CPR Algorithm Adjustments when Caring for Suspected or Confirmed COVID Cases

In Featured, Guidelines, Infographics by Kara TastadLeave a Comment

The infographic above was designed in collaboration with the American Heart Association (AHA) and highlights interim guidance for life support when caring for COVID-19 patients​1​. Check out their full list of COVID-19 resources for resuscitation here.

Reduce Provider Exposure

When caring for confirmed COVID-19 cases, it is essential for healthcare providers to protect themselves from exposure as best they can. Healthcare providers who contract COVID-19 can increase the burden on an already strained workforce, especially if they become critically ill​1​. It is important to ensure all healthcare providers don PPE that guards against both airborne and droplet particles before entering a resuscitation scene​1​. Furthermore, it is critical to limit healthcare providers in the room to only essential personnel, especially in a resuscitation setting. When appropriate, utilizing mechanical CPR devices in place of manual chest compressions can help reduce the number of rescuers required in the resuscitation room​1​.

Prioritize Strategies with Lower Aerosolization Risk

With confirmed COVID-19 cases, healthcare providers should aim to prioritize oxygenation and ventilation strategies with lower aerosolization risks1. When intubating, consider utilizing a closed circuit using a cuffed endotracheal tube connected to a ventilator with a HEPA filter in the path of exhaled gas and in-line suction catheter to significantly lower risk​1​,​2​.  

Other oxygenation and ventilation strategies that lower aerosolization include​1​:

  • Using a bag-mask with a HEPA filter or a non-rebreather face mask covered with a surgical mask before intubation
  • Attaching a HEPA filter to any ventilation device in the path of exhaled gas before breaths are administered
  • Intubating cardiac arrest patients with a cuffed tube at the earliest opportunity
  • Delegating intubation to the health care provider who has the best chance at first-pass success to decrease the risk of failed intubations
  • Pausing chest compressions when intubating
  • Considering use of video laryngoscopy
  • Minimizing disconnections once the patient is intubated on a closed circuit

Consider the Appropriateness of Resuscitation

Never forget that CPR is a high-intensity rescue measure​1​,​3​. Mortality for critically ill COVID-19 patients is high and increases with comorbidities​1​. Consequently, ensure that the patient’s age, comorbidities, and severity of the illness is considered when determining the appropriateness of resuscitation​1​,​4–8​. Confirming that goals of care have been addressed early with COVID-19 patients or their proxy can help set expectations if or when increased levels of care are needed​1​.

References:

  1. 1.
    Edelson DP, Sasson C, Chan PS, et al. Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19:From the Emergency Cardiovascular Care Committee and Get With the Guidelines            ®            -Resuscitation Adult and Pediatric Task Forces of the American Heart Association in Collaboration with the American Academy of Pediatrics, American Association for Respiratory Care, American College of Emergency Physicians, The Society of Critical Care Anesthesiologists, and American Society of Anesthesiologists: Supporting Organizations: American Association of Critical Care Nurses and National EMS Physicians. Circulation. Published online April 9, 2020. doi:10.1161/circulationaha.120.047463
  2. 2.
    ECRI Institute. Mechanical ventilation of SARS patients: lessons from the 2003 SARS outbreak. Health Devices. Published February 18, 2020. https://www.ecri.org/components/HDJournal/Pages/Mechanical-Ventilation-of-SARS-Patients-2003-SARS-Outbreak.aspx?tab=2
  3. 3.
    Volchenboum SL, Mayampurath A, Göksu-Gürsoy G, Edelson DP, Howell MD, Churpek MM. Association Between In-Hospital Critical Illness Events and Outcomes in Patients on the Same Ward. JAMA. Published online December 27, 2016:2674. doi:10.1001/jama.2016.15505
  4. 4.
    Bialek S, Boundy E, et al. Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) — United States, February 12–March 16, 2020. MMWR Morb Mortal Wkly Rep. Published online March 27, 2020:343-346. doi:10.15585/mmwr.mm6912e2
  5. 5.
    Bhatraju PK, Ghassemieh BJ, Nichols M, et al. Covid-19 in Critically Ill Patients in the Seattle Region — Case Series. N Engl J Med. Published online March 30, 2020. doi:10.1056/nejmoa2004500
  6. 6.
    Guo T, Fan Y, Chen M, et al. Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. Published online March 27, 2020. doi:10.1001/jamacardio.2020.1017
  7. 7.
    Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet. Published online February 2020:497-506. doi:10.1016/s0140-6736(20)30183-5
  8. 8.
    Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA. Published online March 17, 2020:1061. doi:10.1001/jama.2020.1585

This post was reviewed and edited by Sparsh Shah and Alvin Chin

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Kara Tastad

Kara Tastad

Kara Tastad a final-year medical student at the University of Saskatchewan. Her interests include medical education, emergency medicine, and trauma care. Outside of medicine, you are likely to find her traveling, swimming, painting, or baking.
Sparsh Shah

Sparsh Shah

Sparsh Shah is an incoming Emergency Medicine Resident at the University of Toronto. He has interests in trauma, global health, and healthcare innovation.
Meenhas Oravil

Meenhas Oravil

Dr. Meenhas Oravil is a Senior Emergency Medicine Resident at Jubilee Mission Medical College & Research Institute, Kerala, India. He is a CanadiEM Infographic Editor, and is interested in FOAMed, Medical Research & Innovation, Trauma care, Toxicology, and Point of Care Ultrasound.