EACTA/SCA Recommendations for the Cardiac Anesthesia Management of Patients With Suspected or Confirmed COVID-19 Infection: An Expert Consensus From the European Association of Cardiothoracic Anesthesiology and Society of Cardiovascular Anesthesiologists With Endorsement From the Chinese Society of Cardiothoracic and Vascular Anesthesiology

Abstract

The European Association of Cardiothoracic Anaesthesiology (EACTA) and the Society of Cardiovascular Anesthesia (SCA) aimed to create joint recommendations for the perioperative management of patients with suspected or proven SARS-CoV-2 infection undergoing cardiac surgery or invasive cardiac procedures. To produce appropriate recommendations, we combined the evidence from the literature review, re-evaluating the clinical experience of routine cardiac surgery in similar cases during the Middle East Respiratory Syndrome (MERS-CoV) outbreak and the current pandemic with suspected COVID-19 patients, and the expert opinions through broad discussions within EACTA and SCA. We took into consideration the balance between established procedures and the feasibility during the present outbreak. We represent an agreement between the European and United States practices in managing patients during the COVID-19 pandemic. The recommendations take into consideration a broad spectrum of issues with a focus on preoperative testing, safety concerns, overall approaches to general and specific aspects of preparation for anesthesia, airway management, transesophageal echocardiography, perioperative ventilation, coagulation, and hemodynamic control and postoperative care. As the COVID-19 pandemic is spreading, it will continue to represent a challenge for the worldwide anesthesiology community. To allow these recommendations to be updated as long as possible, we provided weblinks to international public and academic sources providing timely updated data. Our document should be the basis of future Task Forces to develop a more comprehensive consensus considering new evidence uncovered during the COVID-19 pandemic.

Thoracic Anesthesia during the COVID-19 Pandemic: 2021 Updated Recommendations by the European Association of Cardiothoracic Anaesthesiology and Intensive Care (EACTAIC) Thoracic Subspecialty Committee

“…In general, every patient should be screened clinically and virologically for SARS-CoV 2 infection by pharyngeal or nasal swab prior to surgery. [ click here ] 22 , 23 …”

“…Testing should be performed as close to surgery as possible (preferably less than 48 hours, not exceeding 5 days) to decrease the risk that a patient becomes positive while waiting for the surgical procedure. 24 23 …”

“…A computerized chest tomography (CT) should be considered for patients with clinical symptoms suggestive of SARS-CoV-2 infection with a negative PCR test result [ click here ]. 23 , 25 …”

“…The Centers for Disease Control and Prevention (CDC) have developed a recommended approach to the management of patients undergoing surgery after contracting coronavirus, as follows [click here] . 23 Retesting is not recommended in asymptomatic patients who have recovered from laboratory-confirmed SARS-CoV-2 infection within 90 days of their initial diagnosis. 23 An adult does not require repeated testing or quarantine for SARS-CoV-2 in the context of the new exposure to someone with suspected or confirmed COVID-19 if he/she: Has recovered from illness due to laboratory-confirmed SARS-CoV-2 infection and has already met criteria to end isolation [Online supplement 1], and Is within the first 90 days following the onset of symptoms of their initial laboratory-confirmed SARS-CoV-2 infection or within the first 90 days of their first positive SARS-CoV-2 test result if they were asymptomatic during initial infection, and Has remained asymptomatic since the new exposure.…”

“… 23 Retesting is not recommended in asymptomatic patients who have recovered from laboratory-confirmed SARS-CoV-2 infection within 90 days of their initial diagnosis. 23 An adult does not require repeated testing or quarantine for SARS-CoV-2 in the context of the new exposure to someone with suspected or confirmed COVID-19 if he/she: Has recovered from illness due to laboratory-confirmed SARS-CoV-2 infection and has already met criteria to end isolation [Online supplement 1], and Is within the first 90 days following the onset of symptoms of their initial laboratory-confirmed SARS-CoV-2 infection or within the first 90 days of their first positive SARS-CoV-2 test result if they were asymptomatic during initial infection, and Has remained asymptomatic since the new exposure. If an adult has a new exposure to a person with suspected or confirmed SARS-CoV-2 infection and meets the first two above criteria but has or develops new symptoms consistent with SARS-CoV-2 infection within 14 days of the new exposure, consultation with infectious disease or infection control experts may be necessary.…”