IACTS guidelines: practice of cardiovascular and thoracic surgery in the COVID-19 era

Abstract

Patients undergoing cardiovascular and thoracic procedures are at an accentuated risk of higher morbidity and mortality, which are a consequence of the proliferative nature of the severe acute respiratory syndrome-corona virus 2 (SARS-CoV-2) on the lung vasculature, which in turn reflects as a cascading effect on the interdependent physiology of the cardiovascular and pulmonary organ systems. These are secondary to systemic inflammatory response syndrome and immunosuppressive responses to surgery and mechanical ventilation. Thus, the need to establish guidelines for the practice of cardiothoracic surgery which is safe for both the patient and the healthcare team presents as a priority, which is the mainstay of this article.

Keywords: COVID-19; Cardiovascular; India; SARS-CoV-2; Thoracic.

Fig. 1

Protocol for preoperative testing. (Abbreviations: RT PCR-reverse transcription polymerase chain reaction test; HRCT-high resolution computed tomography; PPE-personal protective equipment. Illustration by Aditya N.D, Sujith N.S, C.S Hiremath)

Fig. 2

Schematic detailing management of symptoms. (Abbreviations: ARDS- acute respiratory distress syndrome; ECMO-extracorporeal membrane oxygenation. Illustration by Aditya N.D, Sujith N.S, C.S Hiremath)

Fig. 3

Establishing a simple triage-based system to categorise patients based on severity of presenting (non-COVID19 like) symptoms. (Illustration by Aditya N.D, Sujith N.S, C.S Hiremath)