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Covid-19 HSE Clinical Guidance and Evidence

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Acute / Maternity, Paediatric Hospital Information - Navigation

Guidance on Management of STEMI patients NSTEMI patients during the Covid-19 pandemic

Guidance on Management of STEMI patients NSTEMI patients during the Covid-19 pandemic (CD 19-054 001/21.04.20)


Introduction
  • This document was prepared by a sub-group of the Acute Coronary Syndrome National Clinical Programme and will be reviewed periodically during the Covid-19 pandemic.
  • Please refer to Infection and Prevention control guidance as set out on HPSC.ie: 
  • The Acute Coronary Syndrome (ACS) Programme will do what it can in these exceptional times to maintain a PPCI service for those with STEMI and diagnostic  + / - revascularization services for NSTEMI patients.
  • The outline operational plan is clearly subject to a number of different variables, many of which are outside the control of the programme; notably the national policy for patient transfer at this time, the pressures being put on the ambulance service, the availability of PPE and the health status of the staff providing the diagnostic and revascularization procedures. In addition, local units may be limited in their capacity to adhere to some/ all of the steps outlined below, and in those circumstances consultation with colleagues in cardiology and infectious disease may be helpful. Reverting to thrombolysis in certain circumstances may be the accepted best course of action.
     
ST Elevation Myocardial Infarction (STEMI) Management

Attempts will be made to provide emergent PCI with the following modifications of the service in place prior to the Covid-19 epidemic:

  • Before transfer, consultation between the referral and receiving centres is mandatory to confirm the availability of staff at the referral centre to perform the procedure.
  • Ambulance service transferring the patient should as a default position wait for information as to whether there will be a need to repatriate the patient immediately on completion of procedure to the referral hospital or the hospital in the locality of the patient, if the patient was a community transfer. However, in many circumstances, the receiving cardiac team will not require this and will release the ambulance crew immediately.
  • Cases presenting with a less clear indication for Primary PCI or where the benefit may be deemed marginal (e.g. OHCA with significant down-time) should be discussed at senior physician level between the referral and receiving hospitals to clarify if transfer is the most appropriate strategy.
  • If any conditions exist (including though not confined to those listed outlined in i-iii above) that might compromise swift transfer of the patient then thrombolysis in the absence of contraindications should be considered.  Subsequent clarification of the patients Covid status should be performed to help guide any further decision on later onward referral.
     
Non-ST Elevation Myocardial Infarction (NSTEMI)
  • The majority of these presentations will settle with standard conservative management. Routine assessment of the need for elective angiography plus or minus intervention during that hospitalisation should be made by the admitting consultant. If transfer is deemed necessary to obtain angiography, then consultation with the accepting team should be undertaken prior to transfer. Standard precautions for Covid 19 should be followed.
     
Abbreviations

ACS

Acute Coronary Syndrome

COVID

Corona Virus Disease

NSTEMI

 Non ST segment elevation myocardial infarction

OHCA

Out of Hospital Cardiac Arrest

PPCI

Primary Percutaneous Coronary Intervention

PPE

Personal Protective Equipment

STEMI

ST segment elevation myocardial infarction

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