STS Responds to the COVID-19 Crisis — March 31, 2020

A Message about COVID-19 from STS President Joseph A. Dearani, MD (March 31, 2020)

STS applauds surgeons, providers and hospitals performing lifesaving surgery on patients that are COVID positive or turn COVID positive immediately after surgery. STS also recognizes that front line workers and hospital administration are struggling to manage valuable resources such as PPE and ventilators. Fortunately, decision-making is now being driven more by science, not conjecture. This message will focus on five important questions and answers about what the STS is doing for you.

What is STS doing to help us get the supplies we need - PPEs, ventilators, ECMO supplies, etc.?  
STS has been in direct communication with high-level officials at HHS, FDA, CDC, Congress, and NIH and called for increased medical supplies, greater availability of testing and removal of barriers interfering with the supply chain to ensure these products reach the hospitals in need and increase availability of medical supplies such as Lasix, heparin, ventilators and ECMO equipment. Our efforts are paying off. The Washington DC Administration responded by calling on industry to produce more ventilators, and there are signs that more supplies are reaching hospitals – not enough – but improvement in response to the medical community outreach.

What help can STS provide regarding ECMO availability and use? 
The Society thinks it can best serve its members and the medical community at large by coordinating, rather than competing with groups that are also developing COVID-19 related initiatives. As such, STS is working closely with ELSO to provide relevant resources for ECMO-related matters. The STS website directs people to the ELSO registry, now open and at no cost to enter ECMO data on COVID-19 patients into registry for real-time information; directing physicians to the ELSO online map, tracking ECMO centers nationwide and their availability to accept patients. The STS website also has an ELSO ECMO guidance document created for non-COVID patients and we recently added a video prepared by some of our members in Philadelphia that demonstrates proper PPE use when preparing patients for ECMO.

What about published guidance documents?  
The cardiothoracic surgery community has expressed substantial interest in contributing to the literature with guidance documents. Some are already in our journals, and others will be available in coming days. They include a crisis management documents in congenital and adult heart surgery and triage of operations for thoracic malignancies. Documents that have a theme of guidance that provide direction, allow flexibility and adaptability are the most helpful at this stage while more evidence is being accumulated.

How is the STS database being leveraged during the COVID-19 crisis?
STS is working hard to use the power of your STS National Database to examine specific data elements that would provide added support to providers. In addition to the current STS risk calculator, we are developing - and soon to be complete - a tool that provides information to estimate resource utilization for patients being considered for cardiac surgery. This tool will be available through the STS website. Finally, STS cannot precisely account for the impact of COVID on surgical outcomes. Data from these patients will still be recorded in the STS Database using an additional field regarding their COVID status. But in fairness to all surgeons and their programs, COVID patients will be excluded from performance analyses, including public reporting.

How are surgeons coping with triage of surgery?
It’s not easy. This has been very difficult for me and most all of us on the front line. Cardiothoracic surgical decision-making has shifted to who gets surgery, when to do the surgery, when to transfer out of your hospital, when to accept an incoming transfer, when to offer or not offer ECMO, and the list goes on. The right decision often collides with the desired decision since it is not our nature to delay or deny treatment. On a daily basis, we are adding helpful new resources to the STS website. We also have perspectives from members inside and outside of the United States, along with tips on how to stay grounded during this pandemic. A moderated webinar series will start next week, and the first will address the realities and challenges facing cardiothoracic surgeons in the COVID hotspots in the United States.

Lastly, a personal reach out to each of you from me. Isolation has been stressful. Not being in the operating room has been difficult and most of us have been troubled, frustrated, and even depressed. Clear thinking and mental toughness is difficult under these circumstances, but being decisive is essential since poor decision-making could result in the collapse of a program.

I have found it very helpful to have short phone conversations with colleagues to check on their personal and professional well-being. I connect with four different surgeons each day. Learning how they are balancing their personal and professional life and how they’re maintaining emotional stability has been informing and reassuring to me. I encourage all of you to do the same.

We may be socially distancing, but we are coming closer together in a new spirit of cooperation. Let’s turn this situation into an opportunity that we learn from. We are cardiothoracic surgeons. We know how to pivot, take charge, and handle uncertainty. The health care workforce is in the spotlight and the world is seeing us in action. We’re getting there. Be positive. We may not know when this pandemic will end … but we do know that we will win this battle. 

A sincere thank you to each of you and your respective teams for your grit and perseverance through this difficult time.