麻豆传媒

Faced with the decision to perform CPR during the COVID-19 pandemic, responders should weigh the odds of successful resuscitation against the potential infection risk to themselves, according to interim guidance from several medical societies.

"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," according to Comilla Sasson, MD, PhD, of the American Heart Association's Emergency Cardiovascular Care program, and colleagues.

"Therefore, it is reasonable to consider age, comorbidities, and severity of illness in determining the appropriateness of resuscitation and balance the likelihood of success against the risk to rescuers and patients from whom resources are being diverted," Sasson's group said in a paper published in .

The statement was drafted by 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. Further support was provided by the American Association of Critical Care Nurses and National EMS Physicians.

Hospitals and EMS workers in COVID-19 hotspots have already made the difficult decision that some patients will not be given full resuscitation efforts during the pandemic.

Paramedics in New York City, where hospital emergency departments are already stretched to the breaking point, are being ordered not to bring cardiac arrest patients to the hospital if they .

Even , some hospitals are implementing for coronavirus patients as a way to protect their staff.

"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," Sasson and colleagues wrote.

"Complicating the emergent response to both out-of-hospital and in-hospital cardiac arrest is that COVID-19 is highly transmissible, particularly during resuscitation, and carries a high morbidity and mortality," according to the authors.

Providers should always don PPE and prioritize oxygenation and ventilation strategies with lower aerosolization risk when treating patients with known or suspected coronavirus infection who require life support, the group said.

"Depending on local prevalence of disease and evidence of community spread, it may be reasonable to suspect COVID-19 in all OHCAs [out-of-hospital cardiac arrests], by default," Sasson's group suggested.

But are still encouraged to perform at least hands-only CPR for victims of out-of-hospital cardiac arrest, especially if they are household members who have already been exposed to the victim at home. Children in particular should be given both chest compressions and mouth-to-mouth ventilation, according to the guidance.

Lay rescuers should wear a face mask or cloth covering mouth and nose; they may also put one on the victim.

Moreover, public access automated external defibrillators can be used as they are not highly aerosolizing, the societies recommended.

Earlier, the American Heart Association previously released recommendations on how to protect healthcare workers during aerosol-generating procedures such as CPR and endotracheal intubation.

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