Journal of cardiac surgery
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During the COVID-19 pandemic, emergency room visits have drastically decreased for non-COVID conditions such as appendicitis, heart attack, and stroke. Patients may be avoiding seeking medical attention for fear of catching the deadly condition or as an unintended consequence of stay-at-home orders. ⋯ This case illustrates an example of "collateral damage" caused by the COVID-19 pandemic. What would have been a standard ST-elevation myocardial infarction treated with timely and successful stenting of a dominant right coronary artery occlusion, became a much more dangerous postinfarction ventricular septal defect; all because of a 2-day delay in seeking medical attention by an unsuspecting patient.
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With the ongoing coronavirus, journals and the media have extensively covered the impacts on doctors, nurses, physician assistants, and other healthcare workers. However, one group that has rarely been mentioned despite being significantly impacted is medical students and medical education overall. This piece, prepared by both a medical student and a cardiothoracic surgeon with a long career in academic medicine, discusses the recent history of medical education and how it has led to issues now with distance-based learning due to COVID-19. It concludes with a call to action for the medical education system to adapt so it can meet the needs of healthcare learners during COVID-19 and even beyond.
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We received a response to our Editorial from a group in Brazil that raised valuable concerns about the struggles in transforming medical education in low-income countries. Here, we address the concerns they raised that reinforce the global need for a "Coalition for Medical Education."
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Patient selection and cannulation arguably represent the key steps for the successful implementation of extracorporeal membrane oxygenation (ECMO) support. Cannulation is traditionally performed in the operating room or the catheterization laboratory for a number of reasons, including physician preference and access to real-time imaging, with the goal of minimizing complications and ensuring appropriate cannula positioning. Nonetheless, the patients' critical and unstable conditions often require emergent initiation of ECMO and preclude the safe transport of the patient to a procedural suite. ⋯ In the current pandemic, the strategy of veno-venous bedside cannulation may have additional benefits for the care of patients with refractory acute respiratory distress syndrome due to coronavirus-disease-2019, decreasing the risk of exposure of health care worker or other patients to the novel severe acute respiratory syndrome coronavirus-2 occurring during patient transport, preparation, or during disinfection of the procedural suite and the transportation pathway after ECMO cannulation.