Interventional cardiologists should prioritize the conservation of medical resources, minimization of potential COVID-19 exposure and reallocation of resources, according to a paper published on April 9 in the Journal of Invasive Cardiology.

In the article, Le Bonheur Children's Hospital and the University of Tennessee Health Science Center Interventional Cardiologist Shyam Sathanandam, MD, suggests that catheterization laboratories should develop strategies for patient care by preserving and repurposing resources.

Sathanandam published the work after issuing a web-based survey to 56 unique U.S. centers, with the objective of describing current practice patterns and recommending potential resource allocation for congenital cardiac catheterization during the COVID-19 pandemic.
"We are faced with a fundamental question," said Sathanandam, who serves as the medical director of Le Bonheur Children's Interventional Cardiac Imaging and Interventional Catheterization Laboratory. "How can we, as pediatric and congenital interventional cardiologists, continue to care for patients who require intervention, while also being good stewards of limited medical resources and maintain an appropriate level of preparedness when we are uncertain about how this pandemic will affect our discipline?"

Medical Resource Utilization and Case Selection

The majority of survey respondents felt they had sufficient PPE to care for COVID-19 positive patients or PUIs. However, limited access to PPE and ventilators necessitates postponing elective catheterization cases to assist with the preservation of medical resources. The paper recommends using a multi-disciplinary clinical leadership team to triage case priority and timing - at present, only one-half of the reporting U.S. programs employed this strategy to review case selection.

While responding centers have canceled elective procedures with relative uniformity, centers in counties with 2,000 or more COVID-19 cases were more likely to delay certain cases including PDA closures in premature infants, pre-Glenn catheterization and coarctation stenting.

Minimizing Exposure

The responses suggest that many programs may not be adequately prepared for a surge of COVID-19 positive patients. Centers located in areas with higher number of COVID-19 cases have been more involved in a simulation of donning and doffing PPE equipment than low-prevalence centers (46.7% vs. 10.3%). Only 10.8% had converted a Cath lab to a negative pressure room for potential COVID-19 positive patient or PUI. The majority (65%) were only testing for COVID-19 prior to cardiac catheterization if the patient was symptomatic. Only 15% tested all patients prior to aerosol-generating procedures in the Cath lab.

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