Adult Cardiac Surgery During the COVID-19 Pandemic: A Tiered Patient Triage Guidance Statement

Haft, Jonathan W.; Atluri, Pavan; Ailawadi, Gorav; Engelman, Daniel T.; Grant, Michael C.; Hassan, Ansar; Légaré, Jean‐François; Whitman, Glenn; Arora, Rakesh C.

doi:10.1016/j.athoracsur.2020.04.003

Cited by 109 publications

(100 citation statements)

References 1 publication

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“…The American College of Surgeons (ACS) issued "COVID-19: Elective Case Triage Guidelines for Surgical Care" on March 24, 2020, which outlined the general principles for cardiac surgery [60]. In response to the ACS triage guidelines, the COVID-19 Taskforce at STS published a patient triage guideline statement for cardiac surgery in adult [61] and pediatric [62] patients, in early April. The level of triage is stratified into four tiers for adult patients according to inpatient COVID-19 load and the reduction of operative capacity.…”

Section: Cardiovascular Surgerymentioning

confidence: 99%

“…• Tier 3 In-patients who cannot be discharged safely without surgical intervention/correction including emergency services are indicated to need essential surgery when there is 60-80% inpatient COVID-19 load and severe reduction in operative capacity. • Tier 4 Only emergency services (based on resource availability) are considered to be essential when there is more than 80% inpatient COVID-19 load and minimal operative capacity [61].…”

Section: Cardiovascular Surgerymentioning

confidence: 99%

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COVID-19: clinical issues from the Japan Surgical Society

et al. 2020

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In this unprecedented COVID-19 pandemic, several key issues must be addressed to ensure safe treatment and prevent rapid spread of the virus and a consequential medical crisis. Careful evaluation of a patient's condition is crucial for deciding the triage plan, based on the status of the disease and comorbidities. As functionality of the medical care system is greatly affected by the environmental situation, the treatment may differ according to the medical and infectious disease circumstances of the institution. Importantly, all medical staff must prevent nosocomial COVID-19 by minimizing the effects of aerosol spread and developing diagnostic and surgical procedures. Polymerase chain reaction (PCR) screening for COVID-19 infection, particularly in asymptomatic patients, should be encouraged as these patients are prone to postoperative respiratory failure. In this article, the Japan Surgical Society addresses the general principles of surgical treatment in relation to COVID-19 infection and advocates preventive measures against viral transmission during this unimaginable COVID-19 pandemic.

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Section: Cardiovascular Surgerymentioning

confidence: 99%

Section: Cardiovascular Surgerymentioning

confidence: 99%

COVID-19: clinical issues from the Japan Surgical Society

et al. 2020

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“…The Society of Thoracic Surgeons COVID-19 Taskforce and the Workforce for Adult Cardiac and Vascular Surgery published criteria for centers that should mostly maintain cardiac surgery services and described patients needing emergency operations. 3 Basically, all centers should diminish their routine caseload and only Tier-1 centers (with satisfactory backup) should maintain most of the work selecting emergency patients while deferring the majority of cases. Surgical services are advised to focus on specific patient population:…”

Section: Patient Selectionmentioning

confidence: 99%

Perioperative management of COVID-19 patients undergoing cardiac surgery with cardiopulmonary bypass

Günaydın

Stammers²

2020

Perfusion

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Coronavirus disease 2019 (COVID-19) is a serious health concern which affects all healthcare professionals worldwide. The pandemic puts health services, including cardiac surgery units, under escalating pressure. There are significant challenges caused by this novel virus and ensuing disease that leads to great uncertainty. While it has been advocated to delay elective surgeries, most cardiac surgical patients present in a more urgent manner which elevates the critical nature for intervention, which may make the surgical decision inevitable. To date, no definitive treatments to the pandemic have been promoted. Cardiac surgical centers may experience an increasing number of COVID-19 patients in clinical practice. Preparation for managing these patients will require a change in the current modalities for perioperative care. Therefore, the goal of this report is to share our own experiences, combined with a review of the emerging literature, by highlighting principles for the adult cardiac surgery community regarding treatment of patients scheduled for surgery. The following report will recommend perioperative guidance in patient management to include safety precautions for the heart team, the conduct of extracorporeal circulation and related equipment, and covering the early period in intensive care in the context of the current pandemic.

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“…Elective cardiac surgeries have been postponed or stopped at many centres during the period of nationwide lockdown. The intent of postponing or cancelling cardiac operations are (i) protecting the cardiac patient from undue morbidity and mortality, (ii) protecting the institution and society at large and (iii) protecting the health care team [4]. The Government of India (GOI) has lifted the lockdown from June 1, 2020, with a few restrictions.…”

Section: Indian Health Care-diversity In Its Foundationmentioning

confidence: 99%

An Indian study: impact of COVID-19 on clinical decision-making and consensus in cardiac surgery practice across the country

Idhrees¹,

Padmanabhan

Jagadeesan

et al. 2020

Indian J Thorac Cardiovasc Surg

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Purpose There is a paucity of evidence and guidelines to support clinical decisions in the present unprecedented time. We aimed to use the experience and consensus of the cardiac surgeons for clinical decisions until evidence-based guidelines are formed. Methods An electronic questionnaire was emailed to all the 1434 members of the Indian Association of Cardiovascular and Thoracic Surgery, starting from May 13, 2020, and the members were followed up with reminder emails. For a wider reach, social media like WhatsApp was also used to circulate the questionnaire. Participation was voluntary and anonymized. An effective consensus was considered when > 70% opted the same opinion, and moderate consensus when > 50% opted the same opinion. Results A total of 174 responses were obtained from the surgeons across the country. An effective consensus was obtained for the following: (i) emergency surgery in acute type A aortic dissection, (ii) urgent surgery in significant left main stem disease and mitral/aortic valves with pulmonary oedema, (iii) elective surgery in stable triple vessel disease and (iv) preoperative nasal swab examination for all patients undergoing surgery. Conclusion In the present era, where evidence is evolving and the country is entering a phase after lockdown, the surgeons face a dilemma in operating patients. These consensuses provide interim recommendation; still further evidence is published.

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Adult Cardiac Surgery During the COVID-19 Pandemic: A Tiered Patient Triage Guidance Statement

Cited by 109 publications

References 1 publication

COVID-19: clinical issues from the Japan Surgical Society

COVID-19: clinical issues from the Japan Surgical Society

Perioperative management of COVID-19 patients undergoing cardiac surgery with cardiopulmonary bypass

An Indian study: impact of COVID-19 on clinical decision-making and consensus in cardiac surgery practice across the country

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