Supporting medical staff in managing COVID-19 patients
As the number of infected patients increases exponentially, and more hospital beds are dedicated to COVID-19 patients, all available physicians (exempted from elective activities) and resources should be involved in managing the emergency. It should be noted that a certain number of exposed physicians will become infected, such that the global healthcare system progressively can become inadequate. As anaesthesiologists, pneumologists and intensivists are the front-line in managing these patients, cardiologists and cardiac surgeons can contribute more than other specialties for several reasons. First, in many centres, surgeons are used to managing ICU patients. Secondly, surgeons are used to chest imaging (X-ray, lung echo and CT scan), to blood gas analysis and to circulatory evaluation and support, if needed. Even if they might not be so versed in airway management (including intubation and tracheostomy), they are able to obtain percutaneous arterial and venous access, that are useful both for monitoring and support. Finally, although the most dramatic consequence of a COVID-19 infection is severe respiratory failure, there is some evidence of acute and chronic cardiac involvement [8]. In patients with COVID-19 infection and severe symptoms, up to 30% presented with hypertension, diabetes and cardiovascular disease. Furthermore, in Wuhan, myocardial injury associated with the SARS-CoV-2 occurred in 5 of the first 41 patients diagnosed, and among the people who died from COVID-19, 11.8% of patients had substantial heart damage, with elevated levels of troponin or cardiac arrest during hospitalization [9]. Therefore, in patients with COVID-19, the incidence of cardiovascular symptoms is high, owing to the systemic inflammatory response and immune system disorders arising during disease progression, and can be significantly worsened by respiratory failure-related hypoxia. From this viewpoint, cardiac management of these patients (including fluid management and inotropes) requires skills that commonly belong to members of the cardiac surgery community. The last aspect in which cardiac surgeon can significantly contribute to is mechanical respiratory and circulatory support. The role of extracorporeal membrane oxygenation in the management of COVID-19 is unclear at this point [10]. It has been used in some patients with COVID-19 in China but detailed information is unavailable. Moreover, much about the virus is unknown, including the natural history, incidence of late complications, viral persistence and the prognoses in different subsets of patients. To address this, prompt mobilization of existing registries and clinical research groups (for example, the Extracorporeal Life Support Organization Registry) should help facilitate the systematic collection of data.