Blog from the COVID frontline: How COVID-19 is changing the way we work (Part I)

Doctors and nurses working on the frontline

During the COVID-19 pandemic we’re featuring stories from cardiothoracic surgeons and EACTS members on the frontline.

 

Here, Manuel Castella and Eduard Quintana highlight how they’re supporting patients at their hospital in Barcelona (Part 1).

 

Doctors and nurses working on the frontline

The arrival of COVID-19 felt very sudden. After a small number of patients in February and early March, the third week in March saw patient numbers begin to double every day. It felt like an avalanche. We work in a hospital in Barcelona and all our cardiovascular surgery was put on hold four days before the medical ICU was at full capacity with COVID patients. We were able to drain our few post-op heart surgery patients quickly to prepare our specific Cardiovascular Surgery ICU for patients with this new disease.

We’re currently running a 16-bed ICU treating patients with COVID-19. It’s been at full capacity for six weeks. After five weeks of strict population lock-down, at this moment the hospital hardly receives any new patients with COVID pneumonia. Nevertheless, we face three new threads:
• a new wave of COVID-19 patients could rebound in a moment while we’ve got a full ICU treating chronic patients
• we face increasing waiting lists of cardiovascular surgery patients
• we need to manage how we treat COVID+ patients that will eventually need to undergo their planned cardiovascular operations.

New ways of working

We are experiencing unprecedented challenges and our role has changed. At our hospital, we cardiovascular surgeons take care of our ICU patients but, with COVID, we really have transformed from surgeons to intensivists. We are working longer days than ever; working in shifts of 12 hours day and night.

We needed to learn quickly about this disease. As heart surgeons we’ve had to adapt and learn new skills, such as understanding the different ventilation settings depending on the patient’s lung function and condition.

We’ve also had to rehearse and enforce strict new protective protocols. As surgeons, we’re used to scrubbing at the operating room, but this specific type of disease is so infective that we need to take every precaution. Once you’ve treated a COVID-19 patient, your gloves, goggles and gown are all contaminated with the live virus. When you come out of the box, no single surface can be touched – it just takes one person to touch a door handle with their infected glove to spread the virus.

Coronavirus is new to everyone and as cardiovascular surgeons our expertise in treating this kind of medical disease is fairly limited. But we can help our country’s medical effort – and have been proud to do so. We have the experience to support and reconfigure our ICU to cater for a higher throughput of patients and it’s been a privilege to work alongside our colleagues who have all joined forces to support patients and defeat the virus, particularly anaesthetists, intensivists and cardiologists.

Manuel Castella and Eduard Quintana
Department of Cardiovascular Surgery
Hospital Clínic. University of Barcelona

Part 2 to follow