Table 3.

Proposed Interventions for a Modified Cardiac Enhanced Recovery Program to be Implemented During the COVID-19 Pandemic.

Intervention		Level of Evidence	Expected Benefit in COVID-19	Additional Cost	Impact on Workflow	Implementation Complexity
Preoperative	Smoking and alcohol cessation for 3 weeks before surgery	Moderate	Medium	Low	Low	Low
	Encourage clear-fluid intake up to 4-hours before surgery	Low	Small	Low	Medium	Low
	Provide a liquid carbohydrate beverage 4 hours before surgery	Low	Small	Medium	Medium	Low
	Use a surgical-site infection reduction bundle	Moderate	Large	Medium	High	Medium
Intraoperative	Intraoperative multimodal opioid-sparing analgesia	Moderate	Large	Medium	Medium	Medium
	Administer an intraoperative antifibrinolytic	High	Large	Low	Low	Low
	Maintain intraoperative glucose levels below 180 mg/dL (10 mmol/L)	Moderate	Large	Low	Low	Low
	Avoid hyperthermia (>37.9°C) or excessively rapid rates during re-warming on cardiopulmonary bypass	Moderate	Large	Low	Medium	Low
	Avoid persistent hypothermia (<35°C) postoperatively	Moderate	Large	Low	Medium	Low
Postoperative	Postoperative multimodal opioid-sparing analgesia	Moderate	Large	Medium	Medium	High
	Optimize strategies to ensure extubation as early as safely possible	Moderate	Large	Low	High	High
	Maintain postoperative glucose levels below 180 mg/dL (10 mmol/L)	Moderate	Large	Low	Medium	Medium
	Promote early mobilization and removal of tubes, drains, and lines	Moderate	Large	Low	High	High
	Ensure chemical thromboprophylaxis is initiated for all patients when appropriate	Moderate	Medium	Low	Low	Medium

Adapted from guidelines published by the ERAS Cardiac Society.³⁰

Abbreviations: COVID-19, coronavirus disease 2019.