Response of Cardiac Surgery Units to COVID-19
Authors: Mario Gaudino, Joanna Chikwe, Irbaz Hameed, N. Bryce Robinson, Stephen E. Fremes, Marc Ruel
Journal: Circulation (2020)

The coronavirus disease 2019 (COVID-19) pandemic has had an unprecedented global effect on health care.We quantified the experience and changes implemented in response to the COVID-19 pandemic across cardiac surgery centers participating in an international research consortium.A 40-question questionnaire was e-mailed to all centers participating in the international ROMA trial (Randomized Comparison of the Outcome of Single Versus Multiple Arterial Grafts) 1 on March 23, 2020.Participation was voluntary and anonymized.The questionnaire assessed each center's pandemic response according to regional disease prevalence; local resources and logistics; and institutional, regional, or national policies.The numbers of infections by country were obtained from the Johns Hopkins Coronavirus Resource Center 2 and adjusted by population size per million inhabitants.We used incidence data contemporary to the date of surveys compilation.Correlations between the adjusted number of COVID-19 infections and survey variables were calculated using the Pearson correlation coefficient.The study did not require institutional review board approval.Of the 61 centers approached, 60 (98.3%) completed the survey: 7 from Asia, 2 from Australia, 31 from Europe, 16 from North America, and 4 from South America.Of the survey responses, 57 out of 60 (95%) came from cardiac surgeons holding an administrative leadership position at their center.The median reduction in cardiac surgery case volume was 50% to 75%, correlating with the number of local of COVID-19 cases (correlation coefficient [r]=0.36;P<0.001).A third of the centers reported >50% reduction in the number of dedicated cardiac operating rooms and intensive care unit beds.Most centers restricted cardiac surgery activity to urgent and emergent cases; 5% had canceled all cases including emergencies.Almost a third of the centers relocated personnel to other departments; the majority was relocated to the intensive care unit, highly correlating (r=0.86,P<0.001) with the local number of COVID-19 infections.Half of the centers still permitted fellows and residents to participate in cardiac surgeries, and about half had suspended all research activity.There was no significant difference between continents with respect to relocation of personnel or suspension of cardiac surgery research.South American centers reported lesser reductions in cardiac surgery case volume (P=0.02).Asian centers more frequently were performing elective surgery (P=0.03).There was no statistically significant difference between low-(≤25th percentile) and high-volume (≥75 th percentile) centers in terms of case volume reduction, personnel relocation, suspension of research, or allowed cardiac surgery activity.Most centers discussed ethical issues around decision making during a surge that would overwhelm all healthcare services.Almost all centers instituted protocols to restrict visitors to their cardiac surgery unit, and one third continued to perform in-person patient follow-up.A majority of centers anticipated that the restrictions preventing full cardiac surgery activity would last >1 month (Table ).