ACC Interventional Council, SCAI Address Cath Lab Considerations During COVID-19

A joint statement from the ACC Interventional Council and the Society of Cardiovascular Angiography and Intervention (SCAI) addresses catheterization (cath) lab considerations in light of the COVID-19 pandemic.

Specifically, the statement focuses on three main areas: 1) patient selection for the cath lab; 2) resource allocation and protection for the health care team; and 3) health care workers and personal protection equipment (PPE).

When it comes to patient selection, the authors offer recommendations for managing elective cath lab procedures, as well as patients with STEMI, NSTEMI and those requiring intubation, suctioning or CPR. They note that many U.S. institutions have already placed a moratorium on elective cath lab procedures to preserve resources and avoid potential patient exposure to COVID-19.

The statement urges cath labs to prepare for likely inevitable staff shortages due to infected/exposed/quarantined staff and/or the downstream impacts of school closings and other workforce issues on staff and their families. The authors note that "specific consideration to subspecialty care teams may be required" and recommend that for "known COVID-19 positive patients, restriction of cases to a dedicated laboratory may be of value."

In terms of protection of cath lab personnel, the statement recommends that all staff be fit-tested for N95 masks and be trained/well-versed in proper use of PPE. The document provides additional details on equipment and planning, especially given shortages of equipment, noting that this guidance is "particularly relevant for teaching institutions where multiple physicians often scrub into cases."

According to Frederick G.P. Welt, MD, FACC, chair of ACC's Interventional Section Leadership Council, "The idea and effort for this statement was prompted by many in the interventional community fielding questions from colleagues and/or reaching out to others about how to deal with cardiac cath lab cases during the pandemic. Would we continue with 'business as usual,' how would we deal with STEMIs and NSTEMIs, and were there COVID-19 specific issues that we would need to know. Of course, a huge part of this is how do we protect ourselves. This document had a truly remarkable turnaround, however, this is just the beginning. We need to find ways to continually update our experience with the pandemic as it relates to the cath lab and find avenues to get that information to practicing physicians around the country and world."

The joint statement was published March 17 in the Journal of the American College of Cardiology.

Keywords: Pandemics, Quarantine, Catheterization, COVID-19, Intubation, Intratracheal, Cardiopulmonary Resuscitation, Angiography

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