Compilation of the resuscitation guidelines for COVID-19 patients in resource-constrained developing nations

Abstract

Background The world is presently struggling with the pandemic of COVID-19 (coronavirus disease). Owing to the poor outcome and high contagiousness of COVID-19, cardiopulmonary resuscitation (CPR) of COVID-19-positive patients is still questionable. Main body It is imperative for the healthcare workers to follow the precautions during CPR of suspected or confirmed COVID-19 patients. In the present article, we have compiled the resuscitation guidelines subjected to the availability of resources in India/developing nations. Conclusion Compression-only CPR should be initiated whether cardiac arrest is of presumed hypoxic or cardiac etiology. If a patient with an unknown status/suspected/confirmed COVID-19 has out of the hospital cardiac arrest, hands-only CPR could be performed only after covering the mouth and nose of the patient and healthcare worker with the face mask or cloth. During in-hospital cardiac arrest, patients should be shifted to a negative pressure ventilation room, and healthcare worker should wear personal protective equipments.

State of the globe: Protecting health-care workers from aerosolized infections

“…Some authors believe that COVID-19 has shifted the balance of CPR and as a result, many of the prevalent CPR practices have now been dropped to safeguard the health-care workers from unwanted exposure to COVID-19. [ 3 4 ]…”

“…CPR is one of the high-aerosol-generating processes and therefore guidelines needed modification after the COVID-19 pandemic. [ 4 ] CPR should be started after proper donning of personal protective equipment (PPE) irrespective of the setting, prehospital or in-hospital. The recommended PPE includes double pair of gloves, N95 respirator, fluid-resistant gown, and a face shield.…”

“…The recommended PPE includes double pair of gloves, N95 respirator, fluid-resistant gown, and a face shield. [ 4 ] In out-of-hospital cardiac arrests where COVID-19 status is unknown, the patient's face and nose should be covered with a cloth and hands-only CPR should be given after donning proper PPE. [ 4 ] Defibrillation may take precedence over chest compressions while the team is getting ready with PPE.…”

“…[ 4 ] In out-of-hospital cardiac arrests where COVID-19 status is unknown, the patient's face and nose should be covered with a cloth and hands-only CPR should be given after donning proper PPE. [ 4 ] Defibrillation may take precedence over chest compressions while the team is getting ready with PPE. After donning of PPE, hands-only CPR should be started leaving the oxygen mask on the face of the patient if he/she was already receiving oxygen therapy when cardiac arrest occurred.…”

“…Among airway procedures, aerosol generation is highest during bag and mask ventilation followed by supraglottic devices and least by cuffed endotracheal intubation. [ 4 ] Intubation should ideally be done by an expert to avoid reattempts and the chest compressions should be briefly paused while attempting the airway. Intubation/plastic boxes as used by Ayyan et al .…”