Cardiac Critical Care During the Pandemic: Adapting Roles and Responsibilities to New Challenges

An international perspective based on clinician experiences in areas heavily impacted by the coronavirus disease-2019 (COVID-19) and from military mass casualty medicine provides insights into the changing nature of cardiac critical care during the pandemic, and advice on modifications to existing cardiac critical care infrastructure. The report was published in the Journal of the American College of Cardiology.

Individuals with COVID-19, in addition to presenting with respiratory symptoms, may also have cardiac involvement. Thanks to their expertise in cardiology and critical care medicine, cardiologic intensivists are in a unique position to offer their services as providers and educators, in an environment where many severely ill patients require intensive care for cardiac and noncardiac COVID-19-related issues.

Providers as well as hospitals and healthcare systems must remain agile and adapt rapidly to changing needs, additional stress and limited resource availability during the COVID-19 pandemic, in order to maximize efficiency while keeping practitioners safe and optimizing patient outcomes. With those goals in mind, the authors of the perspective article emphasized 3 areas in which critical care cardiologists can play key roles: scalability of critical care delivery to adapt to patient surges; education of teams and colleagues (particularly nonintensivists asked to deliver critical care); and use of telemedicine to allow for collaboration during social distancing mandates.

During patient surges, a 4-component pandemic classification system would allow critical care cardiologists to adjust their roles and responsibilities, moving from typical duties during a minor surge (≤25% increase) to a more consultative managing role, overseeing multiple teams during a moderate (25-100%) or major (100-200%) surge, to a dynamic reshuffling of staff and resources during a “disaster” scenario (>200% surge). During a surge, existing spaces may have to be converted into intensive care unit (ICU) environments and nonhospital spaces may have to be recruited. In addition numerous changes in critical care staffing and routines may have to be implemented.

Education of providers not usually treating critically ill patients may need to be asked to staff ICUs where critical care cardiologists can train them, particularly for the management of patients with critical cardiac pathologies. This can be achieved using simulation-based training, protocols, care pathways, and rapid communication and dissemination of information.

The use of telemedicine is also essential during this period because of continued social distancing requirements. The technology can enable communication between clinicians and patients at home, and ease communication between practitioners and relatives of hospitalized patients who are prohibited from visiting.

Many of these recommendations and adaptations are based on the military medicine principles of preparedness, team-based care, echelons of care, augmenting the effort, servant leadership, and effective triage, which utilizes the immediate/delayed/minimal/expectant classification system.

“[T]his pandemic should serve as a clarion call to our healthcare systems that we should continue to develop a nimble workforce that can adapt to change quickly during a crisis. We believe critical care cardiologists are well positioned to help serve society in this capacity,” noted the authors.

Reference

Katz JN, Sinha SS, Alviar CL, et al. Disruptive modifications to cardiac critical care delivery during the Covid-19 pandemic: an international perspective. J Am Coll Cardiol. April 2020. doi:10.1016/j.jacc.2020.04.029