Table 1.

Summary of Recommendations for the Care of Patients With Acute Myocardial Infarction During the COVID-19 Pandemic

• All STEMI patients should initially undergo evaluation in the ED. • Patients should be evaluated in the ED prior to CCL activation to ensure appropriate risks are assessed. • All patients require the placement of a face mask to prevent droplet contamination of the CCL and environment prior to transport.

•CCL staff and physicians should have appropriate PPE for safe performance of the procedure, including gowns, gloves, full face mask, and an N95 respiratory mask. If N95 masks are to be reused between cases by a single HCW, then an additional surgical mask should be worn on top of this mask. The number of HCWs present during the procedure should be limited to only those essential for patient care and procedure support.

• Patients with respiratory compromise should be intubated prior to arrival in the CCL if possible. • If intubation is required in the CCL, all personnel should have complete PPE and exposures should be minimized to essential team members only. • For all procedures at high risk of aerosolization, PAPRs should be considered.

•Proper PPE training should be provided and practiced by physicians and CCL staff involved in all cases, and extra consideration should be given to the protection of trainees in high-risk patients and procedures.

•Primary PCI should remain the default strategy in patients with clear evidence of a STEMI; if a primary PCI approach is not feasible, a pharmacoinvasive approach may be considered.

• During the COVID-19 period, there may be delays in D2B times that result from evaluation and/or management of COVID-19 patients. This can be documented in the medical record and coded in the NCDR CathPCI version 5 as follows: • If primary PCI for STEMI, code “Yes” for Seq. #7850 (patient-centered reason for delay in PCI) and selecting “Other” in Seq. #7851 (delay reason). • If primary thrombolytic therapy for STEMI, code “Yes” for Seq. #14208 (patient reason for delay in thrombolytic).

•Within the CCL, a single negative pressure procedure room with essential supplies only is preferable for the care of known COVID-19 positive or probable patients with a terminal clean after the procedure.

•To preserve ICU beds, all hemodynamically stable STEMI patients following PCI should be admitted to an intermediate care telemetry unit with plan for early (<48 h) discharge (27).

CCL = cardiac catheterization laboratory; COVID-19 = coronavirus 2019; ED = emergency department; HCW = health care worker; ICU = intensive care unit; NCDR = National Cardiovascular Data Registry; PAPR = powered air-purifying respirator; PCI = percutaneous coronary intervention; PPE = personal protective equipment; STEMI = ST-elevation myocardial infarction.