Society & Hospital Guidelines
SCAI Position Statement on Optimal Percutaneous Coronary Interventional Therapy for Complex Coronary Artery Disease
Riley RF, et. al. for the Writing Group. Catheter Cardiovasc Interv. Published online. doi: 10.1002/ccd.28994.
This document is meant to discuss the approach to the high-risk PCI procedure defined by anatomic and patient features. The document is extensive and thus this commentary seeks to increase the awareness of some of the benefits and procedure related requirements within this topic which warrant consideration in the framework of achieving optimal PCI outcomes.
- Pre-Procedural Assessment:
- Coronary Anatomic Complexity – May require advanced techniques
- Higher-risk clinical features
- Emphasis on importance on multivessel disease
- Procedure risk
- Recognize high risk of surgical turndowns
- Reduced left ventricular (LV) function
- Acute Coronary Syndrome – Left Main (LM) and Low LVEF
- Emphasized the importance of mechanical Support (MCS)
- Most common is pVAD type of axial pump
- MCS support shown to increase frequency of complete revascularization
- Selected cases MCS supports improved LV function
- Managing the risk of acute kidney injury
- Concomitant valve disease
- Treatment of complex coronary artery disease
- Arterial access
- Anticoagulation and antiplanet treatment
- Intracoronary physiologic testing and imaging
- Special lesion considerations – LM, Bifurcations, Vein Grafts, In-stent Restenosis and Chronic Total Occlusions.
- The authors conclude: “…this SCAI consensus document provides an initial platform to offer guidance for achieving excellent outcomes for complex PCI and to support future investigations of this growing patient population.
Editorial Comment: This document provides an important roadmap for providing optimal outcomes for PCI in patients with complex coronary artery disease – Its more than “getting out of the lab”! it’s about getting optimal acute and late results. In the current era of COVID, certain of these recommendations become particularly important in attempting to reduce hospitalVIEW
Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID 19
From the Emergency Cardiovascular Care Committee and Get With the Guideline-Resuscitation Adult and Pediatric Task Forces of the American Heart Association in collaboration with the American Academy of Pediatrics, American Association for Respiratory Care, American College of Emergency Physicians, The Society of Critical Care Anesthesiologists, and American Society of Anesthesiologists: Supporting Organizations: American Association of Critical Care Nurses and National EMS Physicians.
Edelson DP, Sasson C, Chan PS, et.al. Circulation
Guidelines written regards CPR during the COVID – 19 Pandemic with a major focus on professions safety of Resuscitation Team Members in managing patients known or at risk for COVID – 19 infection.
- Interim Guidelines emphasize protecting responders
- Assess risk of infection vs. the likelihood of a successful resuscitation –Older patients with multiple comorbidities are less likely to survive
- Providers should utilize PPE including a face-mask.
- Hands-only CPR can be performed for out of hospital Cardiac Arrest but some aerosolization can occur even without direct airway management. Ideally a face mask should be placed on the victim as well.
- In-hospital limit personnel in room to be important members of the team; prohibit students or observers.
- For patients with a primary respiratory arrest, consider immediate intubation to minimize aerosolization from breathing bags, high flow oxygen or other used initial treatments.
The publication summarizes multiple areas of focus:
- Comorbid conditions increasing mortality risk include cancer, hypertension, chronic respiratory disease, diabetes, and cardiovascular disease in ascending risk with mortality risk 10.3% for underlying CV Disease.
- Triage CV patients for early identification and early escalation of care because of the high risk of adverse outcomes.
- Develop protocols for screening and management to optimize an early response to high-risk CV patients – particularly those who develop Acute Myocardial Infarction and Cardiogenic Shock.
- Educate staff on inappropriate personal protection use and catheterization lab management.
This website is intended as a resource for clinicians caring for critically-ill COVID-19 patients, based on available evidence and recommendations of governing bodies. The recommendations do not replace clinical judgment or the need for individualized patient care plans.
Section 5 covers Cardiac Complications:
- Acute Cardiac Injury
- Cardiovascular Testing and Consultation
- Acute Coronary Syndromes
- Pericarditis and Myocarditis
Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19)
Background: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of
a rapidly spreading illness, Coronavirus Disease 2019 (COVID-19), affecting thousands of people around
the world. Urgent guidance for clinicians caring for the sickest of these patients is needed.
Methods: We formed a panel of 36 experts from 12 countries. All panel members completed the World
Health Organization conflict of interest disclosure form. The panel proposed 53 questions that are
relevant to the management of COVID-19 in the ICU. We searched the literature for direct and indirect
evidence on the management of COVID-19 in critically ill patients in the ICU. We identified relevant and
recent systematic reviews on most questions relating to supportive care. We assessed the certainty in the
evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE)
approach, then generated recommendations based on the balance between benefit and harm, resource and
cost implications, equity, and feasibility. Recommendations were either strong or weak, or in the form of
best practice recommendations.
Results: The Surviving Sepsis Campaign COVID-19 panel issued 54 statements, of which 4 are best
practice statements, 9 are strong recommendations, and 35 are weak recommendations. No
recommendation was provided for 6 questions. The topics were: 1) infection control, 2) laboratory
diagnosis and specimens, 3) hemodynamic support, 4) ventilatory support, and 5) COVID-19 therapy.
Conclusion: The Surviving Sepsis Campaign COVID-19 panel issued several recommendations to help
support healthcare workers caring for critically ill ICU patients with COVID-19. When available, we will
provide new evidence in further releases of these guidelines.