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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Precautions and Procedures for Coronary and Structural Cardiac Interventions during the COVID-19 Pandemic: Guidance from Canadian Association of Interventional Cardiology</title><author><name sortKey="Wood, David A" sort="Wood, David A" uniqKey="Wood D" first="David A." last="Wood">David A. Wood</name><affiliation><nlm:aff id="aff1">Centre for Cardiovascular Innovation, UBC Division of Cardiology, St Paul’s and Vancouver General Hospital, Vancouver, Canada</nlm:aff></affiliation></author><author><name sortKey="Sathananthan, Janarthanan" sort="Sathananthan, Janarthanan" uniqKey="Sathananthan J" first="Janarthanan" last="Sathananthan">Janarthanan Sathananthan</name><affiliation><nlm:aff id="aff1">Centre for Cardiovascular Innovation, UBC Division of Cardiology, St Paul’s and Vancouver General Hospital, Vancouver, Canada</nlm:aff></affiliation></author><author><name sortKey="Gin, Ken" sort="Gin, Ken" uniqKey="Gin K" first="Ken" last="Gin">Ken Gin</name><affiliation><nlm:aff id="aff1">Centre for Cardiovascular Innovation, UBC Division of Cardiology, St Paul’s and Vancouver General Hospital, Vancouver, Canada</nlm:aff></affiliation></author><author><name sortKey="Mansour, Samer" sort="Mansour, Samer" uniqKey="Mansour S" first="Samer" last="Mansour">Samer Mansour</name><affiliation><nlm:aff id="aff2">Centre Hospitalier de l'Université de Montréal (CHUM) Research Center and Cardiovascular Center, Montreal, Canada</nlm:aff></affiliation></author><author><name sortKey="Ly, Hung Q" sort="Ly, Hung Q" uniqKey="Ly H" first="Hung Q." last="Ly">Hung Q. Ly</name><affiliation><nlm:aff id="aff3">Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada</nlm:aff></affiliation></author><author><name sortKey="Quraishi, Ata Ur Rehman" sort="Quraishi, Ata Ur Rehman" uniqKey="Quraishi A" first="Ata-Ur-Rehman" last="Quraishi">Ata-Ur-Rehman Quraishi</name><affiliation><nlm:aff id="aff4">Dalhousie University and QE II Health Sciences Centre, Halifax, Nova Scotia, Canada</nlm:aff></affiliation></author><author><name sortKey="Lavoie, Andrea" sort="Lavoie, Andrea" uniqKey="Lavoie A" first="Andrea" last="Lavoie">Andrea Lavoie</name><affiliation><nlm:aff id="aff5">University of Saskatchewan & Prairie Vascular, Regina, Saskatchewan, Canada</nlm:aff></affiliation></author><author><name sortKey="Lutchmedial, Sohrab" sort="Lutchmedial, Sohrab" uniqKey="Lutchmedial S" first="Sohrab" last="Lutchmedial">Sohrab Lutchmedial</name><affiliation><nlm:aff id="aff6">Cardiology, New Brunswick Heart Centre, Saint John Regional Hospital / Dalhousie University, Saint John, Canada</nlm:aff></affiliation></author><author><name sortKey="Nosair, Mohamed" sort="Nosair, Mohamed" uniqKey="Nosair M" first="Mohamed" last="Nosair">Mohamed Nosair</name><affiliation><nlm:aff id="aff3">Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada</nlm:aff></affiliation></author><author><name sortKey="Bagai, Akshay" sort="Bagai, Akshay" uniqKey="Bagai A" first="Akshay" last="Bagai">Akshay Bagai</name><affiliation><nlm:aff id="aff7">St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada</nlm:aff></affiliation></author><author><name sortKey="Bainey, Kevin R" sort="Bainey, Kevin R" uniqKey="Bainey K" first="Kevin R." last="Bainey">Kevin R. Bainey</name><affiliation><nlm:aff id="aff8">Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada</nlm:aff></affiliation></author><author><name sortKey="Boone, Robert H" sort="Boone, Robert H" uniqKey="Boone R" first="Robert H." last="Boone">Robert H. Boone</name><affiliation><nlm:aff id="aff1">Centre for Cardiovascular Innovation, UBC Division of Cardiology, St Paul’s and Vancouver General Hospital, Vancouver, Canada</nlm:aff></affiliation></author><author><name sortKey="Liu, Shuangbo" sort="Liu, Shuangbo" uniqKey="Liu S" first="Shuangbo" last="Liu">Shuangbo Liu</name><affiliation><nlm:aff id="aff7">St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada</nlm:aff></affiliation></author><author><name sortKey="Krahn, Andrew" sort="Krahn, Andrew" uniqKey="Krahn A" first="Andrew" last="Krahn">Andrew Krahn</name><affiliation><nlm:aff id="aff1">Centre for Cardiovascular Innovation, UBC Division of Cardiology, St Paul’s and Vancouver General Hospital, Vancouver, Canada</nlm:aff></affiliation></author><author><name sortKey="Virani, Sean" sort="Virani, Sean" uniqKey="Virani S" first="Sean" last="Virani">Sean Virani</name><affiliation><nlm:aff id="aff1">Centre for Cardiovascular Innovation, UBC Division of Cardiology, St Paul’s and Vancouver General Hospital, Vancouver, Canada</nlm:aff></affiliation></author><author><name sortKey="Mehta, Shamir R" sort="Mehta, Shamir R" uniqKey="Mehta S" first="Shamir R." last="Mehta">Shamir R. Mehta</name><affiliation><nlm:aff id="aff9">Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada</nlm:aff></affiliation></author><author><name sortKey="Natarajan, Madhu K" sort="Natarajan, Madhu K" uniqKey="Natarajan M" first="Madhu K." last="Natarajan">Madhu K. Natarajan</name><affiliation><nlm:aff id="aff9">Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada</nlm:aff></affiliation></author><author><name sortKey="Velianou, James L" sort="Velianou, James L" uniqKey="Velianou J" first="James L." last="Velianou">James L. Velianou</name><affiliation><nlm:aff id="aff9">Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada</nlm:aff></affiliation></author><author><name sortKey="Dehghani, Payam" sort="Dehghani, Payam" uniqKey="Dehghani P" first="Payam" last="Dehghani">Payam Dehghani</name><affiliation><nlm:aff id="aff5">University of Saskatchewan & Prairie Vascular, Regina, Saskatchewan, Canada</nlm:aff></affiliation></author><author><name sortKey="Wijeysundera, Harindra C" sort="Wijeysundera, Harindra C" uniqKey="Wijeysundera H" first="Harindra C." last="Wijeysundera">Harindra C. Wijeysundera</name><affiliation><nlm:aff id="aff10">Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada</nlm:aff></affiliation></author><author><name sortKey="Asgar, Anita W" sort="Asgar, Anita W" uniqKey="Asgar A" first="Anita W." last="Asgar">Anita W. Asgar</name><affiliation><nlm:aff id="aff3">Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada</nlm:aff></affiliation></author><author><name sortKey="Virani, Alice" sort="Virani, Alice" uniqKey="Virani A" first="Alice" last="Virani">Alice Virani</name><affiliation><nlm:aff id="aff11">Department of Medical Genetics, University of British Columbia, Vancouver, Canada</nlm:aff></affiliation></author><author><name sortKey="Welsh, Robert C" sort="Welsh, Robert C" uniqKey="Welsh R" first="Robert C." last="Welsh">Robert C. Welsh</name><affiliation><nlm:aff id="aff8">Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada</nlm:aff></affiliation></author><author><name sortKey="Webb, John G" sort="Webb, John G" uniqKey="Webb J" first="John G." last="Webb">John G. Webb</name><affiliation><nlm:aff id="aff1">Centre for Cardiovascular Innovation, UBC Division of Cardiology, St Paul’s and Vancouver General Hospital, Vancouver, Canada</nlm:aff></affiliation></author><author><name sortKey="Cohen, Eric A" sort="Cohen, Eric A" uniqKey="Cohen E" first="Eric A." last="Cohen">Eric A. Cohen</name><affiliation><nlm:aff id="aff10">Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">32299781</idno><idno type="pmc">7102580</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102580</idno><idno type="RBID">PMC:7102580</idno><idno type="doi">10.1016/j.cjca.2020.03.027</idno><date when="2020">2020</date><idno type="wicri:Area/Pmc/Corpus">000178</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000178</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Precautions and Procedures for Coronary and Structural Cardiac Interventions during the COVID-19 Pandemic: Guidance from Canadian Association of Interventional Cardiology</title><author><name sortKey="Wood, David A" sort="Wood, David A" uniqKey="Wood D" first="David A." last="Wood">David A. Wood</name><affiliation><nlm:aff id="aff1">Centre for Cardiovascular Innovation, UBC Division of Cardiology, St Paul’s and Vancouver General Hospital, Vancouver, Canada</nlm:aff></affiliation></author><author><name sortKey="Sathananthan, Janarthanan" sort="Sathananthan, Janarthanan" uniqKey="Sathananthan J" first="Janarthanan" last="Sathananthan">Janarthanan Sathananthan</name><affiliation><nlm:aff id="aff1">Centre for Cardiovascular Innovation, UBC Division of Cardiology, St Paul’s and Vancouver General Hospital, Vancouver, Canada</nlm:aff></affiliation></author><author><name sortKey="Gin, Ken" sort="Gin, Ken" uniqKey="Gin K" first="Ken" last="Gin">Ken Gin</name><affiliation><nlm:aff id="aff1">Centre for Cardiovascular Innovation, UBC Division of Cardiology, St Paul’s and Vancouver General Hospital, Vancouver, Canada</nlm:aff></affiliation></author><author><name sortKey="Mansour, Samer" sort="Mansour, Samer" uniqKey="Mansour S" first="Samer" last="Mansour">Samer Mansour</name><affiliation><nlm:aff id="aff2">Centre Hospitalier de l'Université de Montréal (CHUM) Research Center and Cardiovascular Center, Montreal, Canada</nlm:aff></affiliation></author><author><name sortKey="Ly, Hung Q" sort="Ly, Hung Q" uniqKey="Ly H" first="Hung Q." last="Ly">Hung Q. Ly</name><affiliation><nlm:aff id="aff3">Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada</nlm:aff></affiliation></author><author><name sortKey="Quraishi, Ata Ur Rehman" sort="Quraishi, Ata Ur Rehman" uniqKey="Quraishi A" first="Ata-Ur-Rehman" last="Quraishi">Ata-Ur-Rehman Quraishi</name><affiliation><nlm:aff id="aff4">Dalhousie University and QE II Health Sciences Centre, Halifax, Nova Scotia, Canada</nlm:aff></affiliation></author><author><name sortKey="Lavoie, Andrea" sort="Lavoie, Andrea" uniqKey="Lavoie A" first="Andrea" last="Lavoie">Andrea Lavoie</name><affiliation><nlm:aff id="aff5">University of Saskatchewan & Prairie Vascular, Regina, Saskatchewan, Canada</nlm:aff></affiliation></author><author><name sortKey="Lutchmedial, Sohrab" sort="Lutchmedial, Sohrab" uniqKey="Lutchmedial S" first="Sohrab" last="Lutchmedial">Sohrab Lutchmedial</name><affiliation><nlm:aff id="aff6">Cardiology, New Brunswick Heart Centre, Saint John Regional Hospital / Dalhousie University, Saint John, Canada</nlm:aff></affiliation></author><author><name sortKey="Nosair, Mohamed" sort="Nosair, Mohamed" uniqKey="Nosair M" first="Mohamed" last="Nosair">Mohamed Nosair</name><affiliation><nlm:aff id="aff3">Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada</nlm:aff></affiliation></author><author><name sortKey="Bagai, Akshay" sort="Bagai, Akshay" uniqKey="Bagai A" first="Akshay" last="Bagai">Akshay Bagai</name><affiliation><nlm:aff id="aff7">St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada</nlm:aff></affiliation></author><author><name sortKey="Bainey, Kevin R" sort="Bainey, Kevin R" uniqKey="Bainey K" first="Kevin R." last="Bainey">Kevin R. Bainey</name><affiliation><nlm:aff id="aff8">Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada</nlm:aff></affiliation></author><author><name sortKey="Boone, Robert H" sort="Boone, Robert H" uniqKey="Boone R" first="Robert H." last="Boone">Robert H. Boone</name><affiliation><nlm:aff id="aff1">Centre for Cardiovascular Innovation, UBC Division of Cardiology, St Paul’s and Vancouver General Hospital, Vancouver, Canada</nlm:aff></affiliation></author><author><name sortKey="Liu, Shuangbo" sort="Liu, Shuangbo" uniqKey="Liu S" first="Shuangbo" last="Liu">Shuangbo Liu</name><affiliation><nlm:aff id="aff7">St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada</nlm:aff></affiliation></author><author><name sortKey="Krahn, Andrew" sort="Krahn, Andrew" uniqKey="Krahn A" first="Andrew" last="Krahn">Andrew Krahn</name><affiliation><nlm:aff id="aff1">Centre for Cardiovascular Innovation, UBC Division of Cardiology, St Paul’s and Vancouver General Hospital, Vancouver, Canada</nlm:aff></affiliation></author><author><name sortKey="Virani, Sean" sort="Virani, Sean" uniqKey="Virani S" first="Sean" last="Virani">Sean Virani</name><affiliation><nlm:aff id="aff1">Centre for Cardiovascular Innovation, UBC Division of Cardiology, St Paul’s and Vancouver General Hospital, Vancouver, Canada</nlm:aff></affiliation></author><author><name sortKey="Mehta, Shamir R" sort="Mehta, Shamir R" uniqKey="Mehta S" first="Shamir R." last="Mehta">Shamir R. Mehta</name><affiliation><nlm:aff id="aff9">Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada</nlm:aff></affiliation></author><author><name sortKey="Natarajan, Madhu K" sort="Natarajan, Madhu K" uniqKey="Natarajan M" first="Madhu K." last="Natarajan">Madhu K. Natarajan</name><affiliation><nlm:aff id="aff9">Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada</nlm:aff></affiliation></author><author><name sortKey="Velianou, James L" sort="Velianou, James L" uniqKey="Velianou J" first="James L." last="Velianou">James L. Velianou</name><affiliation><nlm:aff id="aff9">Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada</nlm:aff></affiliation></author><author><name sortKey="Dehghani, Payam" sort="Dehghani, Payam" uniqKey="Dehghani P" first="Payam" last="Dehghani">Payam Dehghani</name><affiliation><nlm:aff id="aff5">University of Saskatchewan & Prairie Vascular, Regina, Saskatchewan, Canada</nlm:aff></affiliation></author><author><name sortKey="Wijeysundera, Harindra C" sort="Wijeysundera, Harindra C" uniqKey="Wijeysundera H" first="Harindra C." last="Wijeysundera">Harindra C. Wijeysundera</name><affiliation><nlm:aff id="aff10">Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada</nlm:aff></affiliation></author><author><name sortKey="Asgar, Anita W" sort="Asgar, Anita W" uniqKey="Asgar A" first="Anita W." last="Asgar">Anita W. Asgar</name><affiliation><nlm:aff id="aff3">Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada</nlm:aff></affiliation></author><author><name sortKey="Virani, Alice" sort="Virani, Alice" uniqKey="Virani A" first="Alice" last="Virani">Alice Virani</name><affiliation><nlm:aff id="aff11">Department of Medical Genetics, University of British Columbia, Vancouver, Canada</nlm:aff></affiliation></author><author><name sortKey="Welsh, Robert C" sort="Welsh, Robert C" uniqKey="Welsh R" first="Robert C." last="Welsh">Robert C. Welsh</name><affiliation><nlm:aff id="aff8">Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada</nlm:aff></affiliation></author><author><name sortKey="Webb, John G" sort="Webb, John G" uniqKey="Webb J" first="John G." last="Webb">John G. Webb</name><affiliation><nlm:aff id="aff1">Centre for Cardiovascular Innovation, UBC Division of Cardiology, St Paul’s and Vancouver General Hospital, Vancouver, Canada</nlm:aff></affiliation></author><author><name sortKey="Cohen, Eric A" sort="Cohen, Eric A" uniqKey="Cohen E" first="Eric A." last="Cohen">Eric A. Cohen</name><affiliation><nlm:aff id="aff10">Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada</nlm:aff></affiliation></author></analytic><series><title level="j">The Canadian Journal of Cardiology</title><idno type="ISSN">0828-282X</idno><idno type="eISSN">1916-7075</idno><imprint><date when="2020">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>The globe is currently in the midst of a COVID-19 pandemic resulting in significant morbidity and mortality. This pandemic has placed considerable stress on health care resources and providers. This document from the Canadian Association of Interventional Cardiology - Association Canadienne de Cardiologie d'intervention, specifically addresses the implications for the care of patients in the Cardiac Catheterization Laboratory (CCL) in Canada during the COVID-19 pandemic. The key principles of this document are to maintain essential interventional cardiovascular care while minimizing risks of COVID-19 to patients/staff and maintaining the overall healthcare resources. As the COVID-19 pandemic evolves, procedures will be increased or reduced based on the current level of restriction to health care services. While some consistency across the country is desirable, provincial and regional considerations will influence how these recommendations are implemented. We believe the framework and recommendations in this document will provide crucial guidance for clinicians and policy makers on the management of coronary and structural procedures in the CCL as the COVID-19 pandemic escalates and eventually abates.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Munster, V J" uniqKey="Munster V">V.J. Munster</name></author><author><name sortKey="Koopmans, M" uniqKey="Koopmans M">M. Koopmans</name></author><author><name sortKey="Van Doremalen, N" uniqKey="Van Doremalen N">N. van Doremalen</name></author><author><name sortKey="Van Riel, D" uniqKey="Van Riel D">D. van Riel</name></author><author><name sortKey="De Wit, E" uniqKey="De Wit E">E. de Wit</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Zhu, N" uniqKey="Zhu N">N. Zhu</name></author><author><name sortKey="Zhang, D" uniqKey="Zhang D">D. Zhang</name></author><author><name sortKey="Wang, W" uniqKey="Wang W">W. Wang</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Bedford, J" uniqKey="Bedford J">J. Bedford</name></author><author><name sortKey="Enria, D" uniqKey="Enria D">D. Enria</name></author><author><name sortKey="Giesecke, J" uniqKey="Giesecke J">J. Giesecke</name></author></analytic></biblStruct><biblStruct></biblStruct></listBibl></div1></back></TEI><pmc article-type="brief-report"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Can J Cardiol</journal-id><journal-id journal-id-type="iso-abbrev">Can J Cardiol</journal-id><journal-title-group><journal-title>The Canadian Journal of Cardiology</journal-title></journal-title-group><issn pub-type="ppub">0828-282X</issn><issn pub-type="epub">1916-7075</issn><publisher><publisher-name>Pulsus Group</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">32299781</article-id><article-id pub-id-type="pmc">7102580</article-id><article-id pub-id-type="publisher-id">S0828-282X(20)30300-7</article-id><article-id pub-id-type="doi">10.1016/j.cjca.2020.03.027</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Precautions and Procedures for Coronary and Structural Cardiac Interventions during the COVID-19 Pandemic: Guidance from Canadian Association of Interventional Cardiology</article-title></title-group><contrib-group><contrib contrib-type="author" id="au1"><name><surname>Wood</surname><given-names>David A.</given-names></name><degrees>MD</degrees><email>david.wood@vch.ca</email><xref rid="aff1" ref-type="aff">1</xref><xref rid="cor1" ref-type="corresp">∗</xref></contrib><contrib contrib-type="author" id="au2"><name><surname>Sathananthan</surname><given-names>Janarthanan</given-names></name><degrees>MBChB, MPH</degrees><xref rid="aff1" ref-type="aff">1</xref></contrib><contrib contrib-type="author" id="au3"><name><surname>Gin</surname><given-names>Ken</given-names></name><degrees>MD</degrees><xref rid="aff1" ref-type="aff">1</xref></contrib><contrib contrib-type="author" id="au4"><name><surname>Mansour</surname><given-names>Samer</given-names></name><degrees>MD</degrees><xref rid="aff2" ref-type="aff">2</xref></contrib><contrib contrib-type="author" id="au5"><name><surname>Ly</surname><given-names>Hung Q.</given-names></name><degrees>MD, SM</degrees><xref rid="aff3" ref-type="aff">3</xref></contrib><contrib contrib-type="author" id="au6"><name><surname>Quraishi</surname><given-names>Ata-ur-Rehman</given-names></name><degrees>MD</degrees><xref rid="aff4" ref-type="aff">4</xref></contrib><contrib contrib-type="author" id="au7"><name><surname>Lavoie</surname><given-names>Andrea</given-names></name><degrees>MD</degrees><xref rid="aff5" ref-type="aff">5</xref></contrib><contrib contrib-type="author" id="au8"><name><surname>Lutchmedial</surname><given-names>Sohrab</given-names></name><degrees>MD</degrees><xref rid="aff6" ref-type="aff">6</xref></contrib><contrib contrib-type="author" id="au9"><name><surname>Nosair</surname><given-names>Mohamed</given-names></name><degrees>MD</degrees><xref rid="aff3" ref-type="aff">3</xref></contrib><contrib contrib-type="author" id="au10"><name><surname>Bagai</surname><given-names>Akshay</given-names></name><degrees>MD</degrees><xref rid="aff7" ref-type="aff">7</xref></contrib><contrib contrib-type="author" id="au11"><name><surname>Bainey</surname><given-names>Kevin R.</given-names></name><degrees>MD</degrees><xref rid="aff8" ref-type="aff">8</xref></contrib><contrib contrib-type="author" id="au12"><name><surname>Boone</surname><given-names>Robert H.</given-names></name><degrees>MD</degrees><xref rid="aff1" ref-type="aff">1</xref></contrib><contrib contrib-type="author" id="au13"><name><surname>Liu</surname><given-names>Shuangbo</given-names></name><degrees>MD</degrees><xref rid="aff7" ref-type="aff">7</xref></contrib><contrib contrib-type="author" id="au14"><name><surname>Krahn</surname><given-names>Andrew</given-names></name><degrees>MD</degrees><xref rid="aff1" ref-type="aff">1</xref></contrib><contrib contrib-type="author" id="au15"><name><surname>Virani</surname><given-names>Sean</given-names></name><degrees>MD</degrees><xref rid="aff1" ref-type="aff">1</xref></contrib><contrib contrib-type="author" id="au16"><name><surname>Mehta</surname><given-names>Shamir R.</given-names></name><degrees>MD</degrees><xref rid="aff9" ref-type="aff">9</xref></contrib><contrib contrib-type="author" id="au17"><name><surname>Natarajan</surname><given-names>Madhu K.</given-names></name><degrees>MD</degrees><xref rid="aff9" ref-type="aff">9</xref></contrib><contrib contrib-type="author" id="au18"><name><surname>Velianou</surname><given-names>James L.</given-names></name><degrees>MD</degrees><xref rid="aff9" ref-type="aff">9</xref></contrib><contrib contrib-type="author" id="au19"><name><surname>Dehghani</surname><given-names>Payam</given-names></name><degrees>MD</degrees><xref rid="aff5" ref-type="aff">5</xref></contrib><contrib contrib-type="author" id="au20"><name><surname>Wijeysundera</surname><given-names>Harindra C.</given-names></name><degrees>MD</degrees><xref rid="aff10" ref-type="aff">10</xref></contrib><contrib contrib-type="author" id="au21"><name><surname>Asgar</surname><given-names>Anita W.</given-names></name><degrees>MD, MSc</degrees><xref rid="aff3" ref-type="aff">3</xref></contrib><contrib contrib-type="author" id="au22"><name><surname>Virani</surname><given-names>Alice</given-names></name><degrees>MA, MS, MPH, PhD</degrees><xref rid="aff11" ref-type="aff">11</xref></contrib><contrib contrib-type="author" id="au23"><name><surname>Welsh</surname><given-names>Robert C.</given-names></name><degrees>MD</degrees><xref rid="aff8" ref-type="aff">8</xref></contrib><contrib contrib-type="author" id="au24"><name><surname>Webb</surname><given-names>John G.</given-names></name><xref rid="aff1" ref-type="aff">1</xref></contrib><contrib contrib-type="author" id="au25"><name><surname>Cohen</surname><given-names>Eric A.</given-names></name><degrees>MD</degrees><xref rid="aff10" ref-type="aff">10</xref></contrib></contrib-group><aff id="aff1"><label>1</label>Centre for Cardiovascular Innovation, UBC Division of Cardiology, St Paul’s and Vancouver General Hospital, Vancouver, Canada</aff><aff id="aff2"><label>2</label>Centre Hospitalier de l'Université de Montréal (CHUM) Research Center and Cardiovascular Center, Montreal, Canada</aff><aff id="aff3"><label>3</label>Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada</aff><aff id="aff4"><label>4</label>Dalhousie University and QE II Health Sciences Centre, Halifax, Nova Scotia, Canada</aff><aff id="aff5"><label>5</label>University of Saskatchewan & Prairie Vascular, Regina, Saskatchewan, Canada</aff><aff id="aff6"><label>6</label>Cardiology, New Brunswick Heart Centre, Saint John Regional Hospital / Dalhousie University, Saint John, Canada</aff><aff id="aff7"><label>7</label>St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada</aff><aff id="aff8"><label>8</label>Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada</aff><aff id="aff9"><label>9</label>Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada</aff><aff id="aff10"><label>10</label>Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada</aff><aff id="aff11"><label>11</label>Department of Medical Genetics, University of British Columbia, Vancouver, Canada</aff><author-notes><corresp id="cor1"><label>∗</label>Address for Correspondence: David A Wood MD, FRCPC, FACC, FSCAI, FESC Centre for Cardiovascular Innovation St. Paul’s and Vancouver General Hospitals, University of British Columbia 2775 Laurel Street (9th Floor) Vancouver, British Columbia, Canada V5Z 1M9 Telephone: 604 875-5601. Fax: 604 875-5504 <email>david.wood@vch.ca</email></corresp></author-notes><pub-date pub-type="pmc-release"><day>24</day><month>3</month><year>2020</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on .</pmc-comment>
<pub-date pub-type="epub"><day>24</day><month>3</month><year>2020</year></pub-date><elocation-id></elocation-id><history><date date-type="received"><day>23</day><month>3</month><year>2020</year></date><date date-type="accepted"><day>23</day><month>3</month><year>2020</year></date></history><permissions><copyright-statement>© 2020 Published by Elsevier Inc. on behalf of the Canadian Cardiovascular Society.</copyright-statement><copyright-year>2020</copyright-year><copyright-holder></copyright-holder><license><license-p>Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.</license-p></license></permissions><abstract id="abs0010"><p>The globe is currently in the midst of a COVID-19 pandemic resulting in significant morbidity and mortality. This pandemic has placed considerable stress on health care resources and providers. This document from the Canadian Association of Interventional Cardiology - Association Canadienne de Cardiologie d'intervention, specifically addresses the implications for the care of patients in the Cardiac Catheterization Laboratory (CCL) in Canada during the COVID-19 pandemic. The key principles of this document are to maintain essential interventional cardiovascular care while minimizing risks of COVID-19 to patients/staff and maintaining the overall healthcare resources. As the COVID-19 pandemic evolves, procedures will be increased or reduced based on the current level of restriction to health care services. While some consistency across the country is desirable, provincial and regional considerations will influence how these recommendations are implemented. We believe the framework and recommendations in this document will provide crucial guidance for clinicians and policy makers on the management of coronary and structural procedures in the CCL as the COVID-19 pandemic escalates and eventually abates.</p></abstract><kwd-group id="kwrds0010"><title>Key Words</title><kwd>COVID-19</kwd><kwd>Pandemic</kwd><kwd>Coronary Interventional Procedures</kwd><kwd>Structural Interventional Procedures</kwd><kwd>Cardiac Catheterization Laboratory</kwd></kwd-group></article-meta></front><body><p id="p0010">The world is currently in the midst of the global COVID-19 pandemic, which has rapidly resulted in significant morbidity and mortality<xref rid="bib1" ref-type="bibr"><sup>1</sup></xref><sup>,</sup><xref rid="bib2" ref-type="bibr"><sup>2</sup></xref>. This pandemic has placed considerable stress on health care resources and providers. Acknowledging the strain on the entire health care system, this document specifically addresses the implications for the care of patients in the Cardiac Catheterization Laboratory (CCL).</p><p id="p0015">Cardiovascular disease encompasses a spectrum of clinical conditions associated with significant morbidity and mortality. As long as the capacity of the Canadian health care system allows, clinicians and policy makers must attempt to maintain essential coronary and structural interventional procedures while minimizing additional burdens on hospital and system resources during the COVID-19 pandemic. The operational challenges are evolving rapidly; therefore, this guidance must be interpreted with flexibility and pragmatism. While some consistency across the country is desirable, provincial and regional considerations will influence how these recommendations are implemented. In collaboration with all 11 Affiliates, CCS<xref rid="bib3" ref-type="bibr"><sup>3</sup></xref> and Canadian Association of Interventional Cardiology - Association Canadienne de Cardiologie d'intervention (CAIC-ACCI: <ext-link ext-link-type="uri" xlink:href="https://caic-acci.org/" id="intref0010">https://caic-acci.org</ext-link>.) have already issued guidance for inpatient and ambulatory cardiovascular care in Canada. In this manuscript, we provide guidance on the management of coronary and structural procedures in the CCL as the COVID-19 pandemic escalates and eventually abates.</p><p id="p0020">The executive, in collaboration with key subspecialty and general cardiologists from across Canada, embraced the following objectives when creating <xref rid="tbl1" ref-type="table">Table 1</xref>. The objectives reflect the core ethical principles of public health ethics: respect; the harm principle; fairness; consistency; least coercive and restrictive means; working together; reciprocity; proportionality; preservation of resources; flexibility; and procedural justice (as indicated in brackets);<table-wrap position="float" id="tbl1"><label>Table 1</label><caption><p>CAIC-ACCI Guidance for the Management of Coronary and Structural Procedures as COVID-19 Escalates and Abates</p></caption><table frame="hsides" rules="groups"><thead><tr><th>Response Level</th><th>Level 1<break></break>Minor restriction in regular services</th><th>Level 2<break></break>Major restriction in regular services</th><th>Level 3<break></break>Complete inability to provide services due to staff/resource limitations</th></tr></thead><tbody><tr><td colspan="4">CORONARY</td></tr><tr><td>STEMI</td><td>Patients with <bold>low</bold> probability of COVID-19 – PPCI OR pharmacoinvasive as per current regional practice.<break></break>Patients with <bold>moderate/High</bold> probability or <bold>COVID-19 +ve</bold> - PPCI with <underline>Aerosol Level PPE and N95 mask</underline> OR pharmacoinvasive at discretion of the treating team. If pharmacoinvasive with successful fibrinolysis, consider emergent COVID-19 testing with planned PCI within 24hrs.</td><td>Most patients now considered <bold>Moderate/High</bold> probability or <bold>COVID-19 +ve</bold> - pharmacoinvasive OR PPCI with <underline>Aerosol Level PPE and N95 mask</underline> at discretion of the treating team. If pharmacoinvasive with successful fibrinolysis, consider emergent COVID-19 testing with scheduled PCI within 24 hours.</td><td>Complete inability to provide PPCI. All patients will be treated with Thrombolysis as per regional protocols.</td></tr><tr><td>Cardiogenic Shock</td><td>Patients with <bold>low</bold> probability of COVID-19 – Continue as per usual regional practice.<break></break>Patients with <bold>moderate/High</bold> probability or <bold>COVID-19 +ve</bold> - Consider an invasive approach with <underline>Aerosol Level PPE and N95 mask</underline> if age OR comorbidities do not preclude a reasonable likelihood of meaningful survival.</td><td>Most patients now considered <bold>Moderate/High</bold> probability or <bold>COVID-19 +ve</bold> - Consider an invasive approach with <underline>Aerosol Level PPE and N95 mask</underline> if age OR comorbidities do not preclude a reasonable likelihood of meaningful survival.</td><td>Medical management of all cardiogenic shock cases.</td></tr><tr><td>Out of Hospital Cardiac Arrest (OHCA)</td><td>Patients with <bold>low</bold> probability of COVID-19 – Continue as per usual regional practice.<break></break>Patients with <bold>moderate/High</bold> probability or <bold>COVID-19 +ve</bold> - Consider an invasive approach with <underline>Aerosol Level PPE and N95 mask</underline> if age OR comorbidities do not preclude a reasonable likelihood of meaningful survival.</td><td>Most patients now considered <bold>Moderate/High</bold> probability or <bold>COVID-19 +ve</bold> - Consider an invasive approach with <underline>Aerosol Level PPE and N95 mask</underline> if age OR comorbidities do not preclude a reasonable likelihood of meaningful survival.</td><td>Medical management of all OHCA</td></tr><tr><td>NSTEMI (High Risk)<break></break>(Refractory symptoms, hemodynamic instability, significant LV dysfunction, suspected LM or significant proximal epicardial disease, GRACE risk score >140)</td><td>Patients with <bold>low</bold> probability of COVID-19 – Invasive approach as per current regional practice.<break></break>Patients with <bold>moderate/High</bold> probability of COVID-19 – Invasive approach with <underline>Aerosol Level PPE and N95 mask</underline>.<break></break><bold>COVID-19 +ve</bold> – consider invasive strategy with <underline>Aerosol Level PPE and N95 mask</underline></td><td>Most patients now considered <bold>Moderate/High</bold> probability or <bold>COVID-19 +ve</bold> - Consider an invasive approach with <underline>Aerosol Level PPE and N95 mask.</underline></td><td>Medical management of all ACS</td></tr><tr><td>Low/Medium Risk NSTEMI and UA</td><td>Invasive approach OR medical management for most patients.<break></break>If medical management selected and failed, screen (symptom questionnaire AND swab) all patients for COVID-19 prior to invasive approach. If <bold>COVID-19 +ve,</bold><underline>Aerosol Level PPE and N95 mask.</underline></td><td>Medical management favored over an invasive approach for most patients.<break></break>If medical management selected and failed, screen (symptom questionnaire AND swab) all patients for COVID-19 prior to invasive approach. If <bold>COVID-19 +ve,</bold><underline>Aerosol Level PPE and N95 mask.</underline></td><td>Medical management of all ACS</td></tr><tr><td>Type 2 MI (Consider COVID-19 myocarditis)</td><td>Investigations and treatment as per clinical judgement. Consider CT coronary angiography with <underline>Droplet Level PPE</underline> instead of an invasive approach.</td><td>Investigations and treatment as per clinical judgement. Consider CT coronary angiography with <underline>Droplet Level PPE</underline> instead of an invasive approach.</td><td>Medical management of all Type 2 MI</td></tr><tr><td>Outpatients</td><td>Consider cardiac catheterization for outpatients who are clinically considered to be moderate to higher risk.<break></break>Screen (symptom questionnaire AND/OR swab) all patients for COVID-19.<break></break>All non-urgent/elective cases should be deferred for > 30 days.</td><td>Consider cardiac catheterization for “urgent” outpatients only including those with symptoms AND non-invasive testing suggesting high risk for CV events in the short term.<break></break>Screen (symptom questionnaire AND/OR swab) all patients for COVID-19.<break></break>Others should be considered lower-risk and deferred for >30 days</td><td>Medical management for all Outpatients</td></tr><tr><td>CHIP</td><td>Limited cases that would facilitate hospital discharge.<break></break>Screen (symptoms questionnaire AND swab) all patients for COVID-19.</td><td>Complete cessation of cases</td><td>Complete cessation of cases</td></tr><tr><td>CTO</td><td>Complete cessation of cases</td><td>Complete cessation of cases</td><td>Complete cessation of cases</td></tr><tr><td colspan="4"><bold>STRUCTURAL HEART</bold></td></tr><tr><td>TAVI</td><td>High risk TAVI cases only with short expected LOS (low EF, valve-in-valve with severe AR, or recent hospitalization).</td><td>Limited inpatient cases that would facilitate hospital discharge</td><td>Complete cessation of cases</td></tr><tr><td>MitraClip</td><td>High risk cases with history of repeated HF hospitalizations or ER visits</td><td>Limited inpatient cases that would facilitate hospital discharge</td><td>Complete cessation of cases</td></tr><tr><td>Myocardial Biopsies</td><td>Limited cases in collaboration with Transplant Team</td><td>Limited cases in collaboration with Transplant Team</td><td>Complete cessation of cases</td></tr><tr><td>ASD/PFO</td><td>Complete cessation of cases</td><td>Complete cessation of cases</td><td>Complete cessation of cases</td></tr><tr><td>LAAC</td><td>Complete cessation of cases</td><td>Complete cessation of cases</td><td>Complete cessation of cases</td></tr><tr><td>Adult Congenital</td><td>Limited cases in collaboration with Adult Congenital Team</td><td>Complete cessation of cases</td><td>Complete cessation of cases</td></tr><tr><td>Pre-Solid Organ Transplant</td><td>Complete cessation of cases</td><td>Complete cessation of cases</td><td>Complete cessation of cases</td></tr><tr><td>Pulmonary HTN</td><td>Limited cases in collaboration with Pulmonary Hypertension Team</td><td>Complete cessation of cases</td><td>Complete cessation of cases</td></tr></tbody></table><table-wrap-foot><fn><p>(STEMI: ST elevation myocardial infarction; NSTEMI: Non-ST elevation myocardial infraction; LV: left ventricular; LM: Left main; UA: Unstable angina; MI: Myocardial infarction; GRACE: global registry of acute coronary events; CHIP: Complex and high risk interventional procedures; CTO: Chronic total occlusions; TAVI: Transcatheter aortic valve implantation; ASD: Atrial septal defect; PFO: Patent foramen ovale; LAAC: Left atrial appendage closure; HTN: Hypertension; LOS: Length of stay; PPE: Personal protective equipment; PPCI: primary percutaneous coronary intervention)</p></fn></table-wrap-foot></table-wrap></p><p id="p0025">1. Limit cardiac use of overall system capacity, especially in-patient/ICU beds (Working together, proportionality)</p><p id="p0030">2. Minimize risk to healthcare workers (Reciprocity, care provider safety, and sustainability)</p><p id="p0035">3. Maximize preservation of personal protective equipment (Preservation of resource)</p><p id="p0040">4. Maximize compliance with social and healthcare distancing (The harm principle)</p><p id="p0045">5. Minimize the incremental risk of patients acquiring COVID-19 related to cardiac investigations or procedures (The harm principle, proportionality)</p><p id="p0050">6. Maintain essential interventional cardiology service to patients at high risk of cardiovascular events in the short term (Preservation of resources)</p><p id="p0055">7. Minimize adverse outcomes for cardiovascular patients during the COVID-19 pandemic (The harm principle)</p><p id="p0060">8. Ensure decisions are made in a consistent manner (Procedural justice, accountability, reasonableness)</p><p id="p0065">9. Ensure decisions are communicated in a transparent and sensitive manner (Respect and transparency)</p><p id="p0070">Given the unavoidable interaction of these individual recommendations, the order doesn’t necessarily reflect priority ranking. Relative prioritization will vary over time and in different regions as the crisis evolves.</p><p id="p0075">The principles above are predicated on balancing anticipated benefits and risks for individual patients while also considering societal needs during this crisis. A reduction in CCL activity is inevitable, at least over the short term and possibly longer; criteria are therefore based on identifying groups of patients most likely to benefit from a specific intervention, or conversely, most likely to suffer harm without such an intervention. In situations for which the treatment effect is small, or evidence uncertain, alternate approaches that place less burden on hospital resources may be used, even if these deviate from the usual pattern of care.</p><p id="p0080">The recommendations are outlined in <xref rid="tbl1" ref-type="table">Table 1</xref>. As the COVID-19 pandemic evolves, procedures will be increased or reduced based on the current level of restriction to health care services. Recommendations also vary based on the likelihood of COVID-19 in the population in order to mitigate the risk of transmission to both Health Care Workers (HCW) and patients. CAIC-ACCI acknowledges that this document is predominantly based on consensus agreement. This approach reflects the considerable challenge of making practice recommendations in the face of a rapidly evolving global pandemic, with limited scientific evidence to guide clinical practice. The unknown duration of the crisis mandates timely review of these recommendations. Postponement rather than cancellation may be appropriate for many procedures; however, lengthy delays (several months) could have a significant negative impact on morbidity and mortality, even for patients facing relatively low short-term risk.</p><p id="p0085">A few important additional considerations: 1) We encourage all Canadian research teams to carefully track cardiovascular outcomes in the coming months, and focus on key research gaps recently identified4. If we document a large increase in potentially avoidable cardiac deaths from unavailable procedures, then difficult but necessary discussions about allocation of resources to infection vs. emergent cardiovascular procedures will be crucial; 2) Certain cardiac catheterization staff with comorbidities associated with adverse events in the setting of contracting COVID-19 (age >60 years, diabetes, hypertension, or pre-existing cardiovascular disease) may wish to refrain from procedures with an increased risk of aerosolization if adequate personal protective equipment (PPE) cannot be provided. Depending on their level of competency and in accordance with their training programs, trainees may also wish to refrain from cardiac catheterization procedures; 3) PPE use, including correct donning and doffing, changing scrubs and showering between cases with a high likelihood of COVID-19, and changing civilian clothes and footwear upon entering and leaving the hospital will remain our best defence during the pandemic5; 4) The threshold for performing percutaneous vs surgical coronary and valvular interventions may vary as the pandemic escalates and abates. After review by the Heart Team, multivessel percutaneous coronary intervention (PCI), transcatheter aortic valve intervention (TAVI) or MitralClip may be appropriate to facilitate hospital discharge and reduce length of stay (LOS); 5) In the setting of ST-elevation myocardial infarction ( STEMI) or other situations requiring emergent cardiac catheterization, pre-hospital screening for symptoms of influenza-like illnesses, pre-existing knowledge of COVID-19 positivity, and if available in the future, rapid COVID-19 testing should be strongly encouraged so that patients can receive appropriate care and by-pass the emergency department; 6) The goal of rapid but safe discharge with teleconference or telephone follow-up should be promoted to facilitate maximizing the use of bed capacity and avoid hospital exposure.</p><p id="p0090">In summary, we believe the above framework and the recommendations in <xref rid="tbl1" ref-type="table">Table 1</xref> will provide crucial guidance for clinicians and policy makers on the management of coronary and structural procedures in the CCL as the COVID-19 pandemic escalates and eventually abates.</p><sec id="sec1"><title>Uncited reference</title><p id="p0095"><xref rid="bib4" ref-type="bibr">4.</xref>, <xref rid="bib5" ref-type="bibr">5.</xref>.</p></sec></body><back><ref-list id="cebib0010"><title>References</title><ref id="bib1"><label>1</label><element-citation publication-type="journal" id="sref1"><person-group person-group-type="author"><name><surname>Munster</surname><given-names>V.J.</given-names></name><name><surname>Koopmans</surname><given-names>M.</given-names></name><name><surname>van Doremalen</surname><given-names>N.</given-names></name><name><surname>van Riel</surname><given-names>D.</given-names></name><name><surname>de Wit</surname><given-names>E.</given-names></name></person-group><article-title>A Novel Coronavirus Emerging in China - Key Questions for Impact Assessment</article-title><source>N Engl J Med</source><volume>382</volume><issue>8</issue><year>2020</year><fpage>692</fpage><lpage>694</lpage><pub-id pub-id-type="pmid">31978293</pub-id></element-citation></ref><ref id="bib2"><label>2</label><element-citation publication-type="journal" id="sref2"><person-group person-group-type="author"><name><surname>Zhu</surname><given-names>N.</given-names></name><name><surname>Zhang</surname><given-names>D.</given-names></name><name><surname>Wang</surname><given-names>W.</given-names></name></person-group><article-title>A Novel Coronavirus from Patients with Pneumonia in China, 2019</article-title><source>N Engl J Med</source><volume>382</volume><issue>8</issue><year>2020</year><fpage>727</fpage><lpage>733</lpage><pub-id pub-id-type="pmid">31978945</pub-id></element-citation></ref><ref id="bib3"><label>3</label><mixed-citation publication-type="other" id="sref3">Guidance from the CCS COVID-19 Rapid Response Team. Canadian Cardiovascular Society. <ext-link ext-link-type="uri" xlink:href="https://www.ccs.ca/en/" id="intref0015">https://www.ccs.ca/en/</ext-link>. Published 2020. Accessed.</mixed-citation></ref><ref id="bib4"><label>4</label><element-citation publication-type="journal" id="sref4"><person-group person-group-type="author"><name><surname>Bedford</surname><given-names>J.</given-names></name><name><surname>Enria</surname><given-names>D.</given-names></name><name><surname>Giesecke</surname><given-names>J.</given-names></name></person-group><article-title>COVID-19: towards controlling of a pandemic</article-title><source>Lancet</source><year>2020</year></element-citation></ref><ref id="bib5"><label>5</label><mixed-citation publication-type="other" id="sref5">Driggin E MM, Bikdeli B, Chuich T, Laracy J, Bondi-Zoccai G, Brown TS, Nigoghossian CD, Zidar DA, et al. Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the Coronavirus Disease 2019 (COVID-19) Pandemic. Journal of the American College of Cardiology 2020.</mixed-citation></ref></ref-list><fn-group><fn id="d32e469"><p id="ntpara0010">Financial disclosures/Funding sources: All authors report no financial disclosures relevant to the contents of this manuscript.</p></fn></fn-group></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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