Adult cardiac surgery and the COVID-19 pandemic: Aggressive infection mitigation strategies are necessary in the operating room and surgical recovery

Engelman, Daniel T.; Lother, Sylvain; George, Isaac; Funk, Duane J.; Ailawadi, Gorav; Atluri, Pavan; Grant, Michael C.; Haft, Jonathan W.; Hassan, Ansar; Légaré, Jean‐François; Whitman, Glenn; Arora, Rakesh C.

doi:10.1016/j.jtcvs.2020.04.059

Cited by 41 publications

(71 citation statements)

References 16 publications

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“…The highest viral load of the virus causing COVID‐19 is in sputum and upper airway secretions and endotracheal intubation is the commonest and most relevant aerosol‐generating procedure in cardiac surgery 8 . Apart from intubation and extubation, bag mask ventilation, suctioning of airways, insertion of chest drains, and thoracotomies can all lead to aerosol generation 9 . In pediatric cardiac surgery, valve repairs and at times in coronary artery bypass operations as well, transesophageal echocardiography (TEE) is often used.…”

Section: Main Sources Of Aerosol Generation In Cardiac Surgical Operamentioning

confidence: 99%

Aerosol‐mediated transmission of SARS‐Cov‐2 or COVID‐19 in the cardiac surgical operating room

et al. 2020

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Section: Main Sources Of Aerosol Generation In Cardiac Surgical Operamentioning

confidence: 99%

Aerosol‐mediated transmission of SARS‐Cov‐2 or COVID‐19 in the cardiac surgical operating room

et al. 2020

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“…Clinicians must consider the risk of recipient demise, available clinical resources, accuracy of testing, and the postoperative risk of COVID‐19 infection. Both the STS and the American Society of Transplantation (AST) have recommended a triage system that considers both recipient and institutional resources to determine transplant candidacy 38,39 …”

Section: Heart Transplantation Considerationsmentioning

confidence: 99%

Cardiac surgery considerations and lessons learned during the COVID‐19 pandemic

et al. 2020

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The COVID‐19 pandemic has transformed cardiac surgical practices. Limitations in intensive care resources and personal protective equipment have required many practices throughout the globe to pause elective operations and now slowly resume operations. However, much of cardiac surgery is not elective and patients continue to require surgery on an urgent or emergent basis during the pandemic. This continued need for providing surgical services has introduced several unique considerations ranging from how to prioritize surgery, how to ensure safety for cardiac surgical teams, and how best to resume elective operations to ensure the safety of patients. Additionally, the COVID‐19 pandemic has required a careful analysis of how best to carry out heart transplantation, extra‐corporeal membrane oxygenation, and congenital heart surgery. In this review, we present the many areas of multidisciplinary consideration, and the lessons learned that have allowed us to carry out cardiac surgery with excellence during the COVID‐19 pandemic. As various states experience plateaus, declines, and rises in COVID‐19 cases, these considerations are particularly important for cardiac surgical programs throughout the globe.

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“…14 Healthcare workers donned PPE during aerosol-generating procedures (eg, intubation). 12 Although the actual perioperative care of surgical patients is not described, the general practice care was in line with the principle of enhanced recovery to facilitate extubation, ambulation, pulmonary care, and discharge. 9 Surgical follow-up included phone calls for outpatients and chart review for inpatients.…”

mentioning

confidence: 99%

“…Adjustments of the screening algorithm were guided by outcome data and pretest probability, the latter based on questionnaire, temperature measurement, and the regional prevalence of the COVID-19 infection. 5,10,12,21 Preoperative screening and testing for COVID-19 varies among institutions, regions, and among patient types, with greater concern for higher-risk patients and procedures. Questionnaires regarding signs, symptoms, and exposure and temperature recording are universal.…”

mentioning

confidence: 99%

“…Others view negative tests cautiously because of the limitations of testing to the point of treating all patients as if they are positive for COVID-19. 10,12 A practical preprocedural assessment, relying on signs, symptoms, and exposure and selective testing, can be implemented safely in a region of low prevalence and low pretest probability. 5 Although a 10-day absence of signs, symptoms, and exposure was chosen, 10,15,[17][18][19][20] a more conservative policy might use 14 days.…”

mentioning

confidence: 99%

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Testing the Asymptomatic Pre-Surgical Population for Severe Acute Respiratory Syndrome Coronavirus 2

Bobenchik

Maslow²,

Angus

et al. 2021

Journal of Cardiothoracic and Vascular Anesthesia

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IN RESPONSE to the coronavirus disease 2019 (COVID-19) pandemic, healthcare facilities deferred all but emergency surgeries for 12 weeks to minimize/reduce risk to patients and healthcare workers. 1-6 However, by April 2020, increased mortality for delaying necessary cardiac and thoracic procedures prompted multidisciplinary teams to determine how to restart surgical cases safely, balancing the urgent needs of patients, the reported increased morbidity and mortality of COVID-19Àpositive patients undergoing surgical procedures, 2,3,7,8 and the risk of spreading COVID-19 infection among healthcare workers. 4,6,7,9-11 Donning of personal protective equipment (PPE) by healthcare workers and screening of patients for COVID-19 infection are necessary for the success of surgery during the pandemic. 10,12 Screening includes a questionnaire regarding signs and symptoms of COVID-19, exposure to an infected person, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcriptase polymerase chain reaction (PCR) testing with or without thoracic computed tomography (CT). 4,5,10-15 Whereas screening should be universal, PCR testing and CT imaging may not be available or, in low-prevalence areas, may not be necessary. 10,12 Furthermore, universal PCR testing for healthcare workers has not been advocated, except for those with signs, symptoms, and/or exposure. 16 Herein, the results of preoperative screening and PCR SARS-CoV-2 testing (cobas 6800 System; Roche Diagnostics, Basel, Switzerland [approved by the US Food and Drug Administration on March 2020]) at our institution during the time of the restart and ramping up of surgical cases are reported. After approval by the Lifespan Medical Systems Institutional Review Board, 14 weeks of SARS-CoV-2 PCR testing data were collected beginning at the restart of elective surgical cases in April 2020. For comparison, data also included nonsurgical patients with suspicion of infection. All patients underwent a nasopharyngeal SARS-CoV-2 PCR test (Cobas 6800 System), with the surgical group being tested within 72 hours of their procedure. Forehead temperatures were

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Adult cardiac surgery and the COVID-19 pandemic: Aggressive infection mitigation strategies are necessary in the operating room and surgical recovery

Cited by 41 publications

References 16 publications

Aerosol‐mediated transmission of SARS‐Cov‐2 or COVID‐19 in the cardiac surgical operating room

Aerosol‐mediated transmission of SARS‐Cov‐2 or COVID‐19 in the cardiac surgical operating room

Cardiac surgery considerations and lessons learned during the COVID‐19 pandemic

Testing the Asymptomatic Pre-Surgical Population for Severe Acute Respiratory Syndrome Coronavirus 2

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