The Pan London Emergency Cardiac Surgery service: Coordinating a response to the COVID‐19 pandemic

Abstract

Over the last 4 months, the novel coronavirus, SARS‐CoV‐2, has caused a significant economic, political, and public health impact on a global scale. The natural history of the disease and surge in the need for invasive ventilation has required the provision of intensive care beds in London to be reallocated. NHS England have proposed the formation of a Pan‐London Emergency Cardiac surgery (PLECS) service to provide urgent and emergency cardiac surgery for the whole of London. In this initial report, we outline our experience of setting up and delivering a pan‐regional service for the delivery of urgent and emergency cardiac surgery with a focus on maintaining a COVID‐free in‐hospital environment. In doing so, we hope that other regions can use this as a starting point in developing their own region‐specific pathways if the spread of coronavirus necessitates similar measures be put in place across the United Kingdom.

Outcomes of patients diagnosed with COVID-19 in the early postoperative period following cardiac surgery

“…We have instituted local protocols aimed at thorough screening of all patients before and on arrival in our unit to ensure that we do not admit or operate on anyone with the virus and isolating patients with unknown COVID-19 status. Our screening protocol has been published previously [ 5 ] and consists of 2 throat swabs, lymphocyte count, LDH and ferritin levels and a computed tomography chest. Furthermore, all patients have bronchoalveolar lavage for viral testing at the time of intubation in operating theatre.…”

Cardiothoracic surgery in the midst of a pandemic: Operative outcomes and maintaining a coronavirus disease 2019 (COVID-19)–free environment

“…Patients undergoing cardiac or thoracic surgery followed tailored pathways aimed at maintaining a COVID-19-free environment in dedicated ITUs and wards. A detailed overview of our protocol has been published, 6 and a simplified version of the patient pathways and screening protocols is shown in Figure 1. In brief, all patients requiring interhospital transfer for urgent or emergency surgery were screened at the time of referral with a screening questionnaire and upper respiratory tract swab for COVID-19 RNA.…”

COVID‐19 and cardiac surgery: Do outcomes differ?

“…From a total of seven cardiac centers based in London, two were selected as central hubs, with access to their Accident and Emergency departments suspended to maintain a COVID-19 free environment. 16 Healthcare systems within the United States of America adopted a similar approach. 17 Meanwhile, in Canada, a three-stage system with a variable degree of service reduction was implemented.…”

“…26 In addition to an increase in overall mortality, the use of cardiopulmonary bypass (CPB) in patients with COVID-19 is thought to increase the risk of acute respiratory distress syndrome (ARDS). It is hypothesised that exposure of blood to non-endothelial surfaces during CPB triggers a proinflammatory response, increasing both tumor necrosis factor α and interleukin 10, 16 two cytokines implicated in ARDS in COVID-19. 3,27 Given the associated risks and frequency of AGPs involved in cardiac surgery, preoperative testing plays a significant role in resource allocations.…”