Robotic-assisted intervention strategy to minimize air exposure during the procedure: a case report of myocardial infarction and COVID-19

Abstract

Percutaneous coronary interventions (PCI) is traditionally a manual procedure executed by one or more operators positioned at a close distance from the patient. The ongoing pandemic of coronavirus disease 2019 (COVID-19) has imposed severe restrictions to such an interventional environment. The novel SARS-CoV-2 virus that causes COVID-19 is transmitted mainly through expelled respiratory particles, which are known to travel approximately 3-6 feet away from infected persons. During PCI, that contamination range obligatorily poses the team and the patient to direct air exposure. We herein present a case report with the description of a minimum-contact strategy to reduce interpersonal air exposure during PCI. The approach designed to minimize proximity between the patient and the healthcare team included the performance of robotic-assisted PCI, operated by unscrubbed cardiac interventionalists from a control cockpit located outside the catheterization suite.Also included, was the delineation of the potential zone of respiratory particle spread; a circle measuring 4 meters (13.1 feet) in diameter was traced on the floor of the cath lab with red tape, centered on the patient's mouth and nose. The team was rigorously trained and advised to minimize time spent within the 4-meter perimeter as much as possible during the procedure. Following this strategy, a 60-year-old male with non-ST-elevation myocardial infarction and COVID-19 was treated with successful coronary implantation of two stents in the obtuse marginal branch and one stent in the circumflex artery. The total duration of the procedure was 103 minutes and 22 seconds. During most of the procedure, the 4-meter spread zone was not entered by any personnel. For each individual team member, the proposed strategy was effective in ensuring that they stayed outside of the 4-meter area for the majority of their work time, ranging from 96.9% to 59.7% of their respective participation. This case report illustrates the potential of robotic-assisted percutaneous coronary intervention in reducing physical proximity between the team and the patient during the procedure.

Safety and effectiveness of introducing a robotic-assisted percutaneous coronary intervention program in a tertiary center: a prospective study

“…As previously shown by other groups and ours, roboticassisted PCI undeniably provides distancing between the interventionalist and the tableside, producing a muchimproved work environment regarding radiation exposure, procedural ergonomics, orthopedic protection, and interpersonal air sharing (5)(6)(7)(8)(9)(10)(11)(12)(13). Notwithstanding the fact that those are valuable benefits, in order to be fully and largely adopted, the novel technology must be proven functional and reliable, without compromising the already good clinical results achieved with traditional manual intervention.…”

“…With this technology, guide-catheters, guidewires, and interventional devices are operated through a robotic arm, remotely maneuvered by an interventionalist using joysticks and touchscreens from a control cockpit. The novel tool has been previously validated, showing marked reduction in the need of physical closeness between the healthcare team and the operating table (12,13), and thus in radiation exposure (5)(6)(7)(8)(9)(10)(11).…”

The effect of COVID-19 on the in-hospital outcomes of percutaneous coronary intervention in patients with acute coronary syndrome: A large scale meta-analysis

“…Two authors extracted the data followed by another phase of data checking before starting the analysis by another independent member. Additionally, the included papers were tested for quality using the national institute of health (NIH) quality assessment tool 18 . Disagreement in the title and abstract screening, full text screening, data extraction and quality assessment steps, were solved by discussion among all the team members.…”

Impact of COVID-19 on Management Strategies for Coronary and Structural Heart Disease Interventions

“…There seems to be a great opportunity to combine innovative digital health and wearable technology such as remote electrocardiographic monitoring with embedded sensors and electrodes that can transmit real time physiologic data to monitoring centers [ 35 ]. Additionally, robotic PCI emerged as a promising strategy in experienced centers during a pandemic; as it facilitates procedural distancing, minimizes exposure risk, and decreases PPE cost [ 40 , 41 ].…”