The latest update to the American Heart Association (AHA) guidance on cardiopulmonary resuscitation (CPR) for patients with suspected or confirmed COVID-19 now calls for health care providers to don full personal protective equipment (PPE) before starting CPR on any patient with confirmed or suspected COVID-19. This is a big change from the last iteration of this guidance, issued October 21 2021, in which the AHA said that providers should not delay chest compressions to put on PPE or place face covering on these patients.

The change was made based on the emergence of the more highly contagious variants of the SARS-CoV-2 virus, Omicron. In the event initial responders are not already wearing appropriate PPE, they should immediately put on PPE (ie, respirators, gowns, gloves, and eye protection) and then begin CPR in a patient experiencing cardiac arrest with confirmed or suspected COVID-19.

“Based on evolving epidemiology reports and emerging science, the volunteer committee comprised of more than 40 global resuscitation experts has issued new guidance for the resuscitation of patients with suspected or confirmed COVID-19,” said Comilla Sasson, MD, PhD, FAHA, a practicing emergency medicine physician and vice president for science and innovation for emergency cardiovascular care at the American Heart Association. “This guidance also reflects the recommendations issued recently from both the World Health Organization [WHO] and the US Centers for Disease Control and Prevention [CDC].”


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The latest guidance provides added insight into PPE use during potential aerosol-generating procedures (AGPs) and reinforces the need for resuscitation best practices in light of the marked decrease in cardiac arrest survival rates during the COVID-19 pandemic (Table).

Table. Highlights of 2022 Interim Guidance on CPR in Patients With Confirmed or Suspected COVID-19

All healthcare providers should wear a respirator (eg, N95) along with other PPE (gown, gloves, and eye protection) when performing AGPs such as chest compressions, defibrillation, bag-mask ventilation, intubation, or positive-pressure ventilation or in a setting where such procedures are regularly performed
Cardiac arrest survival is dependent on early initiation of CPR, including chest compressions as soon as it is safely possible. Patients with confirmed or suspected COVID-19 should receive the best resuscitative efforts possible.
All healthcare providers should be following appropriate precautions and should have access to PPE in all clinical settings, regardless of the potential of encountering resuscitation events. Effective use of PPE is critical for the safety of healthcare providers performing resuscitations.
AGPs, aerosol-generating procedures; CPR, cardiopulmonary resuscitation; PPE, personal protective equipment
Source: American Heart Association.

Healthcare organizations should continue to secure appropriate PPE as available, ensure training regarding appropriate application and use of PPE, reinforce effective use of PPE, and create systems so that health care providers have immediate access to appropriate PPE when emergency care is required, according to the American Heart Association.

Sources

Atkins DL, Sasson C, Hsu A, et al. 2022 interim guidance to healthcare providers for basic and advanced cardiac 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, The Society of Critical Care Anesthesiologists, and American Society of Anesthesiologists. Circ Cardiovasc Qual Outcomes. 2022 Jan 24. doi:10.1161/CIRCOUTCOMES.122.008900

New CPR guidance addresses more contagious COVID-19 variants amidst evolving pandemic. News release. American Heart Association: January 24, 2022. Accessed January 31, 2022. https://newsroom.heart.org/news/new-cpr-guidance-addresses-more-contagious-covid-19-variants-amidst-evolving-pandemic