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Performing elective cardiac invasive procedures during the COVID-19 outbreak: a position statement from the European
Alaide Chieffo1, Giuseppe Tarantini, Christoph Kurt Naber
1Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.
Insights
Elective cardiac procedures require careful planning during COVID-19 waves. Prioritizing patients and implementing clear protocols for non-coronavirus disease 2019 (COVID-19) patients ensures safe, essential cardiac care.
Area of Science:
- Cardiology
- Infectious Diseases
- Healthcare Management
Background:
- The COVID-19 pandemic necessitated significant healthcare service reorganization, drastically reducing elective cardiac invasive procedures.
- Ongoing and future waves of COVID-19 present persistent challenges for managing non-COVID-19 cardiac care.
- Balancing pandemic response with the need for elective cardiac interventions is critical.
Purpose of the Study:
- To outline strategies for performing elective cardiac invasive procedures during COVID-19 pandemic waves.
- To address the prioritization of cardiac patients and procedures amidst resource constraints.
- To establish clear guidelines for managing cardiac patients in the context of SARS-CoV-2 transmission.
Main Methods:
- Development of distinct care pathways for "hot" (presumed or confirmed COVID-19) and "cold" (non-COVID-19) cardiac patients.
- Consideration of local testing capacity and community transmission levels for pre-procedural SARS-CoV-2 testing.
- Guidance on appropriate personal protective equipment (PPE) for healthcare workers based on patient COVID-19 status.
Main Results:
- Implementation of "hot" and "cold" patient pathways is essential for hospital preparedness.
- Pre-procedural SARS-CoV-2 testing may be indicated based on local epidemiology, irrespective of individual risk assessment.
- Specific PPE recommendations are provided for cardiac interventions involving COVID-19 positive or suspected patients.
Conclusions:
- Clear protocols and resource management are vital for maintaining elective cardiac procedures during the COVID-19 pandemic.
- Tailored testing and PPE strategies are necessary to protect healthcare workers and non-COVID-19 cardiac patients.
- Patient and healthcare worker adherence to masking protocols is crucial for infection control.
Abstract:
The rearrangement of healthcare services required to face the coronavirus disease 2019 (COVID-19) pandemic led to a drastic reduction in elective cardiac invasive procedures. We are already facing a "second wave" of infections and we might be dealing during the next months with a "third wave" and subsequently new waves. Therefore, during the different waves of the COVID-19 pandemic we have to face the problems of how to perform elective cardiac invasive procedures in non-COVID patients and which patients/procedures should be prioritised. In this context, the interplay between the pandemic stage, the availability of healthcare resources and the priority of specific cardiac disorders is crucial. Clear pathways for "hot" or presumed "hot" patients and "cold" patients are mandatory in each hospital. Depending on the local testing capacity and intensity of transmission in the area, healthcare facilities may test patients for SARS-CoV-2 infection before the interventional procedure, regardless of risk assessment for COVID-19. Pre-hospital testing should always be conducted in the presence of symptoms suggestive of SARS-CoV-2 infection. In cases of confirmed or suspected COVID-19 positive patients, full personal protective equipment using FFP 2/N95 masks, eye protection, gowning and gloves is indicated during cardiac interventions for healthcare workers. When patients have tested negative for COVID-19, medical masks may be sufficient. Indeed, individual patients should themselves wear medical masks during cardiac interventions and outpatient visits.