Urgent/emergent Procedures in COVID-19 Infected Patients
Unless urgent/emergent, we have avoided performing procedures on COVID-19 infected patients in the EP laboratory to prevent transmission not only during transport to the laboratory, but also to prevent seeding the lab itself in the case of a prolonged operation. The coronavirus may maintain aerosolization for an unspecified time period and was recently shown to stay viable for up to 72 hours on stainless steel surfaces,8 which are readily found in EP laboratories.
In light of myocarditis and elevated inflammatory markers in active COVID infection, there are likely to be patients that develop clinically-significant bradyarrhythmias during their course. Since these will presumably be more severely-ill patients amidst a prolonged hospitalization, we have used medical management with dopamine and avoiding any medications that may be overtly catecholaminergic due to concern of myocarditis. If clinically significant bradycardia persists, then temporary ventricular pacemaker (TVP) placement is the best option. TVP placement is quick (typically <10 minutes), may be performed at bedside, involves less hospital transport with the potential for aerosolization and health care provider exposure, and allows temporization until the patient either recovers from their systemic illness or deteriorates further.
If it is decided that a COVID-19 infected patient must have a procedure performed in the EP laboratory, we have a protocol illustrated by Figure 1. If the patient is not intubated, a mask is placed on the patient prior to transport and there is a specific room designated for infected patients. That room is thoroughly disinfected after the procedure.