The Exchange

Commentary and Observations from
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What’s Changed for Basic and Advanced Life Support During COVID-19

What’s Changed for Basic and Advanced Life Support During COVID-19

How we do CPR and advanced cardiac life support (ACLS) has changed in the last several months. The American Heart Association collaborated with other organizations (American Academy of Pediatrics, American Association for Respiratory Care, American College of Emergency Physicians, the Society of Critical Care Anesthesiologists, and the American Society of Anesthesiologists) to develop interim guidelines during the COVID-19 pandemic. The main challenge they faced in these interim revisions was ensuring that patients with or without COVID-19 who were experiencing cardiac arrest received the best possible chance of survival without compromising the safety of the rescuer. The group looked at three areas: provider exposure, oxygenation/ventilation, and resuscitation appropriateness.

Reduce provider exposure

  • All rescuers must don PPE before entering the scene or room
  • Limit the personnel needed in the room or on the scene
  • Consider using a mechanical CPR device for chest compressions to reduce the number of rescuers required; make sure that devices meet height and weight criteria for adolescents and adults
  • Make sure to communicate the status of the patient (eg, COVID-19positive) to any new provider

Prioritize oxygenation and ventilation strategies with lower aerosolization risk

  • Attach a high efficiency particulate air (HEPA) filter, if available, for all ventilation
  • Intubate early with a cuffed tube and connect to any manual or mechanical ventilator device, if available, before administering any breaths
  • Assign the provider with the best chance of first-pass success to intubate
  • Pause chest compressions when intubating
  • Consider a video laryngoscope, if available
  • Before intubation, use a bag-mask device with a HEPA filter and a tight seal
  • For adults, consider passive oxygenation with nonrebreathing face mask covered by a surgical mask
  • Minimize closed circuit disconnections to reduce aerosolization

Consider the appropriateness of starting and continuing resuscitation

  • Address goals of care with COVID-19 patients or proxy regarding levels of care
  • Adopt policies to guide front-line providers in determining the appropriateness of starting and terminating CPR for patients with COVID-19

Everyone be safe and thank you for all you are doing.

References
  • Edelson D, et al. Interim guidance for life support for COVID-19 Circulation. 2020;[Epub ahead of print].

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Filed under: Health Policy and Trends, Infectious Diseases

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