Elective cardiac surgery during the COVID-19 pandemic: Proceed or postpone?

Shehata, Islam Mohammad; Elhassan, Amir; Jung, Jai Won; Urits, Ivan; Viswanath, Omar; Kaye, Alan D.

doi:10.1016/j.bpa.2020.07.005

Cited by 20 publications

(20 citation statements)

References 48 publications

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“…Lastly, cardiopulmonary bypass might have a deleterious effect on COVID-19 patients undergoing cardiac surgery. This is explained by an increased inflammatory response triggered by the non-endothelial surfaces of the pump [22]. However, as off-pump CABG is not routinely performed in our institute, this study was unable to evaluate a comparison between this possible effect of on-pump CABG.…”

Section: Discussionmentioning

confidence: 94%

The impact of COVID-19 pandemic on cardiac surgery in Israel

Keizman

Ram

Kachel

et al. 2020

J Cardiothorac Surg

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Background Ever since the coronavirus disease 2019 (COVID-19) has become a pandemic, worldwide efforts are being made to “flatten the curve”. Israel was amongst the first countries to impose significant restrictions. As a result, cardiac surgeons have been required to scale down their routine practice, resulting in a significant reduction in the number of cardiac surgeries. The aim of this study is to characterize the impact of COVID-19 on cardiac surgery in Israel. Methods This is a retrospective observational study performed in two cardiac surgery departments in Israel and includes all patients who underwent cardiac surgery in March and April during the years 2019 and 2020. The patient cohort was divided into two groups based on the year of operation. Analysis of the patients’ baseline characteristics, operative data, and postoperative outcome, was performed. Results The 2019 group (n = 173), and the 2020 group (n = 108) were similar regarding their baseline characteristics, previous medical history, and rates of previous revascularization interventions. However, compared to the 2019 group, patients in the 2020 group were found to be more symptomatic (NYHA class IV; 2.4% vs. 6.2%, p = 0.007). While all patients underwent similar procedures, patients in the 2020 group had significantly longer procedural time (p < 0.001). In-hospital mortality rate was found to be significantly higher in group 2020 (13% vs. 5.2%, p = 0.037). Conclusions While the number of patients undergoing cardiac surgery declined during the outbreak period, the rate of surgical mortality increased. One explanation for this might be delayed hospital arrival.

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Section: Discussionmentioning

confidence: 94%

The impact of COVID-19 pandemic on cardiac surgery in Israel

Keizman

Ram

Kachel

et al. 2020

J Cardiothorac Surg

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“…Many procedures considered "elective" are important to patients, and delaying such procedures can cause emotional and physical harm. 35,36 Surgical procedures are also a financial lifeline for small hospitals and safety net hospitals that can ill-afford to forgo revenue during a pandemic. 37 More research is needed to better understand these tradeoffs.…”

Section: Discussionmentioning

confidence: 99%

Actions Taken by US Hospitals to Prepare for Increased Demand for Intensive Care During the First Wave of COVID-19

Kerlin¹,

Costa²,

Davis³

et al. 2021

Chest

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Background The coronavirus disease 2019 (COVID-19) pandemic placed considerable strain on critical care resources. How United States (U.S.) hospitals responded to this crisis is unknown. Research question What actions did U.S. hospitals take to prepare for a potential surge in demand for critical care services in the context of the COVID-19 pandemic? Study design and methods From September to November 2020 we surveyed the chief nursing officers of a representative sample of U.S. hospitals regarding organizational actions taken to increase or maintain critical care capacity during the pandemic. We calculated weighted proportions of hospitals for each potential action in order to create estimates across the entire population of U.S. hospitals, accounting for both the sampling strategy and non-response. We also examined whether the types of actions taken varied by the cumulative regional incidence of COVID-19 cases. Results We received responses from 169 of 540 surveyed U.S. hospitals (response rate: 31.3%). Almost all hospitals canceled or postponed elective surgeries (96.7%) and non-surgical procedures (94.8%). Few hospitals created new medical units in areas not typically dedicated to health care (12.9%), and almost none adopted triage protocols (5.6%) or protocols to connect multiple patients to a single ventilator (4.8%). Actions to increase or preserve intensive care unit (ICU) staff, including use of ICU telemedicine, were highly variable, without any single dominant strategy. Hospitals experiencing higher incidence of COVID-19 did not consistently take different actions compared to hospitals facing lower incidence. Interpretation Responses of hospitals to the mass need for critical care services due to the COVID-19 pandemic were highly variable. Most hospitals canceled procedures to preserve ICU capacity and scaled up ICU capacity using existing clinical space and staffing. Future work linking hospital response to patient outcomes can inform planning for additional surges of this pandemic or other events in the future.

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“…Increasing evidence attribute, the cause of acute respiratory distress syndrome (ARDS) in COVID‐19 to cytokine storm syndrome, especially that patients with COVID‐19 have been found to have high levels of pro‐inflammatory cytokines (tumor necrosis factor α [TNF‐α] and interleukin‐10 [IL‐10]), which is also associated with the disease severity. Thus, the exposure of blood to the nonendothelial surfaces during CPB which activates the inflammatory response by via coagulation pathways, complement system, and increasing the level of TNF‐α and IL‐10, can have detrimental effect in those high‐risk patients for COVID‐19 infection, especially in the case of silent carriers 14 …”

Section: Methodsmentioning

confidence: 99%

Exploring the impact of the COVID‐19 pandemic on cardiac surgical services: A scoping review

Shah

Zafar

Yasmin

et al. 2021

Journal of Cardiac Surgery

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Cardiac surgery was severely affected by the COVID‐19 pandemic. Reallocation of resources, conversion of surgical intensive care units and wards to COVID‐19 facilities, increased risk of nosocomial transmission to cardiac surgery patients, lead to reduced accessibility, quality, and affordability of health care facilities to cardiac surgery patients. Increasing the mortality and morbidity rate among such patients. Cardiac patients are at an increased risk to develop a severe illness if infected by COVID‐19 and are associated with a high mortality rate. Therefore, measures had to be taken to reduce the spread of the virus. Various approaches such as the hubs and the spokes centers, or parallel system were enforced. Elective surgeries were postponed while urgent surgeries were prioritized. Use of personal protective equipments and surgeries performed by only senior surgeons became necessary. Surgical trainees were also affected as limited training opportunities deprived them of the experience required to complete their fellowship. Some of the trainees were reallocated to COVID‐19 wards, while others invested their time in research opportunities. Online platforms were used for teaching, meetings, and workshops across the globe. Although some efforts have been made to reduce the impact of the pandemic, more research and innovation is required.

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Elective cardiac surgery during the COVID-19 pandemic: Proceed or postpone?

Cited by 20 publications

References 48 publications

The impact of COVID-19 pandemic on cardiac surgery in Israel

The impact of COVID-19 pandemic on cardiac surgery in Israel

Actions Taken by US Hospitals to Prepare for Increased Demand for Intensive Care During the First Wave of COVID-19

Exploring the impact of the COVID‐19 pandemic on cardiac surgical services: A scoping review

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