PCR Spotlight: preparing your interventional Cardiology team for the COVID-19 pandemic
This is the first in a series of short videos on the subject of preparing for COVID-19. In this discussion, interventional cardiologists Jean Fajadet, Toulouse, France, and Flavio Ribichini, Verona, Italy, share how to best prepare teams and cathlabs before and during the pandemic.
The three main things to remember are Prevent, Protect and Prioritise:
- Prevent by following the simple rules that are currently in place across the world
- Protect your staff and patients
- Prioritise your actions: do what is life-saving for your cardiac patients, prioritise your staff
Speakers
Question from Brazil: if you work in a general hospital, how can you keep your cath lab going?
" If you are in a cath lab with multiple suites in spaced levels you can isolate one just for COVID-19 suspected cases. But how do you do this if you work in a General Hospital with multiple specialities, with a general management who is willing to address COVID-19 patients in their ICU? How can you keep your cath lab going, as you have only one or two labs in the same spot? The same ambulance that brings COVID-19 patients is transporting CAD patients right now in my country... do they follow a strict sterilisation procedure after each COVID-19 patient? If you address one CAD patient also infected with COVID-19, that room is finished for the day, right? And we just do not have tests right now for the mild or asymptomatic carriers..."
Answer from Flavio Ribichini:
If you have only one cathlab it is key that you prioritize it for life-saving procedures, and these are, by large, primary PCI procedures in STEMI/ACS patients. So, the first measure would be to schedule elective procedures only in symptomatic patients under OMT and leave most of the cath availability for emergencies. After a primary PCI in patients without suspected COVID symptoms (no fever, no cough, normal chest x ray, normal lab) you just apply regular cleaning, and then the patient goes to the cardiac ICU.
After a primary PCI in a suspected, or known COVID patient, the lab MUST be cautiously disinfected (dedicated protocols are available in each hospital, most use liquid substances with chloro and the cleaning work may take about one hour). The lab can be used again in case of a second STEMI, otherwise, it is better to leave it ventilated for 3 hours, and then you continue to work. The COVID patient must go to a dedicated COVID-unit and the cardiac ICU must be kept CµOVID-clean.
It is essential that the personnel use adequate personal protection equipment and that everything that has been in contact with the patient is either sterilized or discarded.
This video was recorded on 30 March 2020.
The content of this page reflects the view of the authors at a given point in time and does not necessarily represent the view of PCR or PCRonline.
4 comments
thank you very much for sharing with us such a experience and advices! I would like , if its possible, of course to share with us also the best way to protect ourselves in our cathlab during the procedures. Thank you!
Worldwide we receive information concerning the decrease of admission of ACS / STEMI patients and new forms of severe STEMI in very young patients with normal CA. Could you provide us with information on the field and the new role of thrombolyse,
A webinar with Interventional cardiologists who are located in the storm of COVID19 on their experiences in details on percautions and change of strategy treating cardiological cases in details would be a great idea for all of us. Thank you
Dear colleagues, thank you for these comments and suggestions. Future videos and other resources will address the essential topic of personal protection. As mentioned by professor Marco, there are several indications from various regions that the number of patients admitted with typical presentations of an acute coronary syndrome is lower than before the COVID-19 crisis. With the increased overall stress and increased inflammation in infected patients, one would expect exactly the opposite. A series of videos to be released shortly will address this and other issues related to the diagnosis and management of acute coronary syndromes.