The Journal of American College of Cardiology published online a joint statement from the American College of Cardiology (ACC) Interventional Council and the Society of Cardiovascular Angiography and Intervention (SCAI) regarding the considerations needed for catheterization laboratories amid this COVID-19 pandemic.
Welt et al suggest that deferring truly elective cases should be considered at this time. However, the definition of elective case should be individualized specifically weighing the risk of COVID-19 exposure to the consequences of delayed treatment provided in the catheterization lab. The authors suggest procedure types such as true angioplasty for stable angina, endovascular intervention for ilio-femoral disease for claudication or patent foramen ovale may fit these criteria.
This is in line with the announcement released March 19th from the Centers for Medicare & Medicaid Services (CMS) that all elective surgeries, non-essential medical, surgical, and/or dental procedures should be delayed during this COVID-19 outbreak.
Welt et al further comment of the usage of fibrinolytic therapy for patients presented with an ST elevation myocardial infarction (STEMI) should not be ruled out for those patients who have tested positive or are thought to be active with COVID-19. The risk of staff exposure needs to be taken into account when treating these patients and the authors further comment that such patients should only be treated with appropriate personal protective equipment (PPE) is available. Additionally, catheterization laboratories are not normal equipped with ventilation systems designed for infection isolation despite a some have positive ventilation.
The treatment of patients requiring intubation and/or CPR during their stint in the catheterization laboratory with definite or suspected COVID-19 should be intubated prior to lab arrival to reduce the staff exposure.
The reduction in elective cases and potential usage of lytic therapy for STEMI patients may help alleviate stress on the staff. Additionally, the authors stress the importance of availability of PPE including N-95 masks.
Welt FGP, Shah PB, Aronow HD, Bortnick AE, Henry TD, Sherwood MW, Young MN, Davidson LJ, Kadavath S, Mahmud E, KirtaneAJ, from the American College of Cardiology’s (ACC) Interventional Council and the Society of Cardiovascular Angiography and Intervention (SCAI), Catheterization Laboratory Considerations During the Coronavirus (COVID-19) Pandemic: From ACC’s Interventional Council and SCAI, Journal of the American College of Cardiology (2020), doi: https://doi.org/10.1016/j.jacc.2020.03.021.