Urgent/emergent Procedures in COVID-19 Infected Patients
Unless urgent/emergent, we have avoided performing procedures on
COVID-19 infected patients in the EP laboratory to prevent transmission
not only during transport to the laboratory, but also to prevent seeding
the lab itself in the case of a prolonged operation. The coronavirus may
maintain aerosolization for an unspecified time period and was recently
shown to stay viable for up to 72 hours on stainless steel
surfaces,8 which are readily found in EP laboratories.
In light of myocarditis and elevated inflammatory markers in active
COVID infection, there are likely to be patients that develop
clinically-significant bradyarrhythmias during their course. Since these
will presumably be more severely-ill patients amidst a prolonged
hospitalization, we have used medical management with dopamine and
avoiding any medications that may be overtly catecholaminergic due to
concern of myocarditis. If clinically significant bradycardia persists,
then temporary ventricular pacemaker (TVP) placement is the best option.
TVP placement is quick (typically <10 minutes), may be
performed at bedside, involves less hospital transport with the
potential for aerosolization and health care provider exposure, and
allows temporization until the patient either recovers from their
systemic illness or deteriorates further.
If it is decided that a COVID-19 infected patient must have a procedure
performed in the EP laboratory, we have a protocol illustrated by Figure
1. If the patient is not intubated, a mask is placed on the patient
prior to transport and there is a specific room designated for infected
patients. That room is thoroughly disinfected after the procedure.