Performing elective cardiac invasive procedures during the COVID-19 outbreak: a position statement from the European Association of Percutaneous Cardiovascular Interventions (EAPCI)

EuroIntervention Journal

Abstract

The rearrangement of healthcare services required to face the coronavirus disease 2019 (COVID-19) pandemic led to a drastic reduction in elective cardiac invasive procedures. We are already facing a “second wave” of infections and we might be dealing during the next months with a “third wave” and subsequently new waves. Therefore, during the different waves of the COVID-19 pandemic we have to face the problems of how to perform elective cardiac invasive procedures in non-COVID patients and which patients/procedures should be prioritised. In this context, the interplay between the pandemic stage, the availability of healthcare resources and the priority of specific cardiac disorders is crucial. Clear pathways for “hot” or presumed “hot” patients and “cold” patients are mandatory in each hospital. Depending on the local testing capacity and intensity of transmission in the area, healthcare facilities may test patients for SARS-CoV-2 infection before the interventional procedure, regardless of risk assessment for COVID-19.

Pre-hospital testing should always be conducted in the presence of symptoms suggestive of SARS-CoV-2 infection. In cases of confirmed or suspected COVID-19 positive patients, full personal protective equipment using FFP 2/N95 masks, eye protection, gowning and gloves is indicated during cardiac interventions for healthcare workers. When patients have tested negative for COVID-19, medical masks may be sufficient. Indeed, individual patients should themselves wear medical masks during cardiac interventions and outpatient visits.

Introduction

The rearrangement of healthcare services required to face the coronavirus disease 2019 (COVID-19) pandemic led to drastic reductions of elective cardiac invasive procedures. Regions in Europe differ substantially in terms of local healthcare resources, pandemic extent, phase of the COVID-19 outbreak, changes of the pandemic over time and therefore access to healthcare services other than COVID-19 care. During the “first wave”, these variations had a wide range of implications for regional healthcare services, national healthcare authorities and in-hospital redistribution of resources.
We are now in a phase of the COVID-19 pandemic whereby some countries are already facing a “second wave” of infections and we might be dealing during the coming months with a “third wave” and subsequently new waves of infection. Therefore, we have to face the problems of how to perform elective cardiac invasive procedures in non-COVID patients and which patients/procedures should be prioritised during the different waves of the COVID-19 pandemic.

Simultaneously, during these phases, protocols that provide maximum safety of patients and healthcare workers (HCWs) during the hospitalisation and procedures require to be designed. The European Association of Percutaneous Cardiovascular Interventions (EAPCI) has assembled a panel of interventional cardiologists with first-hand experience from affected areas, representatives of heavily, moderately and marginally affected countries and expertise in network organisation. The objective of this position statement is to define algorithms for safe performance of elective cardiac procedures according to the local extent and phase of the pandemic and available resources to prioritise patient work-up and procedures.
This statement reflects the official position of the EAPCI, meant to provide an overall guidance that should be adapted to the local situation and regulations.

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