Kamel Shibbani, MD; Ziyad M. Hijazi, MD, MPH, FACC, MSCAI, FAHA; Damien Kenny, MD
Introduction
On April 9, 2020, PICS-AICS launched the first in a series of webinars revolving around Interventional Pediatric Cardiology. Due to the ongoing SARS-CoV-2 pandemic, the first webinar focused on the effect of the virus on the world of cardiology as a whole, and pediatric cardiology and cardiac surgery in particular.
The webinar was hosted by Drs. Ziyad Hijazi and Damien Kenny from Sidra Medicine in Doha and Children’s Health Ireland at Crumlin in Dublin, respectively. The guests included Dr. Emile Bacha from Columbia University in New York City, Drs. Yong Peng, Jiafu Wei, and Yuan-Ning Xu from West China Hospital in Chengdu, Dr. Victor Sam Lucas from Ochsner Health Center in New Orleans, and Dr. Shyam Sathanandam from LeBonheur in Memphis.
FIGURE 1 (A). List of PPE as worn in order from innermost to outermost layer. (B). Medical personal after donning all Class II PPE. (C). Division of COVID wards into 3 distinct zones; contaminated zone, spontaneous breathing. In clean zone, and buffer zone in between. (D). Positive pressure headgear (Class III PPE) used when performing procedures with high risk of viral transmission. Photo credit: Dr. Yuan-Ning Xu
Initially, Dr. Xu spoke about the COVID experience in China from a critical care perspective and shared valuable information about measures taken there to ensure staff safety. These included wards dedicated for COVID-19 patients or Person Under Investigation (PUI) with three specific areas: a contaminated area that serves as the isolation ward, a clean area that serves as office space/work rooms/dressing rooms, and a third area in-between that serves as the buffer zone. In addition, personnel caring for COVID-19 patients would don an impressive amount of PPE (listed from innermost to outermost): Scrubs, N95 mask and disposable cap, disposable shoe covers (first layer), disposable gown, goggles, gloves (first layer), disposable apron, gloves (second layer), disposable shoe covers (second layer) (Figure 1). Donning of all the PPE takes between 10-30 minutes and doffing takes 10-20 minutes. An extra layer of protection was available in the form of a positive pressure headgear that could be donned over the class II PPE when performing procedures with high risk of viral transmission. Dr. Xu also shared invaluable lessons learned from his experience in the critical care unit that included a trend of hypercapnia noted after initiation of respiratory support, which he hypothesized could be due to inhibition of spontaneous breathing. In addition, some critically-ill patients had severe CO2 retention requiring extracorporeal CO2 removal, while some had severe hypoxemia requiring VV-ECMO. He also noted that coagulopathies were common in severe COVID-19 patients, necessitating the use of anticoagulation therapy unless otherwise contraindicated. Finally, Dr. Xu informed the audience that corticosteroids did not play a part in routine management of COVID patients, rather they were reserved for those with rapidly progressive deterioration of oxygenation and/or radiological evidence of excessive inflammation. When used, they were restricted to 3-5 days at doses of no more than 1-2mg/kg/day.
To read the full article, please go to the June 2020 Issue of CCT.