Pre-operative viral screening and timing of cardiac surgery in children with congenital heart disease (1172)

Background:

There is evidence that patients with an intercurrent viral illness have more complications, or a longer critical care stay if undergoing cardiac surgery. We have developed a best practice guide to support teams with the challenging decision-making round if and when to cancel and reschedule cardiac surgery if this is the case. Of note there is no evidence to swab/test asymptomatic patients, nor will we test if other family members or carers alone have symptoms of a viral respiratory tract infection.

Guidance:

When reviewed either at cardiac pre-assessment or if there is a call from the family about a patient's symptoms the Cardiac ANP’s or medical team will call the family to discuss the symptoms and consider cancelling an elective cardiac surgical procedure if: 

• The patient has a clear symptomatic infective process (ie fever, coryzal symptoms, new cough, generally unwell, reduced oral intake)
• The patient has a recent history of the above symptoms, within previous 3 weeks, but are now clinically well

If the patient has the above symptoms carers will be advised to have a viral throat swab taken either @ RHC or the GP 

• Viral Throat swab should be sent for:
  • Respiratory virus PCR (Influenza A, influenza B, RSV, adenovirus, m pneumoniae)
  • ITU/immunocompromised pulmonary virus PCR(Parainfluenza type 1,2,3,4, rhino/enterovirus, coronavirus, hMPV) 
  • Covid-19 (SARS CoV-2)
  • Results within 48-72hrs
  • Of note point of care testing (POCT) does not play a role in the testing pathway – clinical symptoms are paramount

It should be noted that the patient’s clinical priority can override this guidance and the associated increased risk and consequences will be discussed during the consent process

On admission to the hospital prior to cardiac surgery patients will be reviewed clinically by the Cardiac ANP/Medical team and anaesthetic and surgical advice sought if: 

• The patient has a clear symptomatic infective process (ie fever, coryzal symptoms, new cough, generally unwell, reduced oral intake)
• The patient has a recent history of the above symptoms, within previous 3 weeks, but are now clinically well
• Viral Throat swab will be sent for:
  • Respiratory virus PCR (Influenza A, influenza B, RSV, adenovirus, m pneumoniae)
  • ITU/immunocompromised pulmonary virus PCR(Parainfluenza type 1,2,3,4, rhino/enterovirus, coronavirus, hMPV) 
  • Covid-19 (SARS CoV-2)
  • Results within 48-72hrs

Guidance for re-scheduling ELECTIVE cardiac surgery following a positive viral swab result:

NB Do not re-swab/test if patient is clinically well         

For URGENT cardiac surgery it should be noted that the patient’s clinical priority can override this guidance and the associated increased risk and consequences will be discussed during the consent process