Recomendaciones de la Sociedad Española de Cirugía Cardiovascular y Endovascular ante la pandemia de COVID-19. En representación de la Sociedad Española de Cirugía Cardiovascular y Endovascular (SECCE)

COVID 19-A Spanish perspective

BACKGROUND

COVID-19 hit hard worldwide. There has been an impact on global activity of cardiac surgery. Spain has been one of the hardest hit countries with one of the highest per population incidences and death.

METHODS

The following is an overview of the epidemiology and impact on resources, the caseload and surgical societal implemented recommendations, the description of the ECMO activity and nosocomial transmission among healthcare workers.

RESULTS

There was a reduction of 5-6 times of the regular caseload. As of July 17, 160 ECMO implants were performed. In a 13-center survey, at least 1 staff surgeon had SARS-COV-19 infection.

CONCLUSION

Cardiac surgical activity has suffered a negative impact all over the country.

ECMO-Challenges, strategies, and preparation from Spain

Providing complex therapies such as extracorporeal membrane oxygenation (ECMO) during outbreaks of infectious diseases has singular challenges. The impact of the SARS‐CoV‐2 pandemic has implied a mentality change by force of circumstances, and cardiac surgery has not been stranger to this trend. The need to treat critically ill patients with an unknown evolution has compelled cardiovascular surgeons to decide whether or not to implant an ECMO system, despite the limited scientific evidence available in the context of COVID‐19. To add some confusion, doubts were raised about its potential deleterious outcome in COVID‐19 patients, due to its effect on lymphocyte counts and interleukin‐6 concentrations. The care of the critically ill patient in a moment of national emergency in Spain took precedence over those possible formal doubts. The Spanish perspective on ventricular assist devices during and after the COVID‐19 pandemic, focused on ECMO as a particular case of mechanical circulatory support, is presented. We address both the challenges posed by the pandemic and the organizational model established in Spain; changes in ECMO therapy and some lessons learned for the next outbreaks are also described. It is not about reinventing the wheel in each country; it is enough to learn from experience and take advantage of the knowledge generated by those who have already gone through similar situations in our environment.