NS1shRNA nanoparticles and demonstrated successful inhibition of influenza replication in several in vitro and in vivo (mouse) assays (Singh N, Ranjan P, Cao W, Patel J, Gangappa S, Davidson BA, Sullivan JM, Prasad PN, Knight PR, Sambhara S: A dual functioning 5’PPP-NS1shRNA that activates RIG-I antiviral pathway and suppresses influenza nonstructural protein 1. Mol Ther Nucleic Acids 19 (Mar):1413-1422, 2020). We will test the efficacy of our nanoparticle construct to stimulate the host antiviral Type I interferon-mediated response using a B16-Blue IFN-a/b-SEAP reporter cell line (InVivoGen, San Diego, CA). We will also test the efficacy of the shRNA targeting of the SARS-CoV-2 gene product using a SARS-CoV-2 gene sequence inserted into an MCS-IRES-SEAP plasmid and transforming HEK293T cells with the plasmid to produce a reporter cell line. These cells will be exposed to the chitosan-TPP-5’PPP-shRNA nanoparticles to test the ability of the nanoparticles to inhibit SEAP production (an indication that the SARS-CoV-2 gene sequence was successfully attacked).
The procedures described above are BSL-2 or less. However, once we have confirmed that our formulations are efficacious in the experiments above, we will initiate in vitro and in vivo studies with wild-type SARS-CoV-2, a BSL-3 pathogen. A SARS-CoV-2-susceptible transgenic mouse strain, B6.Cg-Tg(K18-ACE2)2Primn/J, that expresses human ACE2 on the respiratory epithelium, will be used in the in vivo studies.
Rapid (<15 minute) point of care test to determine antibodies to COVID Convalescent plasma donation
Stony Brook University, Stony Brook, NY
Links:
Stony Brook Researchers Collect Convalescent Serum (Blood Plasma) From COVID-19 Survivors
Volunteers Needed to Donate Blood Plasma to Help Hospitalized Patients with COVID-19
Stony Brook, Chembio Diagnostics partner on COVID-19 trial
Newsday article on antibody testing in plasma research
Study on clinicaltrials.gov:
Engineering a New Ventilator, from Conceptual Design to Animal Testing
Stony Brook University, Stony Brook, NY
Joint Canada-US research initiative that directly responds to the essential sedative drug shortage
Sunnybrook Health Sciences Centre, Toronto, ON, Canada
During the COVID-19 pandemic, a global shortage of essential sedative and neuromuscular relaxants drugs has emerged to be a major issue in delivering safe care for critically ill patients. Use of inhaled volatile-based anesthetic regimens can ease this drug pressure and may also provide pulmonary benefits. A collaborative team of anesthesiologists, critical care physicians and epidemiologists from Canada (University of Toronto, London Health Sciences Centre) and United States (Massachusetts General Hospital) are prospectively investigating patient and health system benefits of inhalation sedation regimens compared to traditional intravenous medications in the SAVE (SedAtion Using Volatiles AnEsthesia Trial in ICU) clinical trial. The team includes internationally renowned experts in prolonged inhalational sedation therapy for critically ill patients with experience in education, safety and patient outcome studies. Hospitals and researchers interested in participating are welcome to contact the investigative team.
University of Kansas Medical Center COVID-19 Research Activities (PDF)
University of Kansas, Kansas City, KS
University of Washington Research and Education Efforts
University of Washington, Seattle, WA
Sara Nikravan, M.D., Associate Professor of Anesthesiology and Pain Medicine, Burhkard, Mike Hall, Ron Pauldine, and Katerine O’Heller, in collaboration with Jim Kirkpatrick, Florence Sheehan, and Amy Morris submitted a grant application to the AHA proposing a study to try and valuate the utility of AI for guiding POCUS image acquisition in non-expert bedside scanners (PDF) as tool for potentially limiting personal exposure/time at bedside in clinically indicated POCUS evaluations without (hopefully) compromising imaging quality. The idea, of course, was spurred by the need to limit patient travel and personal exposure while still providing optimal patient care in the COVID era. We will probably find out in the beginning of May if we received the AHA grant or not.
Vikas O’Reilly-Shah, M.D., PhD
Nita Khandelwal, M.D. - site-PI for the Society of Critical Care Medicine's Discovery VIRUS COVID-19 study
Jacob Sunshine, M.D. - Alexa, Do I Have Coronavirus?
University of California, San Francisco, CA
Bioethics Lessons from Three of the Early Heroes of the Coronavirus Pandemic March 18, 2020
Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA
Many Hospitals Still Haven’t Canceled Elective Procedures. They Need to Do That Now. March 16, 2020
Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA
