Table 3.

Pre-, intra-, and postoperative considerations for caring for cardiac surgery patients in the COVID-19 era

Preoperative	Intraoperative	Postoperative
•Routine COVID-19 infection testing 24-48 h before •Travel and potential exposure history •Close CXR review •Forego nonessential testing when possible •Consider use of older testing data when possible •Preoperative care via telehealth •Patients don surgical mask upon hospital arrival •Early intubation preoperatively for suspected COVID-19 + patients in respiratory distress •Deferring case if COVID+	•Non-COVID operating rooms •Conversion of ORs to negative-pressure •Airborne precautions and PPE worn by all providers •Nonessential staff not in room •Attending level surgical staff only •Video laryngoscopy for intubation •Minimize staff turnover within room •Forego TEE if appropriate •Avoid pleural entry and lung injury •Avoid procedures with CO2 insufflation	•Clean recovery area •Suspect COVID-19 infection if prolonged respiratory failure •Minimize risks of renal failure and prolonged respiratory failure •Enhanced recovery protocol if appropriate: early extubation, mobilization, and removal of chest tubes and pacing wires •Patients don surgical mask immediately after extubation •Early coordination with family for at-home postoperative recovery •Early discharge when medically stable •Close and frequent virtual follow-up after discharge •Repeat COVID-19 if clinical symptoms develop

COVID-19, Coronavirus disease 2019; CXR, chest X-ray, OR, operating room; PPE, personal protection equipment, TEE, transesophageal echocardiography.