Management of adult cardiac arrest in the
            <scp>COVID</scp>
            ‐19 era: consensus statement from the Australasian College for Emergency Medicine

Background and objectives To assess the impact of personal protective equipment (PPE) on different aspects of chest compression (CC) during cardiopulmonary resuscitation, we conducted this study. Methods This systematic review was performed according to the PRISMA. We searched PubMed, EMBASE and Web of Science from inception to June-6, 2020, limiting to the studies that reported the comparison of the effectiveness of CC in terms of CC rate, CC depth, the proportion of adequate CC rate, the proportion of adequate CC depth or proportion of adequate recoil; in study arms with or without PPE. Risk of bias was assessed by the ROB-2 and ROBINS-I tool. Quantitative data synthesis was done using the generic inverse variance method and the fixed-effects model. Results Five simulation-based studies were finally included. A Significant decrease in CC rate (SMD: -0.28, 95%CI: −0.47 to −0.10) and CC depth (SMD: -0.26, 95%CI: −0.44 to −0.07) were observed in the PPE arm as compared to the no-PPE arm. The difference in CC rate was more prominently seen in adult CPR than in paediatric CPR. Without PPE, the proportion of adequate CC rate delivered was 0.74, which reduced significantly to 0.60 after use of PPE ( p - 0.035). Similarly, the proportion of adequate CC depth was significantly lesser ( p - 0.001) in PPE arm (0.55), as compared to that of the no-PPE arm (0.78). Conclusion The use of PPE compromises the quality of CC during CPR significantly, and newer ways to deliver chest compression has to be investigated. This study was prospectively registered in PROSPERO (CRD42020192031).

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“…[1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] …”

Section: Uncited Referencesunclassified

Impact of personal protective equipment on the effectiveness of chest compression - A systematic review and meta-analysis

Sahu

Suresh

Mathew

et al. 2021

The American Journal of Emergency Medicine

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“…Este principio exige que la atención médica esté justificada por el potencial beneficio del paciente. En el marco de las decisiones sobre la reanimación cardiopulmonar, este principio indica que estas se justifican únicamente cuando la reanimación cardiopulmonar suponga un beneficio real para el paciente según la lex artis (6).…”

Section: Principio De Beneficio Y Lex Artisunclassified

“…Este principio ordena que a toda persona se le proteja de cualquier daño que pueda sobrevenir por causa de la atención médica. En el contexto que nos ocupa, este principio obliga a hacer la reanimación cardiopulmonar solo en aquellos casos en que esta no constituya una futilidad o una forma de encarnizamiento terapéutico (6,7). Su aplicación debe garantizar la protección del derecho a la integridad del paciente, que es conexo con el derecho a la salud.…”

Section: Principio De No Daño Y Respeto Por El Derecho a La Integridaunclassified

“…Este principio obliga a hacer la reanimación cardiopulmonar solo en aquellos casos en que no se exponga a los pacientes y al personal clínico y administrativo de las instituciones de salud a graves riesgos de salud (5)(6)(7)(8)(9). En el marco de este principio, deben garantizarse todas las medidas y equipos de protección personal al personal de salud antes de cualquier procedimiento que suponga riesgo de contagio para ellos, incluso cuando no exista certeza completa sobre la magnitud y el alcance de dicho riesgo (principio de precaución) (5,8,10).…”

Section: Principio De Precauciónunclassified

“…Cuando haya escasez de respiradores no deben realizarse maniobras de reanimación cardiopulmonar en aquellos pacientes que no hayan sido priorizados con base en las reglas de asignación éticamente justificadas, pues eventualmente requerirían de respiradores que pueden no estar disponibles (11). A los pacientes que no tengan prioridad se les deben garantizar todas las medidas de cuidado paliativo y confort físico, emocional y espiritual que requieran durante el final de su vida (6).…”

Section: A No Actuar De Forma Injustaunclassified

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Pautas éticas para la reanimación cardiopulmonar en el contexto de la pandemia de COVID-19 en Colombia

et al. 2020

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La pandemia de COVID-19 se ha asociado con un incremento en el número de casos de paro cardiorrespiratorio y con ello han aumentado las inquietudes éticas en torno a la exigencia de la reanimación cardiopulmonar, así como sobre las condiciones para realizarla. El riesgo de contagio por aerosoles y las incertidumbres clínicas sobre la eficacia, las potenciales secuelas y las circunstancias que podrían justificar la limitación del procedimiento durante la pandemia, han multiplicado las dudas éticas sobre cómo proceder en estos casos.Con base en fundamentos éticos y jurídicos, en el presente artículo se ofrece una guía práctica sobre cómo proceder en los casos de paro cardiopulmonar en el contexto de la pandemia. Los criterios de justicia, beneficio, no daño, respeto a la autonomía, precaución, integridad y transparencia, se presentan de forma organizada y práctica para la adopción de decisiones en materia de reanimación cardiopulmonar.

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Resuscitation of Drowned Persons During the COVID-19 Pandemic

et al. 2022

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IMPORTANCE Resuscitation is a niche example of how the COVID-19 pandemic has affected society in the long term. Those trained in cardiopulmonary resuscitation (CPR) face the dilemma that attempting to save a life may result in their own harm. This is most of all a problem for drowning, where hypoxia is the cause of cardiac arrest and ventilation is the essential first step in reversing the situation. OBJECTIVETo develop recommendations for water rescue organizations in providing their rescuers with safe drowning resuscitation procedures during the COVID-19 pandemic. EVIDENCE REVIEW Two consecutive modified Delphi procedures involving 56 participants from 17 countries with expertise in drowning prevention research, resuscitation, and programming were performed from March 28, 2020, to March 29, 2021. In parallel, PubMed and Google Scholar were searched to identify new emerging evidence relevant to each core element, acknowledge previous studies relevant in the new context, and identify knowledge gaps. FINDINGS Seven core elements, each with their own specific recommendations, were identified in the initial consensus procedure and were grouped into 4 categories: (1) prevention and mitigation of the risks of becoming infected, (2) resuscitation of drowned persons during the COVID-19 pandemic, (3) organizational responsibilities, and (4) organizations unable to meet the recommended guidelines. The common measures of infection risk mitigation, personal protective equipment, and vaccination are the base of the recommendations. Measures to increase drowning prevention efforts reduce the root cause of the dilemma. Additional infection risk mitigation measures include screening all people entering aquatic facilities, defining criteria for futile resuscitation, and avoiding contact with drowned persons by rescuers with a high-risk profile. Ventilation techniques must balance required skill level, oxygen delivery, infection risk, and costs of equipment and training.Bag-mask ventilation with a high-efficiency particulate air filter by 2 trained rescuers is advised. Major implications for the methods, facilities, and environment of CPR training have been identified, including nonpractical skills to avoid being infected or to infect others. Most of all, the organization is responsible for informing their members about the impact of the COVID-19 pandemic and taking measures that maximize rescuer safety. Research is urgently needed to better understand, develop, and implement strategies to reduce infection transmission during drowning resuscitation. CONCLUSIONS AND RELEVANCEThis consensus document provides an overview of recommendations for water rescue organizations to improve the safety of their rescuers during the COVID-19 pandemic and balances the competing interests between a potentially lifesaving intervention and risk to the rescuer. The consensus-based recommendations can also serve as an example for other volunteer organizations and altruistic laypeople who may provide resuscitation.

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Management of adult cardiac arrest in the COVID ‐19 era: consensus statement from the Australasian College for Emergency Medicine

Cited by 31 publications

References 12 publications

Impact of personal protective equipment on the effectiveness of chest compression - A systematic review and meta-analysis

Impact of personal protective equipment on the effectiveness of chest compression - A systematic review and meta-analysis

Pautas éticas para la reanimación cardiopulmonar en el contexto de la pandemia de COVID-19 en Colombia

Resuscitation of Drowned Persons During the COVID-19 Pandemic

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