- 1.Cardiac surgeons should be actively engaged in the emergency response teams of their respective institutions during the pandemic response.
- 2.The first priority of the cardiac surgery team is to ensure that the cardiac surgery needs of the hospital, the health region, and—in certain instances—the province, are met within the context of the COVID-19 burden within their jurisdictions. However, cardiac surgeons, in this time of need, should also be willing to take on additional responsibilities, including—but not limited to—performing noncardiac surgery, caring for nonsurgical cardiovascular patients, and caring for critically ill patients irrespective of their COVID-19 status.
- 3.Cardiac surgeons should be involved in regular discussions with their administrations, cardiology colleagues, and critical care colleagues to evaluate resource availability to ensure the appropriate utilization of potentially scarce resources including—but not limited to—ward and intensive care unit beds, ventilators, ECMO circuits, operating rooms, equipment, drapes, PPE, medications, blood products, and health care personnel.
- 4.Cardiac surgeons should triage patients that are in hospital or on the elective wait list in a manner that is based not only on the patient’s clinical status and risk-factor profile but also on the extent to which services are available or have been reduced in response to the COVID-19 pandemic (Fig. 2). This is a strategy similar to the one recently adopted by the Canadian Association of Interventional Cardiology (CAIC).
- 5.Cardiac surgeons should advocate for a continued role for the heart-team model to solicit the input of clinical cardiology, interventional cardiology, interventional radiology, and critical care in determining the optimal intervention for patients: in particular, those who cases are complex or who are at high risk.
- 6.In an effort to minimize risk to patients, cardiac surgeons should employ virtual clinics—using either a secure form of teleconferencing or videoconferencing—to assess patients from home who are either new referrals, postoperative follow-ups, or currently on the wait list. Similar technology may be used, if available, to assess inpatients from other institutions to avoid potentially unnecessary hospital-to-hospital transfers.
- 7.When it is feasible, cardiac surgical programs should make every effort to maintain areas within their institutions for cardiac surgery patients that are completely separate from patients with COVID-19, given the vulnerability of the average cardiac surgery patient (increased biological age and cardiovascular risk factors) were they to become infected with COVID-19.
- 8.Nonemergent cardiac surgical interventions for patients suffering from acute viral infections (such as—but not limited to—COVID-19) are largely discouraged, based on the belief that this could significantly elevate the risk of postoperative acute respiratory distress syndrome and mortality in that setting.5In the event that a cardiac surgical procedure is performed on presumed or confirmed COVID-19–positive patients, cardiac surgeons must be closely engaged with their hospital administrations and infection control personnel to ensure the safety of the health care team.
- 9.Cardiac surgeons should take the necessary steps (eg, donning and doffing PPE), as mandated by their institution and their local health authorities, to ensure their own health and well-being as well as the health and well-being of the members of the health care teams that they work with.
- 10.Cardiac surgeons and their health care teams must be aware of procedures and techniques that may potentially generate increased quantities of aerosol matter including—but not limited to—double-lumen vs single-lumen endotracheal intubation, reoperative minimally invasive surgery requiring lung dissection, and redo sternotomy vs traditional sternotomy.
- 11.Cardiac surgeons across Canada are encouraged to share their expertise and novel experiences as they relate to the COVID-19 pandemic in a timely manner to improve overall outcomes. For example, protocols for triaging of patients on the wait list, ECMO use, and the operating-room management of COVID-19–positive patients should be posted online, using readily available Web-based platforms that would allow for cardiac surgeons and their teams to learn from each other in real time.
- WHO Director-General's Opening Remarks at the Media Briefing on COVID-19 - 11 March 2020. World Health Organization.(March 11, 2020)www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020(Accessed April 1, 2020)
- Coronavirus Disease (COVID-19) Situation Dashboard. World Health Organization, April 1, 2020.Accessed April 1, 2020)
- Government of Canada. Canada.ca, Government of Canada, April 1, 2020.Accessed April 1, 2020)
Wood DA, Sathananthan J, Cohen EA. Precautions and procedures for coronary and structural cardiac interventions during the COVID-19 pandemic: guidance from Canadian Association of Interventional Cardiology [e-pub ahead of print]. Can J Cardiol, https://doi.org/10.1016/j.cjca.2020.03.027.
- Influenza season and ARDS after cardiac surgery.N Engl J Med. 2018; 378: 772-773
See page 955 for disclosure information.