COVID-19 & STEMI

An Ultra-Simple and Uncomplicated Decision Tree for Managing STEMI in the COVID-19 Era

Sameer Mehta, MD, Samantha Quintero, MD, Lumen Foundation, Miami, Florida

Sameer Mehta, MD, Samantha Quintero, MD, Lumen Foundation, Miami, Florida

The prevailing crisis with COVID-19 has unleashed a plethora of protocols, most of which are ridiculously complicated and take the reader through a labyrinth of rungs that recommend either unavailable resources or impractical pathways. 

We present an ultra-simple protocol (Figure 1) that is based upon the following two fundamentals:

1) Consider thrombolysis as an alternate to prevent exposure of the operators and cardiac cath lab staff from potential COVID-19 patients presenting with ST-elevation myocardial infarction (STEMI); 

2) Rely on the rapid COVID-19 test to initiate an easy triage into primary percutaneous coronary intervention (PCI) or thrombolysis.

In addition to the flow chart, we have three additional recommendations:

1) If possible, in conjunction with the supplemental oxygen (preferably nasal cannula), place a face mask on the patient;

2) Abandon door-to-balloon time pursuits. Do not worry, nobody will be penalizing delayed door-to-balloon times;

3) Avoid transfers from non-PCI institutions and recommend thrombolysis for such patients at the index facility. 

The authors can be contacted via Dr. Sameer Mehta at sameer.lumenglobal@gmail.com

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