key: cord-333554-0wlgg450
authors: Curzen, Nick
title: An Extended Statement by the British Cardiovascular Intervention Society President Regarding the COVID-19 Pandemic
date: 2020-04-16
journal: Interv Cardiol
DOI: 10.15420/icr.2020.10
sha: 
doc_id: 333554
cord_uid: 0wlgg450

nan

and uncertainty about how we will be able to maintain the highest standards of clinical care.

As a group, our reaction to the challenges thrown at us by needs to be reasoned, calm, positive and energetic.

As before, the hottest issues remain:

• What is the appropriate nature and application of PPE?

• Are there some categories of patient who should not be offered treatment that we would normally consider (e.g. out of hospital cardiac arrest ventilated patients) or who should be offered 

The presidents of BCS and BCIS have released a joint statement of support and advice to our members, and have contributed to an NHS England statement about recommendations for ongoing cardiology activities. 2,3 Consistent with these guidelines, BCIS recommends that all our members follow some general principles, outlined here.

• Members should adopt, and comply with, national and local policies for testing, self-isolation and PPE compliance (see below).

• Members should develop local plans for possible scenarios in which their cath lab cannot provide emergency cover, whether due to staff absence or inadequate facilities/resources. We suggest that clinical leads/senior cath lab staff have discussions across local networks regarding potential cross cover for emergency patients between local centres, in case this becomes necessary.

• Be cautious about the implications of changing treatment pathways as a reflex response to this crisis. To this end, the NHS England guidance continues to recommend primary PCI for STEMI and angiography with a view to revascularisation for all non-ST-elevation MI (NSTEMI) patients, except perhaps the lowest risk group. This advice is based upon the assumption that the access to the cath lab and its specialised staff will remain stable. Clearly, in circumstances in which lab access is compromised by staff shortage or case load, hard alternative choices will need to be made. But the fact is that primary PCI for STEMI is associated with the best outcome for these patients, with the lowest mortality, fewest complication rates and shortest hospital stay. The same is true of a high-risk NSTEMI case.

Making a rapid diagnosis using angiography and providing effective revascularisation, as appropriate, is again associated with a shorter admission, with a much lower reinfarction and subsequent revascularisation rate. By contrast, deferring NSTEMI patients may 

The early variation in practices around the UK for PPE at all stages of patient contact was pretty alarming at the beginning of this crisis, but is becoming more uniform as NHS England catches up with the rapid spread of the virus and lessons learned from other countries. All patient exposure should now be associated with some form of PPE according to the latest national advice, a policy welcomed almost universally.

However, for BCIS members, it is the optimal PPE for cath lab procedures, especially primary PCI for STEMI, that has raised most anxiety and contention. Table 1 .

This guidance adopts an approach in which the PPE strategy is Ward environments are covered within the PHE guidance.

For cath lab procedures the PHE guidance can be applied to the individual case by the assessment of the senior clinician, together with senior cath lab staff, taking into account (a) the likelihood that the patient has the virus and (b) the chance the procedure will be AGP.

We will all continue to face the challenges offered up to us by this For patients admitted to the lab already intubated or where there is felt to be a very high risk of arrest with prolonged resuscitation, then all those in the lab to wear type 2 PPE.

For other situations the cath lab, when deemed low risk of AGP, can be regarded as an inpatient area or operating theatre with suspected or confirmed COVID-19 cases, and type 1 PPE is recommended for all those with direct patient contact. 

British Cardiovascular Intervention Society. Statement by BCIS regarding the Covid-19 pandemic

British Cardiovascular Intervention Society. Cardiology services during the Covid-19 pandemic

Clinical guide for the management of cardiology patients during the coronavirus pandemic