Table 2.

STEMI Regional Systems of Care

System-wide: emergency medical services, STEMI referral hospitals, and PCI centers

•Each regional STEMI system should update their system of care immediately to maximize patient and provider safety including adequate PPE during transport and procedures for STEMI patients who are COVID-19 positive or probable. •First medical contact to reperfusion time remains of paramount importance and should not substantially delay primary PCI for STEMI patients. Additional time at the primary PCI center ED or ICU may be a necessary delay required for confirmation of COVID-19 and STEMI status prior to transfer to the CCL. •STEMI patients with cardiogenic shock and/or resuscitated cardiac arrest should still be prioritized for a primary PCI approach. If timely PCI is not possible or team/room/PPE not available, a pharmacoinvasive strategy may be considered. •It is critical to ensure PPE and rapid sterilization procedures are prioritized throughout the entire system of care and that communication occurs among transfer hospital, EMS, ED, and CCL providers regarding COVID-19 status.

Emergency medical services, field-activated STEMI, and referral (non-PCI) hospitals

•EMS should include a brief assessment of COVID-19 status (positive, probable, or possible) in their report to the PCI center for an incoming STEMI patient. If a patient is COVID-19 positive or probable, EMS should follow CDC guidelines regarding droplet precautions during and immediately after transfer. •All transfer STEMI patients should be re-evaluated at the primary PCI center ED or ICU for COVID-19 status and the concept of ED bypass should not be utilized during the pandemic. •Patients with STEMI at a referral hospital with established COVID-19 infection should be discussed prior to transfer to a PCI center. Fibrinolysis within 30 min of STEMI diagnosis, and transfer for rescue PCI when necessary, may be preferable for all COVID-19 positive STEMI patients who are at a referral hospital, provided the diagnosis of a true STEMI is highly likely.

CDC = Centers for Disease Control and Prevention; CCL = cardiac catheterization laboratory; COVID-19 = coronavirus 2019; ED = emergency department; EMS = emergency medical system; ICU = intensive care unit; PCI = percutaneous coronary intervention; PPE = personal protective equipment; STEMI = ST-elevation myocardial infarction.