Existing American Heart Association (AHA) cardiopulmonary resuscitation (CPR) guidelines do not address the challenges of providing resuscitation in the setting of the COVID-19 global pandemic, wherein rescuers must continuously balance the immediate needs of the victims with their own safety. To address this gap, the AHA, in collaboration with the American Academy of Pediatrics, etc. They compiled interim guidance to help rescuers treat victims of cardiac arrest with suspected or confirmed COVID-19.
This statement applies to all adult, pediatric, and neonatal resuscitations in patients with suspected or confirmed COVID-19 infection unless otherwise noted. The guidance contained herein is based on expert opinion and needs to be adapted locally based on current disease burden and resource availability.
Summary of adjustments to CPR algorithms in suspected or confirmed COVID-19 patients.
Reduce provider exposure
- Don PPE before entering the room/scene
- Limit personnel
- Consider using mechanical CPR devices for adults and adolescents who meet height and weight criteria
- Communicate COVID-19 status to any new providers
Prioritize oxygenation and ventilation strategies with lower aerosolization risk
- Use a HEPA filter, if available, for all ventilation
- Intubate early with a cuffed tube, if possible, and connect to a mechanical ventilator, when able
- Engage the intubator with highest chance of first-pass success
- Pause chest compressions to intubate
- Consider use of video laryngoscopy, if available
- Before intubation, use a bag-mask device (or T-piece in neonates) with a HEPA filter and a tight seal
- For adults, consider passive oxygenation with nonrebreathing face mask as alternative to bag mask device for short duration
- If intubation delayed, consider supraglottic airway
- Minimize closed circuit disconnections
Consider resuscitation appropriateness
- Address goals of care
- Adopt policies to guide determination, taking into account patient risk factors for survival
Note: This list is a brief compilation of some of the key recommendations included in the Guideline and is not exhaustive and does not constitute medical advice.
Kindly refer to the original publication in the document attached below