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1.
Ann Thorac Surg ; 114(2): 387-393, 2022 08.
Article in English | MEDLINE | ID: covidwho-1872926

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic continues to disrupt the provision of cardiac procedural services due to overwhelming interval surges in COVID-19 cases and the associated crisis of cardiac intervention deferment. Despite the availability of widespread testing, highly efficacious vaccines, and intensive public health efforts, the pandemic is entering its third year, where new severe acute respiratory syndrome-coronavirus-2 variants have increased the likelihood that patients scheduled for a cardiac intervention will contract COVID-19 in the perioperative period. The Society of Thoracic Surgeons (STS) Workforce on Critical Care, the STS Workforce on Adult Cardiac and Vascular Surgery, and the Canadian Society of Cardiac Surgeons have developed this document, endorsed by the STS and affirmed by the Society of Cardiovascular Angiography and Interventions and the Canadian Association of Interventional Cardiology, to provide guidance for cardiac procedure deferment and intervention timing for preoperative patients diagnosed with COVID-19. This document is intended for the perioperative cardiac surgical team and outlines the present state of the pandemic, the impact of COVID-19 on intervention outcome, and offers a recommended algorithm for individualized cardiac procedure triage and timing.


Subject(s)
COVID-19 , Cardiac Surgical Procedures , Surgeons , Adult , Canada , Humans , SARS-CoV-2 , Triage/methods
2.
J Card Surg ; 36(9): 3040-3051, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1266339

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has had an unprecedented impact on health care and cardiac surgery. We report cardiac surgeons' concerns, perceptions, and responses during the COVID-19 pandemic. METHODS: A detailed survey was sent to recruit participating adult cardiac surgery centers in North America. Data regarding cardiac surgeons' perceptions and changes in practice were analyzed. RESULTS: Our study comprises 67 institutions with diverse geographic distribution across North America. Nurses were most likely to be redeployed (88%), followed by advanced care practitioners (69%), trainees (28%), and surgeons (25%). Examining surgeon concerns in regard to COVID-19, they were most worried with exposing their family to COVID-19 (81%), followed by contracting COVID-19 (68%), running out of personal protective equipment (PPE) (28%), and hospital resources (28%). In terms of PPE conservation strategies among users of N95 respirators, nearly half were recycling via decontamination with ultraviolet light (49%), followed by sterilization with heat (13%) and at home or with other modalities (13%). Reuse of N95 respirators for 1 day (22%), 1 week (21%) or 1 month (6%) was reported. There were differences in adoption of methods to conserve N95 respirators based on institutional pandemic phase and COVID-19 burden, with higher COVID-19 burden institutions more likely to resort to PPE conservation strategies. CONCLUSIONS: The present study demonstrates the impact of COVID-19 on North American cardiac surgeons. Our study should stimulate further discussions to identify optimal solutions to improve workforce preparedness for subsequent surges, as well as facilitate the navigation of future healthcare crises.


Subject(s)
COVID-19 , Surgeons , Adult , Decontamination , Humans , Pandemics , Perception , SARS-CoV-2
3.
Can J Cardiol ; 37(5): 790-793, 2021 05.
Article in English | MEDLINE | ID: covidwho-965375

ABSTRACT

Hospitals and ambulatory facilities significantly reduced cardiac care delivery in response to the first wave of the COVID-19 pandemic. The deferral of elective cardiovascular procedures led to a marked reduction in health care delivery with a significant impact on optimal cardiovascular care. International and Canadian data have reported dramatically increased wait times for diagnostic tests and cardiovascular procedures, as well as associated increased cardiovascular morbidity and mortality. In the wake of the demonstrated ability to rapidly create critical care and hospital ward capacity, we advocate a different approach during the second and possible subsequent COVID-19 pandemic waves. We suggest an approach, informed by local data and experience, that balances the need for an expected rise in demand for health care resources to ensure appropriate COVID-19 surge capacity with continued delivery of essential cardiovascular care. Incorporating cardiovascular care leaders into pandemic planning and operations will help health care systems minimise cardiac care delivery disruptions while maintaining critical care and hospital ward surge capacity and continuing measures to reduce transmission risk in health care settings. Specific recommendations targeting the main pillars of cardiovascular care are presented: ambulatory, inpatient, procedural, diagnostic, surgical, and rehabilitation.


Subject(s)
COVID-19/epidemiology , Cardiovascular Diseases/therapy , Critical Care/methods , Delivery of Health Care/organization & administration , Pandemics , Canada/epidemiology , Cardiovascular Diseases/epidemiology , Comorbidity , Humans
4.
Can J Cardiol ; 36(8): 1313-1316, 2020 08.
Article in English | MEDLINE | ID: covidwho-733905

ABSTRACT

The COVID-19 pandemic has raised ethical questions for the cardiovascular leader and practitioner. Attention has been redirected from a system that focuses on individual patient benefit toward one that focuses on protecting society as a whole. Challenging resource allocation questions highlight the need for a clearly articulated ethics framework that integrates principled decision making into how different cardiovascular care services are prioritized. A practical application of the principles of harm minimisation, fairness, proportionality, respect, reciprocity, flexibility, and procedural justice is provided, and a model for prioritisation of the restoration of cardiovascular services is outlined. The prioritisation model may be used to determine how and when cardiovascular services should be continued or restored. There should be a focus on an iterative and responsive approach to broader health care system needs, such as other disease groups and local outbreaks.


Subject(s)
Cardiology Service, Hospital , Cardiovascular Diseases , Coronavirus Infections , Ethics, Institutional , Infection Control/methods , Pandemics , Patient Care Management , Pneumonia, Viral , Betacoronavirus/isolation & purification , COVID-19 , Canada/epidemiology , Cardiology Service, Hospital/organization & administration , Cardiology Service, Hospital/trends , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/therapy , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Humans , Models, Organizational , Organizational Innovation , Pandemics/prevention & control , Patient Care Management/ethics , Patient Care Management/methods , Patient Care Management/standards , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , SARS-CoV-2
6.
Ann Thorac Surg ; 110(2): 697-700, 2020 08.
Article in English | MEDLINE | ID: covidwho-701360

ABSTRACT

In the setting of the current novel coronavirus pandemic, this document has been generated to provide guiding statements for the adult cardiac surgeon to consider in a rapidly evolving national landscape. Acknowledging the risk for a potentially prolonged need for cardiac surgery procedure deferral, we have created this proposed template for physicians and interdisciplinary teams to consider in protecting their patients, institution, and their highly specialized cardiac surgery team. In addition, recommendations on the transition from traditional in-person patient assessments and outpatient follow-up are provided. Lastly, we advocate that cardiac surgeons must continue to serve as leaders, experts, and relevant members of our medical community, shifting our role as necessary in this time of need.


Subject(s)
Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Thoracic Surgery/organization & administration , Triage , Adult , Betacoronavirus , COVID-19 , Cardiac Surgical Procedures , Coronavirus Infections/prevention & control , Health Resources/supply & distribution , Humans , Occupational Exposure/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , SARS-CoV-2
7.
J Thorac Cardiovasc Surg ; 160(2): 447-451, 2020 08.
Article in English | MEDLINE | ID: covidwho-661781

ABSTRACT

The COVID-19 pandemic necessitates aggressive infection mitigation strategies to reduce the risk to patients and healthcare providers. This document is intended to provide a framework for the adult cardiac surgeon to consider in this rapidly changing environment. Preoperative, intraoperative, and postoperative detailed protective measures are outlined. These are guidance recommendations during a pandemic surge to be used for all patients while local COVID-19 disease burden remains elevated.


Subject(s)
Betacoronavirus/pathogenicity , Cardiac Surgical Procedures/standards , Coronavirus Infections/prevention & control , Cross Infection/prevention & control , Heart Diseases/surgery , Infection Control/standards , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Infectious Disease Transmission, Professional-to-Patient/prevention & control , Operating Rooms/standards , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Recovery Room/standards , COVID-19 , Cardiac Surgical Procedures/adverse effects , Consensus , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Coronavirus Infections/virology , Cross Infection/epidemiology , Cross Infection/transmission , Cross Infection/virology , Heart Diseases/epidemiology , Humans , Occupational Health/standards , Patient Safety/standards , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Risk Assessment , Risk Factors , SARS-CoV-2 , Virulence
10.
Can J Cardiol ; 36(8): 1317-1321, 2020 08.
Article in English | MEDLINE | ID: covidwho-597883

ABSTRACT

Cardiac rehabilitation programs across Canada have suspended in-person services as a result of large-scale physical distancing recommendations designed to flatten the COVID-19 pandemic curve. Virtual cardiac rehabilitation (VCR) offers an alternate mechanism of care delivery, capable of providing similar patient outcomes and safety profiles compared with centre-based programs. To minimize care gaps, all centres should consider developing and implementing a VCR program. The process of this rapid implementation, however, can be daunting. Centres should initially focus on the collation, utilization, and repurposing of existing resources, equipment, and technology. Once established, programs should then focus on ensuring that quality indicators are met and care processes are protocolized. This should be followed by the development of sustainable VCR solutions to account for care gaps that existed before COVID-19, and to improve cardiac rehabilitation delivery, moving forward. This article reviews the potential challenges and obstacles of this process and aims to provide pragmatic guidance to aid clinicians and administrators during this challenging time.


Subject(s)
Cardiac Rehabilitation , Cardiovascular Diseases , Coronavirus Infections , Pandemics , Pneumonia, Viral , Telerehabilitation , Betacoronavirus , COVID-19 , Canada , Cardiac Rehabilitation/methods , Cardiac Rehabilitation/trends , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/prevention & control , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Humans , Infection Control/organization & administration , Models, Organizational , Organizational Innovation , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Risk Assessment , SARS-CoV-2 , Telerehabilitation/methods , Telerehabilitation/organization & administration
11.
Can J Cardiol ; 36(9): 1550-1553, 2020 09.
Article in English | MEDLINE | ID: covidwho-620877

ABSTRACT

Severe acute respiratory distress syndrome (ARDS) can complicate novel pandemic coronavirus disease (COVID-19). Extracorporeal life support (ECLS) represents the final possible rescue strategy. Variations in practice, combined with a paucity of rigourous guidelines, may complicate blood-product resource availability and allocation during a pandemic. We conducted a literature review around venovenous extracorporeal membrane oxygenation (VV-ECMO) transfusion practices for platelets, packed red blood cells, fresh frozen plasma, prothrombin complex concentrate, and antithrombin. Pertinent society guidelines were examined, and the practice of Canadian ECLS experts was sampled through an environmental scan. This paper represents a synthesis of these explorations, combined with input from the Canadian Cardiovascular Critical Care (CANCARE) Society, Canadian Society of Cardiac Surgeons, and the Canadian Critical Care Society. We offer a pragmatic guidance document for restrictive transfusion thresholds in nonbleeding patients on VV-ECMO, which may attenuate transfusion-related complications and simultaneously shield national blood product inventory from strain during pandemic-induced activation of the National Plan for the Management of Shortages of Labile Blood Components.


Subject(s)
Anticoagulants , Blood Component Transfusion/methods , Coronavirus Infections/complications , Extracorporeal Membrane Oxygenation , Pneumonia, Viral/complications , Respiratory Distress Syndrome , Adult , Anemia/blood , Anemia/etiology , Anemia/therapy , Anticoagulants/classification , Anticoagulants/therapeutic use , Betacoronavirus , Blood Coagulation Tests/methods , COVID-19 , Canada , Consensus , Extracorporeal Membrane Oxygenation/adverse effects , Extracorporeal Membrane Oxygenation/methods , Humans , Pandemics , Respiratory Distress Syndrome/blood , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/therapy , SARS-CoV-2 , Thrombosis/blood , Thrombosis/etiology , Thrombosis/prevention & control
12.
Ann Thorac Surg ; 110(2): 712-717, 2020 08.
Article in English | MEDLINE | ID: covidwho-271258

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has had a profound global impact. Its rapid transmissibility has transformed healthcare delivery and forced countries to adopt strict measures to contain its spread. The vast majority of the United States cardiac surgical programs have deferred all but truly emergent/urgent operative procedures in an effort to reduce the burden on the healthcare system and to mobilize resources to combat the pandemic surge. While the number of COVID-19 cases continue to increase worldwide, the incidence of new cases has begun to decline in many North American cities. This "flattening of the curve" has prompted interest in reopening the economy, relaxing public health restrictions, and resuming nonurgent healthcare delivery. The following document provides a template whereby adult cardiac surgical programs may begin to ramp-up the care delivery in a deliberate and graded fashion as the COVID-19 pandemic burden begins to ease. "Resuscitating" the timely delivery of care is guided by three principles: (1) Collaborate to permit increased case volumes, balancing the clinical needs of patients awaiting surgical procedures with the local resources available within each healthcare system. (2) Prioritize patients awaiting elective procedures while proactively engaging all stakeholders, focusing on those with high-risk anatomy, changing/symptomatic clinical status, and, once these variables have been addressed, prioritizing by waiting times. (3) Reevaluate local conditions continuously to assess for any increase in admissions due to a recrudescence of cases, to assure adequate resources to care for patients, and to monitor in-hospital infectious transmissions to both patients and healthcare workers.


Subject(s)
Coronavirus Infections/epidemiology , Delivery of Health Care/organization & administration , Pneumonia, Viral/epidemiology , Thoracic Surgery/organization & administration , Advisory Committees , Betacoronavirus , COVID-19 , Cardiac Surgical Procedures , Humans , Pandemics , SARS-CoV-2 , Surgeons
13.
Can J Cardiol ; 36(7): 1139-1143, 2020 07.
Article in English | MEDLINE | ID: covidwho-172998

ABSTRACT

The coronavirus disease 2019 (COVID-19) has had a profound global effect. Its rapid transmissibility has forced whole countries to adopt strict measures to contain its spread. As part of necessary pandemic planning, most Canadian cardiac surgical programs have prioritized and delayed elective procedures in an effort to reduce the burden on the health care system and to mobilize resources in the event of a pandemic surge. While the number of COVID-19 cases continue to increase worldwide, new cases have begun to decline in many jurisdictions. This "flattening of the curve" has inevitably prompted discussions around reopening of the economy, relaxing some public health restrictions, and resuming nonurgent health care delivery. This document provides a template for cardiac surgical programs to begin to ramp-up the delivery of cardiac surgery in a deliberate and graded fashion as the COVID-19 pandemic burden begins to ease that is guided by 3 principles. First, all recommendations from public health authorities regarding COVID-19 containment must continue to be followed to minimize disease spread, ensure patient safety, and protect health care personnel. Second, patients awaiting elective cardiac surgery need to be proactively managed, reprioritizing those with high-risk anatomy or whose clinical status is deteriorating. Finally, case volumes should be steadily increased in a mutually agreed upon fashion and must balance the clinical needs of patients awaiting surgery against the overall requirements of the health care system.


Subject(s)
Cardiac Surgical Procedures/standards , Coronavirus Infections/epidemiology , Delivery of Health Care/organization & administration , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Practice Guidelines as Topic , COVID-19 , Canada , Cardiac Surgical Procedures/statistics & numerical data , Coronavirus Infections/prevention & control , Cost of Illness , Female , Humans , Male , Outcome Assessment, Health Care , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Risk Assessment , Safety Management/organization & administration , Societies, Medical/organization & administration , Surgeons/statistics & numerical data
14.
Can J Cardiol ; 36(6): 952-955, 2020 06.
Article in English | MEDLINE | ID: covidwho-77143

ABSTRACT

On March 11, 2020, the World Health Organization declared that COVID-19 was a pandemic.1 At that time, only 118,000 cases had been reported globally, 90% of which had occurred in 4 countries.1 Since then, the world landscape has changed dramatically. As of March 31, 2020, there are now nearly 800,000 cases, with truly global involvement.2 Countries that were previously unaffected are currently experiencing mounting rates of the novel coronavirus infection with associated increases in COVID-19-related deaths. At present, Canada has more than 8000 cases of COVID-19, with considerable variation in rates of infection among provinces and territories.3 Amid concerns over growing resource constraints, cardiac surgeons from across Canada have been forced to make drastic changes to their clinical practices. From prioritizing and delaying elective cases to altering therapeutic strategies in high-risk patients, cardiac surgeons, along with their heart teams, are having to reconsider how best to manage their patients. It is with this in mind that the Canadian Society of Cardiac Surgeons (CSCS) and its Board of Directors have come together to formulate a series of guiding statements. With strong representation from across the country and the support of the Canadian Cardiovascular Society, the authors have attempted to provide guidance to their colleagues on the subjects of leadership roles that cardiac surgeons may assume during this pandemic: patient assessment and triage, risk reduction, and real-time sharing of expertise and experiences.


Subject(s)
Cardiac Surgical Procedures/methods , Cardiovascular Diseases , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Betacoronavirus/isolation & purification , COVID-19 , Canada , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/surgery , Comorbidity , Humans , Pandemics , Patient Selection , Risk Management/organization & administration , SARS-CoV-2 , Triage/methods , Triage/organization & administration
15.
J Thorac Cardiovasc Surg ; 160(2): 452-455, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-72075

ABSTRACT

In the setting of the current novel coronavirus pandemic, this document has been generated to provide guiding statements for the adult cardiac surgeon to consider in a rapidly evolving national landscape. Acknowledging the risk for a potentially prolonged need for cardiac surgery procedure deferral, we have created this proposed template for physicians and interdisciplinary teams to consider in protecting their patients, institution, and their highly specialized cardiac surgery team. In addition, recommendations on the transition from traditional in-person patient assessments and outpatient follow-up are provided. Lastly, we advocate that cardiac surgeons must continue to serve as leaders, experts, and relevant members of our medical community, shifting our role as necessary in this time of need.


Subject(s)
Betacoronavirus/pathogenicity , Cardiac Surgical Procedures/standards , Coronavirus Infections/prevention & control , Cross Infection/prevention & control , Heart Diseases/surgery , Infection Control/standards , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Infectious Disease Transmission, Professional-to-Patient/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Triage/standards , COVID-19 , Cardiac Surgical Procedures/adverse effects , Consensus , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Coronavirus Infections/virology , Cross Infection/epidemiology , Cross Infection/transmission , Cross Infection/virology , Heart Diseases/epidemiology , Humans , Occupational Health/standards , Patient Safety/standards , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Risk Assessment , Risk Factors , SARS-CoV-2 , Virulence
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