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COVID-19 Message Board

Tuesday, April 21, 2020

By

Mark Ferguson

The classification of the COVID-19 threat by the WHO as a pandemic underscores the massive impact that this infection is having around the world, both now and for the foreseeable future. Cardiothoracic surgeons are among those at the forefront of mitigating this pandemic through a variety of means: educating our colleagues, patients and friends; changing our professional and personal behaviors to reduce risks; and providing direct care to the sickest of the sick.

Each individual who is involved in any of these responses to the COVID-19 pandemic learns something new from every patient interaction. Most such individuals also are faced with questions for which answers are not readily available. In its role of promoting the sharing of knowledge among cardiothoracic surgeons, CTSNet has created a message board that will facilitate conversations among caregivers in real time, and an open access online COVID-19 Portal will be available shortly. These tools will help improve the quality and timeliness of the care that we provide our patients.

Please use the comment function for this COVID-19 Message Board to offer advice, insights, algorithms, and technical tips, and to pose questions for the cardiothoracic community regarding COVID-19. We will maintain this functionality while the need persists. The message board will be appropriately monitored and edited to ensure that it is maintained as a focused clinical resource.

Disclaimer

The COVID-19 Message Board is an information exchange board only. CTSNet takes no responsibility for the accuracy of the information, and please note that the appropriateness and accuracy of the information may change over time.

Comments

Submitted by Sanford Zeigler on
Our CVICU is now closed to visitors, except in specific situations. These specific situations include: 1. Chronically critically ill 2. Extreme anxiety requiring companionship 3. Day of surgery 4. End of life For groups 1 and 2, we are allowing a single visitor with no in and out privileges. They are instructed to self monitor and hand wash on the way in and out. They are allowed to use the patient toilet. Working with nutrition about securing food trays for visitors. Groups 3 and 4, 2 visitors, with same precautions. In extenuating circumstances, we have allowed up to 10 patients, 2 at a time, for brief visits. We have screening at the hospital entrance in place. All staff in CVICU is instructed to self-monitor.
Submitted by Amy Fiedler on
Thanks for your comment Sanford. We have instituted a strict 1 visitor per patient per day policy, with all staff required to self-monitor and not come to work if ill or suspect infection. We are also prioritizing operative cases, which is a fluid process as the situation evolves.
Submitted by Joel Dunning on
See here for Simulation of the intubation plan for COVID-19 patients in the current pandemic. Simulation follow the FICM, RCoA, ICS and AAGBI online published guidance. - https://youtu.be/yytVJzTgV_c
Submitted by Mariano Camporrotondo on
Hello. Few questions, How do you manage elective cases? do you still operate elective cases? Do you conformate surgery team in case of infection of team members? In our hospital we create two teams of surgeons, residents, anesthesiologist for 14days in case some team meamber get the disease.
Submitted by Joseph Lugo on
As with respect elective cases our hospital ( like every other hospital ) has moved to postponing all elective surgery and other procedures. I'm getting pushback from the two cardiologists on our TAVR team regarding postponing TAVRs (except for clinically deteriorating patients) for the next 30 days. Any thoughts?
Submitted by Edward Bender on
We are postponing TAVR cases just like open cases. The heart team has determined that these cases should be treated like elective cath's. I would direct the physicians in question to whomever is coordinating the clinical changes in your hospital - probably an administrative type. If there is a clinical change in the patient, and if there are resources to do TAVR (facemarks, gloves, etc) then we would do them. If not, they get medically treated as best as possible - hopefully as an outpatient.
Submitted by Amy Fiedler on
Hi all, Thank you for your comments. Mariano, regarding elective cases, in the US each hospital system seems to be creating their own plans. Many have said that all elective cases will be re-scheduled, and the OR will run for emergencies only. Many hospitals are also functioning in "teams" so if a healthcare provider on the team becomes infected, that team will be at home for 14 days and another team will replace them. In my opinion, unless clinically deteriorating, as Ed Bender states, that TAVR should be postponed and treated like elective caths. Amy
Submitted by Amy Fiedler on
Hi Hafil, Thank you for your comment. There is some nice information on the role of ECMO in the management of the COVID-19 patient posted in the COVID-19 portal on the headline bar of CTSNet. Sadly, institutions in areas that have been the hardest hit have had the most experience, and we thank them for providing their institutional expertise surrounding this matter. Amy
Submitted by Elie Elmann on
Hi all, Same. Agree with ECMO reviews on the CTSnet website. Our ECMO experience for COVID is very limited and reserved to potential survivors (young and low co-morbidities). Major issue as we are close to peak in numbers of very sick patients admitted to our ICUs. Interestingly, that we are seeing 20% superimposed non-COVID infections and a run of type II MIs, more than anticipated. I wonder about other centers experience. Elie.
Submitted by Amy Fiedler on
Hi Elie. Thank you for your comment and for serving on the front lines in NY/NJ. I have read anectodes regarding a run of type II MIs in COVID positive patients.. will certainly be interesting to hear from others. Wonder if any of our colleagues in Seattle or California may have some additional information? Amy
Submitted by Edgar Tuazon on
Hi. In the absence of testing, either due to the urgency of the procedure or limited in testing kits available, and having to perform an emergent/ urgent procedure, do you treat these patients as potential Covid positives in light of sub clinical asymptomatics that become positive after the OR? Do you wear PPEs for that matter when doing the operation?
Submitted by Amy Fiedler on
Hi Edgar, Thank you for the comment. At my institution, and many others around the US, in the absence of testing we are treating the patients as PUI and take all appropriate precautions, such as N95 while operating. Amy
Submitted by Patrick Myers on
That depends on the situation and ressources available at your institution I think. We have considered it as such, except in patients readmitted with HF from severe AS. And also considering: we don't want to expose high risk elderly patients to COVID by being hospitalized if not needed.
Submitted by Patrick Myers on
COVID has impacted our cardiac surgery practices. We would like to learn how much and in what ways from all of our colleagues in cardiac surgery. Please take a look & fill out our survey, through our twitter feed (https://twitter.com/pomyers/status/1255532401805189123?s=20), or directly on our form: https://bit.ly/2xZTGUg Posted on Posted on behalf of Francesco Onorati (Verona), Pietro Bajona (Pittsburgh), Edu Quintana (Barcelona) and myself. It should take about 5 minutes. Thanks!
Submitted by Rafiq Khan on
Beating heart off pump minimally invasive cardiac surgery can be the best option in COVID 19 ear in terms of shorter surgery time ,fast tract extubation, less personnel involved and shorter icu and hospita stay

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