COVID-19: resuscitation in hospital settings

• Patients with a COVID-19 like illness, who are at risk of acute deterioration or cardiac arrest should be identified early. Appropriate steps to prevent cardiac arrest and avoid unprotected CPR should be taken
• Use of physiological track and trigger systems (i.e. NEWS2) will enable early detection of acutely ill patients. Patients for whom a ‘do not attempt CPR and/or other similarly decision is appropriate should be identified early.
• The locally/nationally agreed minimum level of PPE must be used to assess a patient, start chest compressions and establish monitoring of the cardiac arrest rhythm
• The need to don PPE may delay CPR in patients with COVID-19 – staff safety is paramount. In a cardiac arrest of presumed hypoxic aetiology (including paediatric events) early ventilation with oxygen is usually advised. Any airway intervention performed without then correct PPE protection will subject the rescuer to a significant risk of infection. Consequently, the UK Resus Council recommend even in presumed hypoxic arrest starting with chest compressions.
• Recognise cardiac arrest – Look for the absence of signs of life and normal breathing. Feel for a carotid pulse if trained to do so. DO NOT listen or feel for breathing by placing your ear and cheek close to the patient’s mouth. When calling 2222, state the risk of COVID-19
• If a defibrillator is readily available defibrillate shockable rhythms rapidly prior to starting chest compressions. The early restoration of circulation may prevent the need for further resuscitation measures.
• Full Aerosol Generating Procedure (AGP) Personal Protective Equipment must be worn by all members of the resuscitation/emergency team before entering the room. Sets of AGP PPE must be readily available where resuscitation equipment is being locally stored. Only suitable clothed start compression only CPR and monitor the patients cardiac arrest rhythm as soon as possible.
• DO NOT do mouth-to-mouth ventilation or use a pocket mask. If the patient is already receiving supplemental oxygen therapy using a face mask, leave the face mask on the patients face during chest compressions as this may limit aerosol spread. If not insitu but one is readily available put a simple oxygen mask on the patients face.
• Restrict the number of staff in the room
• Airway interventions (such as intubation) must be carried out by experienced individuals.
• Identify and treat any reversible causes before considering stopping CPR
• Dispose of or clean all equipment used following manufacturers recommendations/local guidelines
• Remove PPE Safely to avoid self-contamination and dispose of clinical waste bags as per local guidelines. Hand hygiene has an important role in decreasing transmission, thoroughly wash hands with soap and water.

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