Presentation for students

1. HRISTO RAHMAN 03/04/20
COVID-19 & CARDIAC
SURGERY
DEPARTMENT OF CARDIAC AND VASCULAR
SURGERY
MEDICAL UNIVERSITY PLOVDIV

2. HRISTO RAHMAN 03/04/20
• CARDIAC SURGERY IS ONE OF THE FRONTLINE SPECIALTIES IN
THE RESPONSE TO PANDEMIC
• OUR PATIENTS AND CARE PROVIDERS FACE VERY SPECIFIC
CHALLENGES
COVID-19 & CARDIAC SURGERY

3. HRISTO RAHMAN 03/04/20
• CARDIOTHORACIC SURGEONS, ANESTHESIOLOGISTS, CRITICAL CARE
NURSING PROVIDERS, CARDIAC TECHNICIANS, ADVANCED
HEALTHCARE PRACTITIONERS, CARDIAC REHAB SPECIALISTS,
LABORATORY ASSISTANTS, MEDICAL ORDERLIES, ETC. ARE
PARTICULARLY EXPOSED TO THE RISK OF INFECTION WHEN
INTUBATING OR PERFORMING BRONCHOSCOPY ON COVID-
19 PATIENTS
PROVIDING CARE TO COVID-19
PATIENTS

4. HRISTO RAHMAN 03/04/20
• CARDIAC SURGEONS PROVIDE SPECIALISED CARE, SPECIFICALLY IN
THE FORM OF TEMPORARY MECHANICAL CIRCULATORY SUPPORT
( VA- AND VV-ECMO ) FOR PATIENTS WITH:
• - SEVERE ARDS (
REFRACTORY TO MAX. CRITICAL CARE SUPPORT )
• - CARDIOMYOPATHY (
REFRACTORY TO MAX. CRITICAL CARE SUPPORT )
PROVIDING CARE TO COVID-19
PATIENTS
DUE TO
COVID-
19

5. HRISTO RAHMAN 03/04/20
EXTRACORPOREAL MEMBRANE OXYGENATION (
ECMO )
VENO-VENOUS ECMO IN SEVERE ARDS VENO-ARTERIAL ECMO IN TERMINAL HEART FAILURE

6. HRISTO RAHMAN 03/04/20
• CARDIAC SURGERY PATIENTS ARE:
• - FREQUENTLY OLDER;
• - WITH MULTIPLE PRE-EXISTING AND OTHER HEALTH CONDITIONS.
• CARDIAC SURGERY PATIENTS ARE AT HIGH-RISK FOR
SUSCEPTIBILITY TO SEVERE FORMS OF COVID-19 INFECTION PRE- AND
POST-OPERATIVELY
PROVIDING CARE TO COVID-19
PATIENTS

7. HRISTO RAHMAN 03/04/20
• CARDIAC SURGERY “ELECTIVE” PATIENTS MAY FACE SERIOUS RISK
OF ADVERSE EVENTS WHILE WAITING FOR SURGERY
• THEY ARE DISPROPORTIONATELY IMPACTED BY SUSPENDING
NORMAL ELECTIVE OPERATING SCHEDULES
PROVIDING CARE TO COVID-19
PATIENTS

8. HRISTO RAHMAN 03/04/20
CHINESE SOCIETY OF CARDIOLOGY (SCS):
1. CONSIDER PREVENTION AND CONTROL
OF COVID-19 AS THE HIGHEST PRIORITY,
INCLUDING SELF-PROTECTION OF MEDICAL
STAFF;
2. PATIENT RISK ASSESSMENT OF BOTH
INFECTION AND CARDIOVASCULAR ISSUES.
WHERE APPROPRIATE, PREFERENTIAL USE
OF CONSERVATIVE MEDICAL THERAPEUTIC
APPROACHES TO MINIMISE DISEASE
SPREAD;
3. AT ALL TIMES, MEDICAL PRACTICES AND
INTERVENTIONAL PROCEDURES SHOULD
BE CONDUCTED IN ACCORDANCE WITH
THE DIRECTIVES OF INFECTION CONTROL
DEPARTMENT OF LOCAL HOSPITALS AND
HEALTH COMMISSIONS

9. HRISTO RAHMAN 03/04/20
• THE DECISION TO PURSUE INVASIVE STRATEGY OF DIAGNOSIS AND INVASIVE/SURGICAL THERAPY
SHOULD BE CONSIDERED WITH CAUTION
• FOR SUSPECTED/CONFIRMED PATIENTS FOR WHOM EMERGENCY INTERVENTION AND
SURGICAL PROCEDURE IS REQUIRED, ALL THE RECOMMENDED FOLLOWING CONDITIONS MUST BE
MET, ASSUMING FAILURE OF OPTIMISED, GOAL-DIRECTED, MEDICAL THERAPY:
• - 1. ONE OF THE EMERGENCIES ( TABLE 1 );
• - 2. TAKING PLACE IN HOSPITAL DESIGNATED FOR COVID-19;
• - 3. INTERVENING IN CARDIAC SURGICAL LAB / OPERATING ROOM WITH NEGATIVE- PRESSURE
VENTILATION FOLLOWED BY STRICT PERI-PROCEDURAL DISINFECTION;
• - 4. HIGHEST PROTECTION LEVEL IS ADOPTED;
• - 5. APPROVAL BY LOCAL HEALTH COMMISSION
STRATEGY OF CARDIOVASCULAR
INTERVENTION

10. HRISTO RAHMAN 03/04/20
CARDIOVASCULAR
EMERGENCIES
CARDIOVASCULAR DISEASE IN PATIENTS WITH SUSPECTED/CONFIRMED COVID-19
INFECTION
STEMI IN PATIENTS WITH HAEMODYNAMIC INSTABILITY
NSTEMI LIFE-THREATENING
ACUTE AORTIC DISSECTION (
STANFORD A )
LIFE-THREATENING
ACUTE AORTIC DISSECTION (
STANFORD B )
LIFE-THREATENING
BRADYARHYTHMIAS
COMPLICATED WITH SYNCOPE OR NON-STABLE
HAEMODYNAMICS, NECESSITATING PACEMAKER
IMPLANTATION
ACUTE PULMONARY EMBOLISM IN PATIENTS WITH HAEMODYNAMIC INSTABILITY AND
CONTRAINDICATED FOR FIBRINOLYTICSTABLE 1.

11. HRISTO RAHMAN 03/04/20
HIGHEST
POSSIBLE
SELF-
PROTECTION
LEVEL WITH PPE
OF MEDICAL
STAFF

13. HRISTO RAHMAN 03/04/20
• THE ABILITY TO PERFORM CARDIAC SURGERY IS LIMITED BY ANY
REDUCTION IN VENTILATOR OR ICU BED AVAILABILITY
PROVIDING CARE TO COVID-19
PATIENTS

14. HRISTO RAHMAN 03/04/20
• THE NEEDS ARE 24/7
• COVID-19 RESPONSE TEAMS FACE: FATIGUE, BURN-OUT
IN ADDITION TO ILLNESS
PROVIDING CARE TO COVID-19
PATIENTS

15. HRISTO RAHMAN 03/04/20
• MUCH IS UNKNOWN REGARDING HOW COVID-19 PANDEMIC
WILL TRULY AFFECT CARDIAC SURGERY SPECIALTY AND
BULGARIAN HEALTHCARE SYSTEM
PROVIDING CARE TO COVID-19
PATIENTS