Introduction

We are aware of the concerns regarding risk of transmission of COVID-19 (Coronavirus), but wish to emphasise the crucial importance of doing CPR for the person in cardiac arrest.

When someone has a cardiac arrest, they are not breathing normally and their heart has stopped. With no treatment, this person will die, usually within a few minutes. Early CPR and defibrillation give them their best chance of survival.

Patients with a COVID-19 like illness, who are at risk of acute deterioration or cardiac arrest, should be identified early. Appropriate steps to prevent cardiac arrest and avoid CPR should be taken. Use of Early Warning Scores, NEWS2, PEWS and MEOWS will enable early detection of acutely ill patients.

Where we think deterioration is continuing despite best efforts, and intubation/ ventilation/ CPR may be needed, in any patient irrespective of their COVID-19 status the staff and team should don full PPE for AGP as per scenario 2 in the event that further interventions are needed.

The need to don PPE may delay CPR in patients with COVID-19. PPE kits are on all ward resuscitation trolleys, this will minimise these delays. Staff safety is paramount. Each ward has 3 sets of Core PPE.

For ILS trained staff defibrillators are readily available and should be used to defibrillate shockable rhythms rapidly prior to starting chest compressions. The early restoration of circulation may prevent the need for further resuscitation measures. Remove the defibrillator from the resus trolley and only take into the room/area what is required.

Personal Protective Equipment (PPE) required for CPR as per scenario 2

The RCUK guidance for patients with known or suspected COVID-19 aligns with the High and Medium risk categories. We therefore recommend that the COVID-19 algorithms are followed and that AGP PPE continues to be used during resuscitation for patients allocated to these two categories.
For patients allocated to the Low Risk category, the standard pre-COVID algorithms can be used and all healthcare staff attending resuscitation events should wear a minimum of a Type II fluid resistant surgical mask, eye protection, disposable gloves, and an apron.

Resuscitation services pathway and PPE requirement

Resuscitation guidelines for inpatient areas excluding ED and EAU4

Click here to view PPE scenario 2.

Outpatient PPE locations

Guidelines for Adult Paediatric Resuscitation in community settings October 2020

Core PPE

  • Water repellent gown Surgical gloves
  • Theatre cap Eye protection
  • FFP3 Mask
  • must be worn by all members of the resuscitation/emergency team before entering the room.
  • No chest compressions or airway procedures should be undertaken without full core PPE.
  • Once suitably clothed staff should start CPR and monitor the patient’s cardiac arrest rhythm as soon as possible.
  • Restrict the number of staff in the room (if a single room).
  • Allocate a gatekeeper to do this and to pass essential item only into the team.

Please refer to the algorithm and video below for further information about how to deliver CPR.

ReSPECT

We are here to ensure that all people receive the resuscitation treatment that is appropriate for their medical condition, personal values and expressed preferences. In many situations that appropriate response will be to receive the best chance of survival with resuscitation, performing emergency CPR and using a defibrillator. In other situations, a person may have reached a point in their life or illness where, on balance, they are unlikely to benefit from resuscitation attempts or have a preference not to be resuscitated.

ReSPECT is a process which facilitates conversations between patients and health care professionals, allowing them to express what matters most to them in a medical emergency. What we’ve learned most of all is that it’s always best to have these conversations before an emergency, when you are well and able to express your views.

The ReSPECT process during the COVID-19 crisis will help health care professional and patients understand and decide on the treatments they may or may not want to receive in an emergency. We advocate these conversations taking place early in patients care.

Advanced life support for COVID-19 patients