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Scand J Trauma Resusc Emerg Med ; 29(1): 19, 2021 Jan 27.
Article in English | MEDLINE | ID: covidwho-1054826


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.

/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
Arq. bras. cardiol ; 114(5): 805-816, maio 2020. tab, graf
Article in Portuguese | LILACS (Americas) | ID: covidwho-910581


Resumo 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.

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.

Humans , Pneumonia, Viral/complications , Cardiovascular Diseases/virology , Health Personnel/standards , Coronavirus Infections/complications , Betacoronavirus , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/therapy , Cardiovascular Physiological Phenomena , Risk Factors , Cardiopulmonary Resuscitation/standards , Practice Guidelines as Topic , Coronavirus Infections , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Ventricular Dysfunction/etiology , Pandemics , Patient Care/standards , Heart/physiopathology
Rev. enferm. UERJ ; 28: e50721, jan.-dez. 2020.
Article in English, Portuguese | LILACS (Americas) | ID: covidwho-828134


Objetivo: apresentar atualizações para a ressuscitação cardiopulmonar em pacientes suspeitos e confirmados com COVID-19. Método: revisão compreensiva da literatura, com síntese narrativa das evidências de diretrizes e recomendações da Organização Mundial de Saúde, Associação de Medicina Intensiva Brasileira, American Heart Association, Resuscitation Council UK, American College of Surgions Committee on Trauma e National Association of Emergency Medical Technicians. Resultados: as principais atualizações trazem informações sobre especificidades das manobras de ressuscitação cardiopulmonar; preparação do ambiente, recursos humanos e materiais, reconhecimento da parada cardiorrespiratória e ações iniciais; estratégias de ventilação e acesso invasivo da via aérea; ajustes do ventilador mecânico e manobras de ressuscitação cardiopulmonar em pacientes pronados. Considerações finais: profissionais de saúde envolvidos no atendimento à parada cardiorrespiratória de pacientes suspeitos e/ou confirmados com COVID-19 podem encontrar inúmeros desafios, portanto devem seguir com rigor o protocolo estabelecido para maximizar a efetividade das manobras de ressuscitação e minimizar o risco de contágio pelo vírus e sua disseminação.

Objective: to present updates for cardiopulmonary resuscitation in suspected and confirmed patients with COVID-19. Method: comprehensive literature review with narrative synthesis of the evidence of guidelines and recommendations from World Health Organization, Associação de Medicina Intensiva Brasileira, American Heart Association, Resuscitation Council UK, American College of Surgions Committee on Trauma and National Association of Emergency Medical Technicians. Results: the main updates bring information about the specifics of cardiopulmonary resuscitation maneuvers; preparation of the environment and human and material resources, recognition of cardiorespiratory arrest and initial actions; ventilation and invasive airway access strategies; mechanical ventilator adjustments and cardiopulmonary resuscitation maneuvers in patients in the prone position. Final considerations: health professionals involved in the care of cardiorespiratory arrest of suspected and/or confirmed patients with COVID-19 can face numerous challenges, so they must strictly follow the protocol established to maximize the effectiveness of resuscitation maneuvers and minimize the risk of contagion by the virus and its spread.

Objetivo: apresentar actualizaciones para la reanimación cardiopulmonar en pacientes sospechos os y confirmados con COVID-19. Método: revisión exhaustiva de la literatura con síntesis narrativa de la evidencia de guías y recomendaciones de la Organización Mundial de la Salud, Associação de Medicina Intensiva Brasileira, American Heart Association, Resuscitation Council UK, American College of Surgions Committee on Trauma and National Association of Emergency Medical Technicians. Resultados: las principales actualizaciones aportan información sobre los detalles de las maniobras de reanimación cardiopulmonar; preparación del medio ambiente y recursos humanos y materiales, reconocimiento de paro cardiorrespiratorio y acciones iniciales; estrategias de ventilación y acceso invasivo a las vías aéreas; ajustes del ventilador mecánico y maniobras de reanimación cardiopulmonar en pacientes en decúbito prono. Consideraciones finales: los profesionales de la salud involucrados en la atención del paro cardiorrespiratorio de pacientes sospechosos y/o confirmados con COVID-19 pueden enfrentar numerosos desafíos, por lo que deben seguir estrictamente el protocolo establecido para maximizar la efectividad de las maniobras de reanimación y minimizar el riesgo de contagio por el virus y supropagación.

Humans , Male , Female , Cardiopulmonary Resuscitation/standards , Coronavirus Infections/complications , Betacoronavirus , Heart Arrest/etiology , Respiration, Artificial/methods , Clinical Protocols/standards , Cardiopulmonary Resuscitation/methods , Containment of Biohazards/standards , Heart Arrest/rehabilitation , Heart Massage/methods , Nursing, Team/standards
Food Chem Toxicol ; 145: 111742, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-753584


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.

Arrhythmias, Cardiac/epidemiology , Arrhythmias, Cardiac/physiopathology , Betacoronavirus , Coronavirus Infections/complications , Heart Arrest/epidemiology , Heart Arrest/physiopathology , Pneumonia, Viral/complications , Arrhythmias, Cardiac/etiology , 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
J Contin Educ Nurs ; 51(9): 399-401, 2020 Sep 01.
Article in English | MEDLINE | ID: covidwho-729673


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.].

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 , Curriculum , Education, Nursing, Continuing/organization & administration , Female , Humans , Male , Middle Aged , Pandemics , Practice Guidelines as Topic
Med J Aust ; 213(3): 126-133, 2020 08.
Article in English | MEDLINE | ID: covidwho-643293


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.

Cardiopulmonary Resuscitation/methods , Coronavirus Infections/epidemiology , Emergency Service, Hospital/organization & administration , Heart Arrest/therapy , Pandemics , Pneumonia, Viral/epidemiology , Adult , Algorithms , Australia/epidemiology , Betacoronavirus , 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
Pediatr Res ; 88(5): 705-716, 2020 11.
Article in English | MEDLINE | ID: covidwho-635228


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.

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 , 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 , /therapy , Shock/etiology , Shock/therapy , Systemic Inflammatory Response Syndrome/epidemiology , Systemic Inflammatory Response Syndrome/therapy
J Cardiothorac Vasc Anesth ; 34(10): 2595-2603, 2020 10.
Article in English | MEDLINE | ID: covidwho-634042


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.

Betacoronavirus , Cardiopulmonary Resuscitation/methods , Coronavirus Infections/therapy , Critical Care/methods , Heart Arrest/therapy , Intensive Care Units , Pneumonia, Viral/therapy , Cardiopulmonary Resuscitation/standards , Coronavirus Infections/epidemiology , Critical Care/standards , Heart Arrest/epidemiology , Humans , Intensive Care Units/standards , Pandemics , Pneumonia, Viral/epidemiology , Workflow
Resuscitation ; 153: 45-55, 2020 08.
Article in English | MEDLINE | ID: covidwho-548156


Coronavirus disease 2019 (COVID-19) has had a substantial impact on the incidence of cardiac arrest and survival. The challenge is to find the correct balance between the risk to the rescuer when undertaking cardiopulmonary resuscitation (CPR) on a person with possible COVID-19 and the risk to that person if CPR is delayed. These guidelines focus specifically on patients with suspected or confirmed COVID-19. The guidelines include the delivery of basic and advanced life support in adults and children and recommendations for delivering training during the pandemic. Where uncertainty exists treatment should be informed by a dynamic risk assessment which may consider current COVID-19 prevalence, the person's presentation (e.g. history of COVID-19 contact, COVID-19 symptoms), likelihood that treatment will be effective, availability of personal protective equipment (PPE) and personal risks for those providing treatment. These guidelines will be subject to evolving knowledge and experience of COVID-19. As countries are at different stages of the pandemic, there may some international variation in practice.

Coronavirus Infections/complications , Heart Arrest/etiology , Heart Arrest/therapy , Pneumonia, Viral/complications , Betacoronavirus , Cardiopulmonary Resuscitation/standards , Europe , Humans , Pandemics , Personal Protective Equipment/supply & distribution , Risk Assessment , Societies, Medical
Arq Bras Cardiol ; 114(5): 805-816, 2020 05 11.
Article in English, Portuguese | MEDLINE | ID: covidwho-272115


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.

Betacoronavirus , Cardiovascular Diseases/virology , Coronavirus Infections/complications , Health Personnel , Pneumonia, Viral/complications , 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 , Ventricular Dysfunction/etiology
Resuscitation ; 151: 145-147, 2020 06.
Article in English | MEDLINE | ID: covidwho-154701


Consensus on Science and Treatment recommendations aim to balance the benefits of early resuscitation with the potential for harm to care providers during the COVID-19 pandemic. Chest compressions and cardiopulmonary resuscitation have the potential to generate aerosols. During the current COVID-19 pandemic lay rescuers should consider compressions and public-access defibrillation. Lay rescuers who are willing, trained and able to do so, should consider providing rescue breaths to infants and children in addition to chest compressions. Healthcare professionals should use personal protective equipment for aerosol generating procedures during resuscitation and may consider defibrillation before donning personal protective equipment for aerosol generating procedures.

Cardiopulmonary Resuscitation/standards , Coronavirus Infections/therapy , Heart Arrest/therapy , Pandemics/statistics & numerical data , Pneumonia, Viral/therapy , Practice Guidelines as Topic , Advisory Committees , Cardiopulmonary Resuscitation/trends , Consensus , Coronavirus Infections/epidemiology , Critical Illness/therapy , Defibrillators/statistics & numerical data , Female , Global Health , Humans , Internationality , Male , Needs Assessment , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Survival Analysis