Patients with severe Covid-19 commonly develop acute respiratory distress syndrome, myocardial injury, ventricular arrhythmias, and shock, all of which, increase their risk of cardiac arrest. Moreover, some medications, such as hydroxychloroquine and azithromycin, used to treat Covid-19 can prolong the QT interval, which also predisposes them to cardiac arrest (Edelson, 2020). It’s well known that survival after cardiac arrest depends on providing immediate high-quality chest compressions and defibrillation (Panchal, 2019).
But with the pandemic, how do health care workers give the best possible care to patients with known or suspected Covid-19, yet protect themselves during resuscitation? It isn’t easy considering the shortages of personal protective equipment and the aerosol-generating procedures required during cardiopulmonary resuscitation (CPR).
The American Heart Association, in collaboration with other professional organizations, released Interim Guidance for Life Support for Covid-19. This guidance aims to protect rescuers delivering CPR, while at the same time providing timely, high-quality resuscitation to patients.
The interim guidance, based on expert opinion, contains three key principles that apply to adult, pediatric, and neonatal resuscitations in patients with confirmed or suspected Covid-19.
1. Reduce health care worker exposure to Covid-19.
2. Prioritize those ventilation and oxygenation interventions that have a lower risk of generating aerosols.
3. Consider whether it’s appropriate to begin and continue CPR.
In addition to these principles, the AHA made revisions to their algorithms for Basic Life Support and Advanced Cardiac Life Support, which can be found in the AHA’s Interim Guidance for Life Support for Covid-19.
Lippincott Solutions note: for the latest coverage on Covid-19 by the Lippincott Nursing team, please visit nursingcenter.com/coronavirus.
Edelson, D.P. (2020). 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 Nation EMS physicians.
Panchal, A.R., et al. (2019). 2019 American Heart Association Focused Update on Advanced Cardiovascular Life Support: Use of Advanced Airways, Vasopressors, and Extracorporeal Cardiopulmonary Resuscitation During Cardiac Arrest: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
About the author
Collette Bishop Hendler, RN, MS, MA, CIC, Editor-in-Chief, Lippincott Solutions, Point-of-Care, is certified by the Certification Board of Infection Control and Epidemiology, Inc. as an Infection Preventionist. She has more than 15 years’ experience in critical care nursing and maintains Alumnus Status as a Critical-Care Registered Nurse.