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1.
Sci Rep ; 12(1): 14575, 2022 08 26.
Article in English | MEDLINE | ID: covidwho-2008311

ABSTRACT

Public access automated external defibrillators (AEDs) represent emergency medical devices that may be used by untrained lay-persons in a life-critical event. As such their usability must be confirmed through simulation testing. In 2020 the novel coronavirus caused a global pandemic. In order to reduce the spread of the virus, many restrictions such as social distancing and travel bans were enforced. Usability testing of AEDs is typically conducted in-person, but due to these restrictions, other usability solutions must be investigated. Two studies were conducted, each with 18 participants: (1) an in-person usability study of an AED conducted in an office space, and (2) a synchronous remote usability study of the same AED conducted using video conferencing software. Key metrics associated with AED use, such as time to turn on, time to place pads and time to deliver a shock, were assessed in both studies. There was no difference in time taken to turn the AED on in the in-person study compared to the remote study, but the time to place electrode pads and to deliver a shock were significantly lower in the in-person study than in the remote study. Overall, the results of this study indicate that remote user testing of public access defibrillators may be appropriate in formative usability studies for determining understanding of the user interface.


Subject(s)
COVID-19 , Cardiopulmonary Resuscitation , Defibrillators/classification , Out-of-Hospital Cardiac Arrest/therapy , Physical Distancing , Cardiopulmonary Resuscitation/methods , Cardiopulmonary Resuscitation/standards , Defibrillators/standards , Defibrillators/statistics & numerical data , Humans , Pandemics , Time Factors , User-Centered Design , User-Computer Interface
2.
Am J Emerg Med ; 52: 128-131, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1561972

ABSTRACT

AIM OF THE STUDY: In this study we aimed to investigate whether changing rescuers wearing N95 masks every 1 min instead of the standard CPR change over time of 2 min would make a difference in effective chest compressions. METHODS: This study was a randomized controlled mannequin study. Participants were selected from healthcare staff. They were divided into two groups of two people in each group. The scenario was implemented on CPR mannequin representing patient with asystolic arrest, that measured compression depth, compression rate, recoil, and correct hand position. Two different scenarios were prepared. In Scenario 1, the rescuers were asked to change chest compression after 1 min. In Scenario 2, standard CPR was applied. The participants' vital parameters, mean compression rate, correct compression rate/ratio, total number of compressions, compression depth, correct recoil/ratio, correct hand position/ratio, mean no-flow time, and total CPR time were recorded. RESULTS: The study hence included 14 teams each for scenarios, with a total of 56 participants. In each scenario, 14 participants were physicians and 14 participants were women. Although there was no difference in the first minute of the cycles starting from the fourth cycle, a statistically significant difference was observed in the second minute in all cycles except the fifth cycle. CONCLUSION: Changing the rescuer every 1 min instead of every 2 min while performing CPR with full PPE may prevent the decrease in compression quality that may occur as the resuscitation time gets longer.


Subject(s)
Cardiopulmonary Resuscitation/methods , Cardiopulmonary Resuscitation/standards , Emergency Service, Hospital/standards , Fatigue/prevention & control , Heart Arrest/therapy , Medical Staff, Hospital , N95 Respirators , Adult , Female , Humans , Male , Manikins , Turkey
3.
Emerg Med J ; 38(9): 679-684, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1311172

ABSTRACT

BACKGROUND: Emergency medical service (EMS) personnel have high COVID-19 risk during resuscitation. The resuscitation protocol for patients with out-of-hospital cardiac arrest (OHCA) was modified in response to the COVID-19 pandemic. However, how the adjustments in the EMS system affected patients with OHCA remains unclear. METHODS: We analysed data from the Taichung OHCA registry system. We compared OHCA outcomes and rescue records for 622 cases during the COVID-19 outbreak period (1 February to 30 April 2020) with those recorded for 570 cases during the same period in 2019. RESULTS: The two periods did not differ significantly with respect to patient age, patient sex, the presence of witnesses or OHCA location. Bystander cardiopulmonary resuscitation and defibrillation with automated external defibrillators were more common in 2020 (52.81% vs 65.76%, p<0.001%, and 23.51% vs 31.67%, p=0.001, respectively). The EMS response time was longer during the COVID-19 pandemic (445.8±210.2 s in 2020 vs 389.7±201.8 s in 2019, p<0.001). The rate of prehospital return of spontaneous circulation was lower in 2020 (6.49% vs 2.57%, p=0.001); 2019 and 2020 had similar rates of survival discharge (5.96% vs 4.98%). However, significantly fewer cases had favourable neurological function in 2020 (4.21% vs 2.09%, p=0.035). CONCLUSION: EMS response time for patients with OHCA was prolonged during the COVID-19 pandemic. Early advanced life support by EMS personnel remains crucial for patients with OHCA.


Subject(s)
COVID-19/transmission , Cardiopulmonary Resuscitation/statistics & numerical data , Emergency Medical Services/statistics & numerical data , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Out-of-Hospital Cardiac Arrest/therapy , Adult , Aged , Aged, 80 and over , COVID-19/complications , COVID-19/epidemiology , COVID-19/virology , Cardiopulmonary Resuscitation/standards , Emergency Medical Services/standards , Emergency Medical Technicians/standards , Emergency Medical Technicians/statistics & numerical data , Female , Humans , Male , Middle Aged , Out-of-Hospital Cardiac Arrest/complications , Out-of-Hospital Cardiac Arrest/epidemiology , Pandemics/prevention & control , Practice Guidelines as Topic , Registries/statistics & numerical data , Retrospective Studies , SARS-CoV-2/pathogenicity , Taiwan/epidemiology , Time-to-Treatment/standards , Time-to-Treatment/statistics & numerical data , Young Adult
4.
Emerg Med J ; 38(9): 673-678, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1287247

ABSTRACT

AIM: Cardiopulmonary resuscitation (CPR) is an emergency procedure where interpersonal distance cannot be maintained. There are and will always be outbreaks of infection from airborne diseases. Our objective was to assess the potential risk of airborne virus transmission during CPR in open-air conditions. METHODS: We performed advanced high-fidelity three-dimensional modelling and simulations to predict airborne transmission during out-of-hospital hands-only CPR. The computational model considers complex fluid dynamics and heat transfer phenomena such as aerosol evaporation, breakup, coalescence, turbulence, and local interactions between the aerosol and the surrounding fluid. Furthermore, we incorporated the effects of the wind speed/direction, the air temperature and relative humidity on the transport of contaminated saliva particles emitted from a victim during a resuscitation process based on an Airborne Infection Risk (AIR) Index. RESULTS: The results reveal low-risk conditions that include wind direction and high relative humidity and temperature. High-risk situations include wind directed to the rescuer, low humidity and temperature. Combinations of other conditions have an intermediate AIR Index and risk for the rescue team. CONCLUSIONS: The fluid dynamics, simulation-based AIR Index provides a classification of the risk of contagion by victim's aerosol in the case of hands-only CPR considering environmental factors such as wind speed and direction, relative humidity and temperature. Therefore, we recommend that rescuers perform a quick assessment of their airborne infectious risk before starting CPR in the open air and positioning themselves to avoid wind directed to their faces.


Subject(s)
COVID-19/transmission , Cardiopulmonary Resuscitation/adverse effects , Models, Biological , Out-of-Hospital Cardiac Arrest/therapy , SARS-CoV-2/pathogenicity , Aerosols/adverse effects , COVID-19/complications , COVID-19/virology , Cardiopulmonary Resuscitation/standards , Computer Simulation , Guidelines as Topic , Humans , Humidity , Hydrodynamics , Out-of-Hospital Cardiac Arrest/complications , Personal Protective Equipment/standards , Risk Assessment/methods , Risk Assessment/statistics & numerical data , Temperature , Wind
5.
Br J Hosp Med (Lond) ; 82(4): 1-6, 2021 Apr 02.
Article in English | MEDLINE | ID: covidwho-1207923

ABSTRACT

In view of the high morbidity and mortality associated with COVID-19, early and honest conversations with patients about goals of care are vital. Advance care planning in its traditional manner may be difficult to achieve given the unpredictability of the disease trajectory. Despite this, it is crucial that patients' care wishes are explored as this will help prevent inappropriate admissions to hospital and to critical care, improve symptom control and advocate for patient choice. This article provides practical tips on how to translate decisions around treatment escalation plans into conversations, both face-to-face and over the phone, in a sensitive and compassionate manner. Care planning conversations for patients with COVID-19 should be individualised and actively involve the patient. Focusing on goals of care rather than ceilings of treatment can help to alleviate anxiety around these conversations and will remind patients that their care will never cease. Using a framework such as the 'SPIKES' mnemonic can help to structure this conversation. Verbally conveying empathy will be key, particularly when wearing personal protective equipment or speaking to relatives over the phone. It is also important to make time to recognise your own emotions during and/or after these conversations.


Subject(s)
Advance Care Planning/organization & administration , COVID-19/epidemiology , Communication , Terminal Care/organization & administration , Advance Care Planning/standards , Cardiopulmonary Resuscitation/standards , Empathy , Humans , Patient Care Planning , Personal Protective Equipment , SARS-CoV-2 , Telephone , Terminal Care/standards
6.
Can J Cardiol ; 37(8): 1267-1270, 2021 08.
Article in English | MEDLINE | ID: covidwho-1155438

ABSTRACT

Cardiac arrest is common in critically ill patients with coronavirus disease 2019 (COVID-19) and is associated with poor survival. Simulation is frequently used to evaluate and train code teams with the goal of improving outcomes. All participants engaged in training on donning and doffing of personal protective equipment for suspected or confirmed COVID-19 cases. Thereafter, simulations of in-hospital cardiac arrest of patients with COVID-19, so-called protected code blue, were conducted at a quaternary academic centre. The primary endpoint was the mean time-to-defibrillation. A total of 114 patients participated in 33 "protected code blue" simulations over 8 weeks: 10 were senior residents, 17 were attending physicians, 86 were nurses, and 5 were respiratory therapists. Mean time-to-defibrillation was 4.38 minutes. Mean time-to-room entry, time-to-intubation, time-to-first-chest compression and time-to-epinephrine were 2.77, 5.74, 6.31, and 6.20 minutes, respectively; 92.84% of the 16 criteria evaluating the proper management of patients with COVID-19 and cardiac arrest were met. Mean time-to-defibrillation was longer than guidelines-expected time during protected code blue simulations. Although adherence to the modified advanced cardiovascular life-support protocol was high, breaches that carry additional infectious risk and reduce the efficacy of the resuscitation team were observed.


Subject(s)
COVID-19 , Cardiopulmonary Resuscitation , Education, Medical , Heart Arrest , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Simulation Training/methods , Time-to-Treatment/standards , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/transmission , Canada/epidemiology , Cardiopulmonary Resuscitation/education , Cardiopulmonary Resuscitation/methods , Cardiopulmonary Resuscitation/standards , Clinical Protocols , Education, Medical/methods , Education, Medical/trends , Guideline Adherence/statistics & numerical data , Heart Arrest/etiology , Heart Arrest/therapy , Humans , Infection Control/methods , SARS-CoV-2/isolation & purification
7.
Scand J Trauma Resusc Emerg Med ; 29(1): 19, 2021 Jan 27.
Article in English | MEDLINE | ID: covidwho-1054826

ABSTRACT

BACKGROUND: Futile resuscitation for out-of-hospital cardiac arrest (OHCA) patients in the coronavirus disease (COVID)-19 era can lead to risk of disease transmission and unnecessary transport. Various existing basic or advanced life support (BLS or ALS, respectively) rules for the termination of resuscitation (TOR) have been derived and validated in North America and Asian countries. This study aimed to evaluate the external validation of these rules in predicting the survival outcomes of OHCA patients in the COVID-19 era. METHODS: This was a multicenter observational study using the WinCOVID-19 Daegu registry data collected during February 18-March 31, 2020. The subjects were patients who showed cardiac arrest of presumed cardiac etiology. The outcomes of each rule were compared to the actual patient survival outcomes. The sensitivity, specificity, false positive value (FPV), and positive predictive value (PPV) of each TOR rule were evaluated. RESULTS: In total, 170 of the 184 OHCA patients were eligible and evaluated. TOR was recommended for 122 patients based on the international basic life support termination of resuscitation (BLS-TOR) rule, which showed 85% specificity, 74% sensitivity, 0.8% FPV, and 99% PPV for predicting unfavorable survival outcomes. When the traditional BLS-TOR rules and KoCARC TOR rule II were applied to our registry, one patient met the TOR criteria but survived at hospital discharge. With regard to the FPV (upper limit of 95% confidence interval < 5%), specificity (100%), and PPV (> 99%) criteria, only the KoCARC TOR rule I, which included a combination of three factors including not being witnessed by emergency medical technicians, presenting with an asystole at the scene, and not experiencing prehospital shock delivery or return of spontaneous circulation, was found to be superior to all other TOR rules. CONCLUSION: Among the previous nine BLS and ALS TOR rules, KoCARC TOR rule I was most suitable for predicting poor survival outcomes and showed improved diagnostic performance. Further research on variations in resources and treatment protocols among facilities, regions, and cultures will be useful in determining the feasibility of TOR rules for COVID-19 patients worldwide.


Subject(s)
COVID-19/prevention & control , Cardiopulmonary Resuscitation/standards , Decision Support Techniques , Medical Futility , Out-of-Hospital Cardiac Arrest/therapy , Aged , Aged, 80 and over , Emergency Medical Services , Female , Humans , Male , Middle Aged , Predictive Value of Tests , Registries , Republic of Korea , Resuscitation Orders
9.
J Emerg Med ; 60(3): 292-298, 2021 03.
Article in English | MEDLINE | ID: covidwho-972127

ABSTRACT

BACKGROUND: Personal protective equipment (PPE) is equipment that protects health care workers from harmful agents and organisms. The importance of this equipment was noticed again with the Coronavirus Disease 2019 (COVID-19) pandemic. OBJECTIVES: In this study, we investigated the effect of different masks used as PPE on resuscitation quality and rescuer fatigue. METHODS: Participants applied chest compression without a mask, with a surgical mask, a filtering face-piece respirator (FFR) mask, and a half-face mask with active P3 filter. A smart watch was worn on the left wrists of the participants during chest compression in each condition. They were requested to rate their fatigue on a visual analogue scale. RESULTS: Statistically higher average pulse rates were found in the FFR mask and half-face mask conditions. FFR mask and half-face mask resulted in statistically worse results than surgical mask and no-mask conditions in the number of compressions per minute, compression depth, and compression effectiveness. Further, half-face mask and FFR mask caused more fatigue in participants. CONCLUSION: Protective masks other than surgical masks used as PPE increase rescuer fatigue in CPR and negatively affect the quality of chest compressions.


Subject(s)
COVID-19/prevention & control , Cardiopulmonary Resuscitation/standards , Fatigue , Health Personnel , Masks/adverse effects , Occupational Exposure/prevention & control , Adult , Electrocardiography , Female , Humans , Male , Pandemics , SARS-CoV-2
11.
Arq Bras Cardiol ; 114(5): 805-816, 2020 05 11.
Article in English, Portuguese | MEDLINE | ID: covidwho-910581

ABSTRACT

In face of the pandemic of the novel coronavirus disease 2019 (COVID-19), the management of patients with cardiovascular risk factors and/or disease is challenging. The cardiovascular complications evidenced in patients with COVID-19 derive from several mechanisms, ranging from direct viral injury to complications secondary to the inflammatory and thrombotic responses to the infection. The proper care of patients with COVID-19 requires special attention to the cardiovascular system aimed at better outcomes.


Frente à pandemia da doença causada pelo novo coronavírus (COVID-19), o manejo do paciente com fator de risco e/ou doença cardiovascular é desafiador nos dias de hoje. As complicações cardiovasculares evidenciadas nos pacientes com COVID-19 resultam de vários mecanismos, que vão desde lesão direta pelo vírus até complicações secundárias à resposta inflamatória e trombótica desencadeada pela infecção. O cuidado adequado do paciente com COVID-19 exige atenção ao sistema cardiovascular em busca de melhores desfechos.


Subject(s)
Betacoronavirus , Cardiovascular Diseases/virology , Coronavirus Infections/complications , Health Personnel , Pneumonia, Viral/complications , COVID-19 , Cardiopulmonary Resuscitation/standards , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/therapy , Cardiovascular Physiological Phenomena , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Health Personnel/standards , Heart/physiopathology , Humans , Pandemics , Patient Care/standards , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Practice Guidelines as Topic , Risk Factors , SARS-CoV-2 , Ventricular Dysfunction/etiology
12.
Food Chem Toxicol ; 145: 111742, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-888511

ABSTRACT

SARS-CoV-2 (Covid-19) infection has recently become a worldwide challenge with dramatic global economic and health consequences. As the pandemic is still spreading, new data concerning Covid-19 complications and related mechanisms become increasingly available. Accumulating data suggest that the incidence of cardiac arrest and its outcome are adversely affected during the Covid-19 period. This may be further exacerbated by drug-related cardiac toxicity of Covid-19 treatment regimens. Elucidating the underlying mechanisms that lead to Covid-19 associated cardiac arrest is imperative, not only in order to improve its effective management but also to maximize preventive measures. Herein we discuss available epidemiological data on cardiac arrest during the Covid-19 pandemic as well as possible associated causes and pathophysiological mechanisms and highlight gaps in evidence warranting further investigation. The risk of transmission during cardiopulmonary resuscitation (CPR) is also discussed in this review. Finally, we summarize currently recommended guidelines on CPR for Covid-19 patients including CPR in patients with cardiac arrest due to suspected drug-related cardiac toxicity in an effort to underscore the most important common points and discuss discrepancies proposed by established international societies.


Subject(s)
Arrhythmias, Cardiac/epidemiology , Arrhythmias, Cardiac/physiopathology , Betacoronavirus , Coronavirus Infections/complications , Heart Arrest/epidemiology , Heart Arrest/physiopathology , Pneumonia, Viral/complications , Arrhythmias, Cardiac/etiology , COVID-19 , Cardiopulmonary Resuscitation/standards , Cardiotoxicity/epidemiology , Cardiotoxicity/etiology , Cardiotoxicity/physiopathology , Coronavirus Infections/drug therapy , Disease Transmission, Infectious/prevention & control , Heart Arrest/etiology , Humans , Pandemics , Pneumonia, Viral/drug therapy , SARS-CoV-2
13.
Hellenic J Cardiol ; 62(1): 24-28, 2021.
Article in English | MEDLINE | ID: covidwho-773675

ABSTRACT

The unprecedented for modern medicine pandemic caused by the SARS-COV-2 virus ("coronavirus", Covid-19 disease) creates in turn new data on the management and survival of cardiac arrest victims, but mainly on the safety of CardioPulmonary Resuscitation (CPR) providers. The Covid-19 pandemic resulted in losses of thousands of lives, and many more people were hospitalized in simple or in intensive care unit beds, both globally and locally in Greece. More specifically, in victims of cardiac arrest, both in- and out- of hospital, the increased mortality and high contagiousness of the SARS-CoV-2 virus posed new questions, of both medical and moral nature/ to CPR providers. What we all know in resuscitation, that we cannot harm the victim and therefore do the most/best we can, is no longer the everyday reality. What we need to know and incorporate into decision-making in the resuscitation process is the distribution of limited human and material resources, the potentially very poor outcome of patients with Covid-19 and cardiac arrest, and especially that a potential infection of health professionals can lead in the lack of health professionals in the near future. This review tries to incorporate the added skills and precautions for CPR providers in terms of both in- and out- hospital CPR.


Subject(s)
COVID-19 , Cardiopulmonary Resuscitation , Heart Arrest , Occupational Health , COVID-19/mortality , COVID-19/prevention & control , COVID-19/transmission , Cardiopulmonary Resuscitation/ethics , Cardiopulmonary Resuscitation/methods , Cardiopulmonary Resuscitation/standards , Heart Arrest/therapy , Heart Arrest/virology , Humans , Occupational Exposure/prevention & control , Occupational Health/ethics , Occupational Health/standards , SARS-CoV-2
14.
J Contin Educ Nurs ; 51(9): 399-401, 2020 Sep 01.
Article in English | MEDLINE | ID: covidwho-729673

ABSTRACT

In light of the COVID-19 pandemic and uncertainties around risk of transmission, urgent hospital resuscitation (also known as "Code Blue") efforts are needed, pivoting to protect health care workers. This article provides teaching tips for "Protected Code Blues." [J Contin Educ Nurs. 2020;51(9):399-401.].


Subject(s)
Cardiopulmonary Resuscitation/education , Cardiopulmonary Resuscitation/nursing , Cardiopulmonary Resuscitation/standards , Coronavirus Infections/nursing , Health Personnel/education , Nursing Staff, Hospital/education , Pneumonia, Viral/nursing , Simulation Training/organization & administration , Adult , Betacoronavirus , COVID-19 , Curriculum , Education, Nursing, Continuing/organization & administration , Female , Humans , Male , Middle Aged , Pandemics , Practice Guidelines as Topic , SARS-CoV-2
17.
Med J Aust ; 213(3): 126-133, 2020 08.
Article in English | MEDLINE | ID: covidwho-643293

ABSTRACT

INTRODUCTION: The global pandemic of coronavirus disease 2019 (COVID-19) has caused significant worldwide disruption. Although Australia and New Zealand have not been affected as much as some other countries, resuscitation may still pose a risk to health care workers and necessitates a change to our traditional approach. This consensus statement for adult cardiac arrest in the setting of COVID-19 has been produced by the Australasian College for Emergency Medicine (ACEM) and aligns with national and international recommendations. MAIN RECOMMENDATIONS: In a setting of low community transmission, most cardiac arrests are not due to COVID-19. Early defibrillation saves lives and is not considered an aerosol generating procedure. Compression-only cardiopulmonary resuscitation is thought to be a low risk procedure and can be safely initiated with the patient's mouth and nose covered. All other resuscitative procedures are considered aerosol generating and require the use of airborne personal protective equipment (PPE). It is important to balance the appropriateness of resuscitation against the risk of infection. Methods to reduce nosocomial transmission of COVID-19 include a physical barrier such as a towel or mask over the patient's mouth and nose, appropriate use of PPE, minimising the staff involved in resuscitation, and use of mechanical chest compression devices when available. If COVID-19 significantly affects hospital resource availability, the ethics of resource allocation must be considered. CHANGES IN MANAGEMENT: The changes outlined in this document require a significant adaptation for many doctors, nurses and paramedics. It is critically important that all health care workers have regular PPE and advanced life support training, are able to access in situ simulation sessions, and receive extensive debriefing after actual resuscitations. This will ensure safe, timely and effective management of the patients with cardiac arrest in the COVID-19 era.


Subject(s)
Cardiopulmonary Resuscitation/methods , Coronavirus Infections/epidemiology , Emergency Service, Hospital/organization & administration , Heart Arrest/therapy , Pandemics , Pneumonia, Viral/epidemiology , Adult , Algorithms , Australia/epidemiology , Betacoronavirus , COVID-19 , Cardiopulmonary Resuscitation/standards , Coronavirus Infections/transmission , Cross Infection/prevention & control , Humans , Infection Control/methods , Infection Control/standards , Infectious Disease Transmission, Patient-to-Professional/prevention & control , New Zealand/epidemiology , Personal Protective Equipment , Pneumonia, Viral/transmission , SARS-CoV-2
18.
Arq Bras Cardiol ; 114(6): 1078-1087, 2020 06.
Article in English, Portuguese | MEDLINE | ID: covidwho-637531

ABSTRACT

Care for patients with cardiac arrest in the context of the coronavirus disease 2019 (COVID-19) pandemic has several unique aspects that warrant particular attention. This joint position statement by the Brazilian Association of Emergency Medicine (ABRAMEDE), Brazilian Society of Cardiology (SBC), Brazilian Association of Intensive Care Medicine (AMIB), and Brazilian Society of Anesthesiology (SBA), all official societies representing the corresponding medical specialties affiliated with the Brazilian Medical Association (AMB), provides recommendations to guide health care workers in the current context of limited robust evidence, aiming to maximize the protection of staff and patients alike. It is essential that full aerosol precautions, which include wearing appropriate personal protective equipment, be followed during resuscitation. It is also imperative that potential causes of cardiac arrest of particular interest in this patient population, especially hypoxia, cardiac arrhythmias associated with QT prolongation, and myocarditis, be considered and addressed. An advanced invasive airway device should be placed early. Use of HEPA filters at the bag-valve interface is mandatory. Management of cardiac arrest occurring during mechanical ventilation or during prone positioning demands particular ventilator settings and rescuer positioning for chest compressions which deviate from standard cardiopulmonary resuscitation techniques. Apart from these logistical issues, care should otherwise follow national and international protocols and guidelines, namely the 2015 International Liaison Committee on Resuscitation (ILCOR) and 2019 American Heart Association (AHA) guidelines and the 2019 Update to the Brazilian Society of Cardiology Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Guideline.


Subject(s)
Cardiopulmonary Resuscitation/standards , Coronavirus Infections/therapy , Coronavirus , Pandemics , Pneumonia, Viral/therapy , Practice Guidelines as Topic , Advisory Committees , Betacoronavirus , Brazil/epidemiology , COVID-19 , Cardiopulmonary Resuscitation/methods , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Humans , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Societies, Medical , United States
19.
Pediatr Res ; 88(5): 705-716, 2020 11.
Article in English | MEDLINE | ID: covidwho-635228

ABSTRACT

BACKGROUND: Fewer children than adults have been affected by the COVID-19 pandemic, and the clinical manifestations are distinct from those of adults. Some children particularly those with acute or chronic co-morbidities are likely to develop critical illness. Recently, a multisystem inflammatory syndrome (MIS-C) has been described in children with some of these patients requiring care in the pediatric ICU. METHODS: An international collaboration was formed to review the available evidence and develop evidence-based guidelines for the care of critically ill children with SARS-CoV-2 infection. Where the evidence was lacking, those gaps were replaced with consensus-based guidelines. RESULTS: This process has generated 44 recommendations related to pediatric COVID-19 patients presenting with respiratory distress or failure, sepsis or septic shock, cardiopulmonary arrest, MIS-C, those requiring adjuvant therapies, or ECMO. Evidence to explain the milder disease patterns in children and the potential to use repurposed anti-viral drugs, anti-inflammatory or anti-thrombotic therapies are also described. CONCLUSION: Brief summaries of pediatric SARS-CoV-2 infection in different regions of the world are included since few registries are capturing this data globally. These guidelines seek to harmonize the standards and strategies for intensive care that critically ill children with COVID-19 receive across the world. IMPACT: At the time of publication, this is the latest evidence for managing critically ill children infected with SARS-CoV-2. Referring to these guidelines can decrease the morbidity and potentially the mortality of children effected by COVID-19 and its sequalae. These guidelines can be adapted to both high- and limited-resource settings.


Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Critical Care/standards , Intensive Care Units, Pediatric/standards , Pandemics , Pneumonia, Viral/therapy , Adolescent , Africa/epidemiology , Americas/epidemiology , Antiviral Agents/therapeutic use , Asia/epidemiology , COVID-19 , Cardiopulmonary Resuscitation/methods , Cardiopulmonary Resuscitation/standards , Child , Child, Preschool , Combined Modality Therapy , Comorbidity , Coronavirus Infections/complications , Coronavirus Infections/drug therapy , Coronavirus Infections/epidemiology , Critical Care/methods , Cross Infection/prevention & control , Europe/epidemiology , Extracorporeal Membrane Oxygenation/standards , Female , Humans , Infant , Infant, Newborn , Infection Control/methods , Infection Control/standards , Male , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Respiration, Artificial/standards , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/therapy , SARS-CoV-2 , Shock/etiology , Shock/therapy , Systemic Inflammatory Response Syndrome/epidemiology , Systemic Inflammatory Response Syndrome/therapy , COVID-19 Drug Treatment
20.
J Cardiothorac Vasc Anesth ; 34(10): 2595-2603, 2020 10.
Article in English | MEDLINE | ID: covidwho-634042

ABSTRACT

Cardiopulmonary resuscitation (CPR) in patients with severe acute respiratory syndrome coronavirus-2-associated disease (coronavirus disease 2019) poses a unique challenge to health- care providers due to the risk of viral aerosolization and disease transmission. This has caused some centers to modify existing CPR procedures, limit the duration of CPR, or consider avoiding CPR altogether. In this review, the authors propose a procedure for CPR in the intensive care unit that minimizes the number of personnel in the immediate vicinity of the patient and conserves the use of scarce personal protective equipment. Highlighting the low likelihood of successful resuscitation in high-risk patients may prompt patients to decline CPR. The authors recommend the preemptive placement of central venous lines in high-risk patients with intravenous tubing extensions that allow for medication delivery from outside the patients' rooms. During CPR, this practice can be used to deliver critical medications without delay. The use of a mechanical compression system for CPR further reduces the risk of infectious exposure to health- care providers. Extracorporeal membrane oxygenation should be reserved for patients with few comorbidities and a single failing organ system. Reliable teleconferencing tools are essential to facilitate communication between providers inside and outside the patients' rooms. General principles regarding the ethics and peri-resuscitative management of coronavirus 2019 patients also are discussed.


Subject(s)
Betacoronavirus , Cardiopulmonary Resuscitation/methods , Coronavirus Infections/therapy , Critical Care/methods , Heart Arrest/therapy , Intensive Care Units , Pneumonia, Viral/therapy , COVID-19 , Cardiopulmonary Resuscitation/standards , Coronavirus Infections/epidemiology , Critical Care/standards , Heart Arrest/epidemiology , Humans , Intensive Care Units/standards , Pandemics , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Workflow
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