Same-Day Discharge for the care of patients in the early stages of COVID 19 helped Detroit doctors minimize their COVID risks
October 19, 2020
This pandemic has challenged us in every facet of our lives. The changes have been unimaginable. As an interventional cardiologist we have rigorously studied and proven the lifesaving benefit of primary PCI as compared to thrombolytic therapy. In the early stages of COVID 19 when our health care institutions in our beloved city of Detroit were besieged with over 90% of the admitted patients having the virus and PPE was at premium, we contemplated ever so briefly to not offer primary PCI and use thrombolytics instead. This short-lived contemplation was the result of an unprecedented time in our history. We concluded that we had to adapt to this new challenge and carry out what we have been trained to do to best serve our patients. The spirit of Detroit not unlike the rest of our nation calls for resilience and ingenuity in such times. We decided all patients that needed primary PCI would get it. We did these acute MI cases via radial and sent them home within 24 hours with a monitor to mitigate length of stay risk. We had a dedicated COVID lab and learned to don and doff. All members of the team were provided PPE. We used POCUS in the ER to facilitate decision making.
As a result of our approach we were able to treat cardiovascular manifestation of COVID beyond AMI to include CGS and PE. For example, we treated a life-threatening massive thrombus occupying the right atrium with vacuum suction thrombectomy and right-side mechanical support. The patient did great and this led to a new indication for Impella RP for massive PE in COVID.
Eventually, when we were allowed to resume non-emergent procedures, we took the extraordinary decision to take several of our cath labs and dedicate them to elective cases. By keeping these rooms dedicated to patients who had tested negative for the virus and taking all the necessary safety precautions we were able to efficiently and effectively perform same day elective PCI. We learned, we adapted, we executed.
About the Author
AMIR KAKI, MD, FACC, FSCAI
Program Director Complex PCI Fellowship, St. John Ascension Hospital Clinical Associate Professor of Medicine, Wayne State University School of Medicine
Dr. Kaki is an Interventional cardiologist the Program Director of Complex PCI fellowship at St. John’s Ascension Hospital. He is also the Associate Clinical Professor of Medicine at Wayne State University. Dr. Kaki is internationally known for cardiac hemodynamic support, complex coronary intervention, and vascular access management.