Division of Cardiac Surgery, University Hospital of Verona, Verona, Italy -
CHUV Cardiovascular Surgery Hospital, Lausanne, Switzerland.
J Cardiovasc Surg (Torino). 2020 Dec;61(6):763-768. doi: 10.23736/S0021-9509.20.11556-8. Epub 2020 Sep 23.
The aim of this study was to investigate the impact of COVID-19 infection on cardiac surgery community and practice.
A 43-question survey was sent to cardiac surgery centers worldwide. The survey analyzed the prepandemic organization of the center, the center's response to Covid-19 in terms of re-organization pathways, surveillance methods, personal-protective equipment (PPE), and allowed surgical practice with results.
Sixty-one out of 64 centers (95.3%) fulfilled the survey. One third of ICUs were transformed into COVID-19 dedicated-ICUs and one-third moved to another location inside the hospital. Negative-pressure rooms were available in 60.6% centers. Informative measures from hospital administration were received after the first COVID-19 admitted case in 36.1% and during the spread of the infection inside the hospital in 19.6%. Inadequate supply of PPE was common, with no COVID-surveillance of the medical personnel in 4.9% of centers. COVID-19 infected 7.4% of staff surgeons, 8.3% of residents and 9.5% of anesthetists. Cardiac surgery caseload declined in 93.4% centers. COVID-19 infection in patients receiving cardiac surgery resulted in 41-50% mortality in 9.5% centers, and 91-100% mortality in 4.7% centers. Successful weaning with survival from veno-venous extra corporeal membrane oxygenation (ECMO) and veno-arterial ECMO was <50% in 79.2% and 80.0% centers respectively. COVID-19 infection in transplanted patients was rare, with a reported mortality of 0.5% and 1% in one center each.
There is room for improvement in hospital surveillance, informative measures and PPE to the personnel. These measurements will reduce current spread of COVID-19 infection among medical personnel and patients, helping the rump up of cardiac surgical practice.
本研究旨在探讨 COVID-19 感染对心脏外科医疗社区和实践的影响。
我们向全球心脏外科中心发送了一份包含 43 个问题的调查问卷。该调查分析了中心在大流行前的组织情况、中心在重新组织途径、监测方法、个人防护设备 (PPE) 以及允许进行手术方面的应对 COVID-19 的措施，以及手术结果。
64 个中心中有 61 个（95.3%）完成了调查。三分之一的 ICU 被改造成 COVID-19 专用 ICU，三分之一转移到医院内的其他位置。60.6%的中心有负压室。36.1%的中心在首例 COVID-19 患者入院后，19.6%的中心在院内感染传播期间收到了医院管理部门的通知。PPE 供应不足的情况很常见，4.9%的中心没有对医务人员进行 COVID 监测。7.4%的外科医生、8.3%的住院医师和 9.5%的麻醉师感染了 COVID-19。93.4%的中心心脏手术工作量减少。在接受心脏手术的患者中，COVID-19 感染导致 9.5%的中心死亡率为 41-50%，4.7%的中心死亡率为 91-100%。79.2%和 80.0%的中心分别有<50%和<50%的患者从静脉-静脉体外膜肺氧合 (ECMO) 和静脉-动脉 ECMO 成功撤机并存活。在移植患者中，COVID-19 感染很少见，每个中心各有 1 例报告死亡率为 0.5%和 1%。
在医院监测、信息措施和 PPE 方面还有改进的空间。这些措施将减少 COVID-19 感染在医务人员和患者中的传播，有助于心脏外科手术的恢复。
