A Nationwide Survey of UK cardiac surgeons’ view on clinical decision making during the COVID-19 pandemic

Umberto Benedetto*, Andrew Goodwin, Simon Kendall, Rakesh Uppal, Enoch Akowuah

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)

Abstract

Background
No firm recommendations are currently available to guide decision making for patients requiring cardiac surgery during the coronavirus disease 2019 (COVID-19) pandemic. Systematic appraisal of senior surgeons' consensus can be used to generate interim recommendations until data from clinical observations become available. Hence, we aimed to collect and quantitatively appraise nationwide UK consultants' opinions on clinical decision making for patients requiring cardiac surgery during the COVID-19 pandemic.

Methods
We E-mailed a Web-based questionnaire to all consultant cardiac surgeons through the Society for Cardiothoracic Surgery in Great Britain and Ireland mailing list on the April 17, 2020, and we predetermined to close the survey on the April 21, 2020. This survey was primarily designed to gather information on UK surgeons' opinions using 12 items. Strong consensus was predefined as an opinion shared by at least 60% of responding consultants.

Results
A total of 86 consultant surgeons undertook the survey. All UK cardiac units were represented by at least 1 consultant. Strong consensus was achieved for the following key questions: (1) before any hospital admission for cardiac surgery, nasopharyngeal swab, polymerase chain reaction, and computed tomography of the chest should be performed; (2) the use of full personal protective equipment should to be adopted in every case by the theater team regardless of the patient's COVID-19 status; (3) the risk of COVID-19 exposure for patients undergoing heart surgery should be considered moderate to high and likely to increase mortality if it occurs; and (4) cardiac procedures should be decided based on a rapidly convened multidisciplinary team discussion for every patient. The majority believed that both aortic and mitral surgery should be considered in selected cases. The role of coronary artery bypass graft surgery during the pandemic was controversial.

Conclusions
In this unprecedented pandemic period, this survey provides information for generating interim recommendations until data from clinical observations become available.
Original languageEnglish
Number of pages7
JournalJournal of Thoracic and Cardiovascular Surgery
Early online date19 May 2020
DOIs
Publication statusE-pub ahead of print - 19 May 2020

Structured keywords

  • Covid19

Keywords

  • COVID-19
  • cardiac surgery
  • consensus
  • survey
  • risk

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