Cardiac Surgery during the pandemic
The State of Alarm imposed extremely harsh restrictions on the
mobility of the citizens (mandatory house confinement) and on
educational, commercial and national and international transport
activity, closed the national borders and established the possibility of
requisitioning of goods. These were amongst the harshest conditions
worldwide and, in practice, a national lockdown.
The MOH took over the command of operations, granting minor management
possibilities to regional and local public administrations within their
sphere of competence. This included privately owned hospitals.
The MOH, autonomic authorities of Health and Management Directions of
health centers organized a contingency plan for Cardiovascular Surgery
services. In practice, all of material and human health resources were
exclusively devoted to fighting the pandemic. Elective activity was
cancelled. The surgical services moved out of the regular facilities and
dedicated operating rooms converted into intensive care for COVID-19
patients.
As stated, the Spanish Society of Cardiovascular and Endovascular
Surgery (SECCE) reacted very quickly issuing a number of Recommendations
(21), with specific instructions and action algorithms guiding the
contingency plan for cardiovascular surgery services. It was then
ensured: a) the correct care of urgent and emerging patients, b) the
organization of a list of preferential patients and the temporal
criteria for surgery, c) the justified and safe delay of the patients
for elective surgery whose illness and clinical situation allow it and
d) the specific application of ECMO programs in the context of COVID-19
(18).
In the regions hardest hit by the pandemic, such as CC. AA. of Madrid
and Catalonia as per national statistics and the Johns Hopkins
Coronavirus Resource Center (22), attempts were made to reboot the
system in the first weeks of May. Strict infection screening protocols
and “clean circuits” were established for elective patients, leading
to a very slow and extremely cautious restart of activity.
The changes in the organization of health care imposed by the pandemic
has had an impact on worldwide surgical activity, although its
quantification is difficult at the present time since at the time of
writing this manuscript, we are still fighting against the virus. The
experience lived in the hardest months of the crisis indicates a
significant decrease in activity; as an example, in the C.A. of Madrid,
about 150 patients underwent surgery in March and April, almost entirely
emergent and urgent. According to the SECCE registry (21), the volume in
this Community in 2018 was 4,206 major cardiac operations, which means
that, in that two-month period and under normal conditions, about
750-800 patients would have undergone cardiac surgery in Madrid.
A careful analysis of the national data, from government sources of from
our scientific society, will allow us to estimate in the near future the
final impact of the pandemic on the global activity of cardiac surgery.
By now, there are only initiatives in a smaller scope at the regional
level, which shortly will offer many precise data on the activity of
cardiac surgery in the COVID era.