Monthly Archives: March 2020

covid cpr

New CPR Guidelines When COVID-19 Is Known or Suspected

Special precautions should be taken when resuscitating people in cardiac arrest with known or suspected COVID-19 coronavirus, according to guidance from the American Heart Association (AHA). The good news is you can learn CPR online, which could help save the life of a family member.

The interim guidance, drawn mostly from CDC recommendations, focused on procedures that generate aerosols — such as CPR, endotracheal intubation, and non-invasive ventilation — and thus pose an extra risk for transmitting the virus that causes COVID-19.

Guide for Prehospital Care

“When COVID-19 is suspected in a patient needing emergency transport, prehospital care providers and healthcare facilities should be notified in advance that they may be caring for, transporting, or receiving a patient who may have COVID-19 infection,” the document says.

If dispatchers advise that COVID-19 is suspected, emergency medical services (EMS) personnel should follow Standard Precautions, including the use of personal protective equipment (PPE).

Appropriate PPE during an aerosol-generating procedure includes respiratory protection (N95s and similar respirators are preferred, but face masks can be used if not available), eye protection, a single pair of disposable gloves, and gowns.

Even if a patient has not been said to potentially have COVID-19, EMS workers should exercise appropriate precautions when responding to someone who may have a respiratory infection.

“Initial assessment should begin from a distance of at least 6 feet from the patient, if possible. Patient contact should be minimized to the extent possible until a facemask is on the patient,” according to CDC guidance cited by the AHA.

Precautions related to EMS equipment and the transport vehicle include:

  • Making sure bag-valve masks and other ventilatory equipment are equipped with HEPA filters
  • Opening the rear doors of the transport vehicle and activating the HVAC system during aerosol-generating procedures (this should be done away from pedestrian traffic)
  • Not allowing family and friends to ride in the transport vehicle with the person with possible COVID-19 (if they must ride along, they should wear a face mask)
  • Creating a negative pressure gradient in the patient area in the case where ventilation must be used and the vehicle does not have an isolated driver compartment: open the outside air vents in the driver area and turn on the rear exhaust ventilation fans to the highest setting

Protective Measures in the Hospital

Airborne Infection Isolation Rooms (AIIRs) are where aerosol-generating procedures such as CPR should be performed in the hospital.

There, the staff should have respiratory protection and the number of personnel present during the procedure should be limited to those essential for patient care and procedural support. These rooms should be cleaned and disinfected following each procedure.

AIIRs should be reserved for patients undergoing aerosol-generating procedures, not given to patients with known or suspected COVID-19. The latter should be cared for in a single-person room with the door closed, the CDC recommends.

As usual, hand hygiene and appropriate PPE were stressed for hospital staff working with patients with suspected or confirmed COVID-19.

“If there are shortages of gowns, they should be prioritized for aerosol-generating procedures, care activities where splashes and sprays are anticipated, and high-contact patient care activities that provide opportunities for transfer of pathogens to the hands and clothing of providers,” the AHA guidance says.

Rapid sequence intubation with appropriate PPE is the preferred method of intubation. In general, aerosol-generating procedures (e.g., bag-valve mask, nebulizers, non-invasive positive pressure ventilation) should be avoided per recommendations attributed to the Anesthesia Patient Safety Foundation and World Federation of Societies of Anesthesiologists.

For patients with acute respiratory failure, the AHA suggested proceeding directly to endotracheal intubation. Avoiding high-flow nasal oxygenation and mask continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) will help reduce aerosol generation, it added.

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video cpr

Analysis of Video Recorded CPR Improves Resuscitation Outcomes

Less than 8 percent of people who suffer from cardiac arrest outside of the hospital survive the incident, according to the American Heart Association. To improve survivorship and better administer life-saving cardiopulmonary resuscitation (CPR), researchers and physicians at The Feinstein Institutes for Medical Research and North Shore University Hospital developed a novel approach called Mechanical, Team-Focused, Video-Reviewed Cardiopulmonary Resuscitation (MTV-CPR) to video record, review and reform practices to improve performance. Their research results published today in the Journal of the American Heart Association.

The first-of-its-kind study to be conducted nationally began in 2018 when emergency department (ED) staff at North Shore University Hospital (NSUH) began video recording the process and use of the mechanical chest compression device (MCCD) for cardiac arrest patients. The goal of the study was to increase the return of spontaneous circulation (ROSC) rate pre- and post- MTV-CPR intervention.

Get online CPR training and help save lives.

A new team-focused strategy was developed with nurse-led Advanced Cardiac Life Support (ACLS) and biweekly, multidisciplinary video review of the cardiac arrests were conducted. The research is spearheaded by Lance Becker, MD, professor in the Institute of Bioelectronic Medicine at the Feinstein Institutes, and Daniel Rolston, MD, MSHPM an Emergency Medicine and Critical Care physician at NSUH.

“It was a simple, yet powerful idea; use overhead video cameras to record and then later review the process of our staff administering mechanical CPR in our emergency rooms to improve outcomes,” said Dr. Becker, who is also the ED chair at Long Island Jewish Medical Center and NSUH. “Our data support the benefit of actively reviewing and improving on real-world CPR techniques to save peoples’ lives. When we saw a problem we developed new protocols to overcome each challenge.”

Four resuscitation rooms in the ED equipped with video review technology which monitored 151 cardiac arrest patients for the ROSC rate. Patients achieving ROSC improved from 26 percent before MTV-CPR intervention to 41 percent afterward.

Dr. Becker and his team of physicians, nurses and technicians gathered to watch video of the resuscitation and review processes, trying to find ways to make each incidence better. Through their analysis, the team implemented personalized feedback for those placing MCCD on patients, reduced chest compression interruptions, developed new assignment roles for an eight-person response team, and created new coordinated transition methods for technicians to go from manual to mechanical CPR.

“Dr. Becker and his team have led early, national efforts to put defibrillators in public spaces,” said Kevin J. Tracey, MD, president and CEO of the Feinstein Institutes. “Now they are leading this new effort to prevent sudden cardiac deaths in hospital emergency departments.”


cpr saves lives 600 seconds

Tennessee Senate Passes Lifesaving Telecommunicator CPR Policy

A lifesaving policy known as Telecommunicator CPR (T-CPR) passed recently from the Tennessee Senate, concurring with the House version, and is now heading to the Governor’s desk. Senate Bill 1958, sponsored by Sen. Rusty Crowe, R-Johnson City, passed with a unanimous vote. Its House companion, House Bill 1933, sponsored by Rep. Scott Cepicky, R- Culleoka, also passed unanimously Feb. 27. Without a single “no” vote during the entire legislative process, the policy is gaining attention and support in Tennessee by both state and local governments this year.

During cardiac arrest – the unexpected loss of heart function – only about 1 in 10 victims survive. Successful resuscitation of victims requires an immediate response to improve their chance of survival. Telecommunicators, including emergency dispatchers and 9-1-1 operators, can be lifesaving coaches when seconds matter.

The American Heart Association, the world’s leading nonprofit organization focused on heart and brain health for all, cheered T-CPR’s passage. Learn CPR online and help save lives.

“As a Sudden Cardiac Arrest Survivor, I know every second counts when it comes to saving a life,” said Carrie Romero, a member of the American Heart Association’s Tennessee State Advocacy Committee and an AED advocate from Thompson’s Station. “The passing of the T-CPR bill is a huge step toward ensuring that every heart in the state of Tennessee has a fighting chance of survival. I’m so grateful for the efforts of Rep. Cepicky and Sen. Crowe as they led the way to get this bill passed.”

“With an estimated 350,000 cardiac arrests happening every year, telecommunicators are the true first responders to every 9-1-1 call and a critical link in the chain of survival,” said Kelley Tune, executive director of the Middle Tennessee American Heart Association. “Being able to provide effective T-CPR can mean the difference between life or death. We’re grateful for the overwhelming support from Tennessee lawmakers prioritizing this lifesaving policy.”

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