Category Archives: CPR in the News

cpr covid19

CPR in a World with COVID-19

Cardiopulmonary resuscitation stands out as an inherently risky activity in the COVID-19 era: SARS-CoV-2 spreads from person to person through the air, and CPR involves many steps that could aerosolize the virus.

However, healthcare workers and bystanders can take precautions to protect themselves while helping others, as outlined in “interim guidance” recently published in Circulation.

Prior to the pandemic, survival from cardiac arrest had steadily improved thanks to prompt use of measures like chest compression and defibrillation. COVID-19 now requires taking a fresh look at “established processes and practices,” Dana P. Edelson, MD (University of Chicago, IL), and colleagues say. “The challenge is to ensure that patients with or without COVID-19 who experience cardiac arrest get the best possible chance of survival without compromising the safety of rescuers, who will be needed to care for future patients.”

Their practical advice—covering adult, pediatric, and neonatal resuscitations in patients with suspected or confirmed COVID-19 infection, for both in-hospital and out-of-hospital cardiac arrest—arises from a team effort by the American Heart Association (AHA) in collaboration with the American Academy of Pediatrics, the American Association for Respiratory Care, the American College of Emergency Physicians, the Society of Critical Care Anesthesiologists, and the American Society of Anesthesiologists, with the support of both the American Association of Critical Care Nurses and National EMS Physicians.

“There’s a reason why we had eight organizations be a part of this. Part of that is because there’s a very small knowledge base right now for how to treat COVID patients and a lot of [that knowledge] is based on things that are literally being published hourly, coming out of China, Italy, France, and other countries,” Comilla Sasson, MD, PhD (University of Colorado Hospital, Denver), told TCTMD. Sasson, who co-authored the document along with 26 other experts, is an emergency medicine physician and the AHA’s vice president for emergency cardiovascular care science and innovation.

“What we tried to do was to take the best-available evidence, for which there is very limited data, combined with what we know from prior infectious disease outbreaks like SARS and MERS, and then really try to figure out [the] delicate balance of making sure that we are trying to optimize patient survival but at the same time being very mindful of exposure risks to providers as well,” she explained.

For the first time, CPR recommendations are calling for clinicians to take a pause and ensure safety before proceeding, Sasson pointed out. “Healthcare providers are a limited, scarce resource, and we have to make sure that their safety is paramount, especially in an infectious disease like this.”

Reduce Exposure, Limit Spread

The document emphasizes three main principles, explaining their rationale and offering specific strategies to achieve them: reduce provider exposure to SARS-CoV-2, prioritize oxygenation and ventilation methods that can lower aerosolization risk, and—for each unique patient and setting—weigh whether it is appropriate to start or continue CPR.

When COVID-19 is a concern, healthcare workers are encouraged to don personal protective equipment prior to initiating CPR and limit the number of personnel present when it occurs. Mechanical CPR devices also can reduce exposure. To limit aerosolization, the right tools can help, such as using a bag-mask device with a HEPA filter and a tight seal; the document also stresses intubation and ventilation of the patient.

Decisions over whether to pursue CPR must be done carefully, though “it is reasonable to consider age, comorbidities, and severity of illness,” according to the guidance.

“Cardiopulmonary resuscitation is a high-intensity team effort that diverts rescuer attention away from other patients. In the context of COVID-19, the risk to the clinical team is increased and resources can be profoundly more limited, particularly in regions that are experiencing a high burden of disease,” Edelson et al observe. “While the outcomes for cardiac arrest in COVID- 19 are as of yet unknown, the mortality for critically ill COVID-19 patients is high and rises with increasing age and comorbidities, particularly cardiovascular disease.”

Importantly, for patients who are COVID-19 negative or aren’t thought to have the disease, “cardiac arrest resuscitations should proceed according to the standard algorithms,” they stress.

Some good news: CPR training is available online. In these uncertain times, it is more important than ever to take measures to insure the safety of your loved ones.

For the entire article, please see the source: https://www.tctmd.com/news/cpr-covid-19-keep-safe-setting-cardiac-arrest

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.

Article Source: https://www.medpagetoday.com/infectiousdisease/covid19/85568

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.”

Source: https://medicalxpress.com/news/2020-03-first-ever-analysis-video-cpr-resuscitation.html