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Erschienen in: Clinical Research in Cardiology 12/2020

Open Access 04.07.2020 | COVID-19 | Original Paper

Off-the-shelf barrier for emergency intubation in the cardiac catheterization laboratory during the coronavirus disease 2019 (COVID-19) pandemic

verfasst von: Bruno Scheller, Davor Vukadinovic, Sebastian Ewen, Felix Mahfoud

Erschienen in: Clinical Research in Cardiology | Ausgabe 12/2020

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Abstract

With the spread of SARS-CoV-2, it is expected that cases of acute coronary syndrome in the setting of coronavirus disease 2019 (COVID-19) develop. As expensive and sophisticated protection devices are not widely available, we have been working on a simple, off-the-shelf protection device for endotracheal intubation of potentially infected patients. For this purpose, we used a large transparent plastic bag (such as the sterile protective cover of the lead glass shield) for protection from airborne infections. The cover is moved over the patient's head from cranial to caudal, covering the catheter table including the torso with no need for patient mobilization. The intubation is done conventionally under direct visual control.
Begleitmaterial
Supplementary file1 Online Video 1: Covering the patient with the sterile protective cover. The cover is moved from cranial to caudal over the patient's head, covering the catheter table so that the patient is not mobilized. The tight rubber band of the cover provides good insulation of the abdominal area. (MOV 84044 kb)
Supplementary file2 Online Video 2: Intubation is done conventionally under direct visual control. (MOV 170474 kb)
Supplementary file3 Online Video 3: Blocking of the tube, connection to the ventilator with breathing filter and fixation of the tube are also carried out by the intubating physician with assistance from outside. (MOV 41918 kb)
Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00392-020-01696-9) contains supplementary material, which is available to authorized users.
A correction to this article is available online at https://​doi.​org/​10.​1007/​s00392-020-01713-x.

Introduction

As the SARS-CoV-2 virus continues to infect patients with cardiovascular disease, it is expected that cases of acute coronary syndrome (ACS) together with coronavirus disease 2019 (COVID-19) occur [1, 3]. In patients with ST-segment elevation myocardial infarction (STEMI), it is recommended to immediately perform primary coronary intervention. STEMI can be complicated by cardiogenic shock requiring endotracheal intubation and mechanical ventilation also during treatment in the catheterization laboratory. Given the logistical challenges, at this point, in the majority of patients, no information on COVID-19 infection will be available. While for intensive care units, extensive preparatory and protective measures have been suggested aiming at reducing the aerosol contamination and, above all, to protect the personnel performing or assisting the laryngoscopy and endotracheal intubation [2], no such recommendations exist for cardiac catherization laboratories.

Case report

In emergency situations during cardiac catherization, there may be limited human resources and time to apply extensive protective measures. Against this background, we present a simple, off-the-shelf protective measure for emergency endotracheal intubation in the cardiac catheterization laboratory, using the sterile protective cover of the lead glass shield, deflected from its normal purpose.
For this, two slots are cut in the cover for the hands of the physician performing the endotracheal intubation. The cover is moved over the patient's head from cranial to caudal, covering the catheter table including the torso with no need for patient mobilization. The tight rubber band of the cover provides good insulation of the abdominal area. The intubation is done conventionally under direct visual control through the transparent sheet or if available by video laryngoscope. Blocking of the tube, connection to the ventilator with breathing filter and fixation of the tube are carried out by the intubating physician with assistance from outside (Fig. 1). The cover can be left in place to prevent contamination of the room. The procedure is shown in detail in the three online videos (covering the patient, endotracheal intubation, and connection of ventilator).

Discussion

With the spread of SARS-CoV-2, it is expected that cases of acute coronary syndrome in the setting of coronavirus disease 2019 (COVID-19) develop, which will pose major challenges to cath lab staff around the globe. As expensive and sophisticated protection devices are not widely available, we have been working on a simple, off-the-shelf protection device for endotracheal intubation of (potentially) infected patients. This measure may indeed turn out to be helpful during the pandemic. Furthermore, this concept could also be adopted in other emergency situations outside the catheter laboratory.

Acknowledgements

Open Access funding provided by Projekt DEAL. We thank our catherization laboratory technicians Matthias Bauer and Johannes Burger for the initial idea and their support in establishing the concept. We would also like to thank our colleagues Drs. Michael Böhm, Andreas Link, Yvonne Clever, Saarraaken Kulenthiran, and Victoria Schwarz for helpful advice and critical input.

Compliance with ethical standards

Conflict of interest statement

None.
Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://​creativecommons.​org/​licenses/​by/​4.​0/​.

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Electronic supplementary material

Below is the link to the electronic supplementary material.
Supplementary file1 Online Video 1: Covering the patient with the sterile protective cover. The cover is moved from cranial to caudal over the patient's head, covering the catheter table so that the patient is not mobilized. The tight rubber band of the cover provides good insulation of the abdominal area. (MOV 84044 kb)
Supplementary file2 Online Video 2: Intubation is done conventionally under direct visual control. (MOV 170474 kb)
Supplementary file3 Online Video 3: Blocking of the tube, connection to the ventilator with breathing filter and fixation of the tube are also carried out by the intubating physician with assistance from outside. (MOV 41918 kb)
Literatur
Metadaten
Titel
Off-the-shelf barrier for emergency intubation in the cardiac catheterization laboratory during the coronavirus disease 2019 (COVID-19) pandemic
verfasst von
Bruno Scheller
Davor Vukadinovic
Sebastian Ewen
Felix Mahfoud
Publikationsdatum
04.07.2020
Verlag
Springer Berlin Heidelberg
Schlagwort
COVID-19
Erschienen in
Clinical Research in Cardiology / Ausgabe 12/2020
Print ISSN: 1861-0684
Elektronische ISSN: 1861-0692
DOI
https://doi.org/10.1007/s00392-020-01696-9

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