COVID-19 resuscitation guidance reminder
Recently, we have received questions about updated guidelines from the American Heart Association regarding COVID-19 resuscitation for adult patients experiencing cardiac arrest.
Our Resuscitation Operations Council carefully reviewed this interim guidance and determined that we will maintain our existing Cleveland Clinic protocols as outlined in the COVID-19 Toolkit.
These guidelines, which have been in place since spring 2020, help safeguard our caregivers. Protecting patients and caregivers from exposure to COVID-19 remains a highest priority.
Please refer to the following resources for more details on COVID-19 protocols:
- Non-ICU Recommendations for Resuscitation of COVID-19 Patients
- Resuscitation of COVID-19 Positive or Suspected Positive Patients
- Critical Response and Resuscitation Committee Recommendations for COVID-19
If you have questions, please speak with your manager or reach out to the Resuscitation Operations Council at [email protected].
Thank you for your commitment to safety of our patients and one another.
Updated: Outpatient COVID-19 treatments in Ohio and Florida
A Cleveland Clinic enterprise team is working on strategies for the equitable distribution and delivery of COVID-19 treatments. Please see below for current treatments as well as Emergency Use Authorizations (EUA) and U.S. Food and Drug Administration (FDA) approval status for anti-viral and preventative therapies.
Oral antiviral agents for COVID-19: Paxlovid and Molnupiravir
Paxlovid (nirmatrelvir and ritonavir) received EUA approval on Dec. 22, 2021, and Molnupiravir received EUA approval on Dec. 23, 2021. These agents are oral antivirals for treatment of mild to moderate COVID-19 infection in high-risk outpatients.
Extremely limited allocation
Both products are purchased by the federal government and distributed by state health departments on extremely limited allocation.
The oral antivirals are EUA approved for outpatients who meet all of the following requirements:
- Test positive for COVID-19
- Are within five days of symptom onset
- Are at high risk for progression to severe COVID-19 which includes hospitalization
Paxlovid can be used for adults and pediatrics at least 12 years of age and at least 88 pounds.;
Molnupiravir is only approved for adults 18 years and older and should not be used in pregnant or lactating women.
Cleveland Clinic locations: Ohio
On Tuesday, Jan. 11, Cleveland Clinic began distribution of Paxlovid. Tomorrow, Thursday, Jan. 13, we will begin distribution of Molnupiravir.
- Patients: Patients should contact their primary care providers to review the EUA fact sheet and determine eligibility.
- Prescribers: Prescribers can find details on the therapies and patient eligibility criteria at this link.
How to order
Prescribers must use the SmartSet in Epic called COVID-19 Oral Therapies. This SmartSet is the only way to order COVID oral antivirals at Cleveland Clinic and includes product availability details and ordering instructions.
Cleveland Clinic Emergency Departments in Northeast Ohio do notprovide outpatient COVID therapies including monoclonal antibody infusions and prescriptions for oral therapies. These therapeutics cannot be ordered by emergency department providers.
Cleveland Clinic locations: Florida
Cleveland Clinic locations in Florida have not received allocations of Paxlovid or Molnupiravir. Only select retail pharmacies in Florida have received supply at this time. We will provide ongoing allocation and distribution updates for these therapies.
Monoclonal antibody infusions for treatment of mild to moderate COVID-19: Sotrovimab
Cleveland Clinic provides monoclonal antibody infusions to treat mild to moderate COVID-19 infection in certain patients who have a high risk for severe illness. The demand for COVID-19 monoclonal antibody infusions outweighs the supply of infusion appointments.
In Northeast Ohio, we offer outpatient COVID-19 monoclonal antibody infusions at three locations:
- Marymount Hospital, adults
- Akron General Health and Wellness Center located at Green, the preferred location for adults with immunocompromising disorders and therapies
- Main campus R building, pediatrics only
In Florida, we offer outpatient COVID-19 monoclonal antibody infusions at the following locations:
- Outpatient infusion sites: Martin North, Weston
- ED infusion sites: Martin North, Martin South, Tradition Hospital, St. Lucie West, Weston, Indian River
Cleveland Clinic’s monoclonal antibody appointments are for patients who are under the care of a Cleveland Clinic primary care provider or select sub specialty provider. Patients should contact their primary care provider or subspecialty provider to determine if they are a candidate for an infusion.
There are additional locations throughout Ohio and Florida that offer COVID-19 monoclonal antibody infusions. Click here using Google Chrome to view an interactive map.
New long-acting monoclonal antibodies for pre-exposure prevention of COVID-19: Evusheld
The FDA issued an EUA for AstraZeneca’s Evusheld (tixagevimab co-packaged with cilgavimab and administered together) for the prevention of COVID-19 in certain high risk adults and pediatric individuals 12 years of age and older weighing at least 88 pounds.
It is a COVID-19 monoclonal antibody combination for prevention of COVID-19 infection in two patient populations:
- Patients who have moderate to severe immune compromise due to a medical condition or receipt of immunosuppressive medications or treatments and may not mount an adequate immune response to COVID-19 vaccination.
- Patients for whom vaccination with any available COVID-19 vaccine, according to the approved or authorized schedule, is not recommended due to a history of severe adverse reaction (e.g., severe allergic reaction) to a COVID-19 vaccine(s) and/or COVID-19 vaccine component(s).
The product is only authorized for those individuals meeting one of the two criteria above, who are not currently infected with COVID-19 and who have not recently been exposed to an individual infected with COVID-19 who meet the above criteria.
The Cleveland Clinic Enterprise team is working to distribute product to patients with the highest risk. This therapy is provided by the federal government on allocation and distribution is limited.
For the latest information on COVID-19 monoclonal antibody therapeutics, click here.