Can you perform CPR on someone with COVID?

Can you perform CPR on someone with COVID

Can You Do CPR on Someone with COVID?

Wondering. COVID is a very infectious virus that is transmitted mainly through droplets in the air. In cardiopulmonary resuscitation (CPR), multiple aerosol-generating procedures (AGPs), such as chest compression, positive pressure ventilation, and airway intervention, are used. This is why those who give CPR in the medical field are at high risk of getting COVID. However, whether it is suspected or confirmed, CPR must be administered to patients with COVID, without jeopardizing the security of medical personnel.

So can you perform CPR on someone with COVID?

The answer is that it is strongly advised that bystanders give chest compressions or CPR to others.

In fact, by helping the dying man, you may have a chance to preserve his life hundreds of times higher than your mortality from COVID.

Let’s dive into the details. 

Statistics and If You Can Perform CPR on Someone with COVID

The rates of death and morbidity of Covid-19 are very high. Multiple aerosol-producing techniques, such as chest compression, positive pressure ventilation, and airway manipulation, are used in cardiopulmonary resuscitation (CPR). Due to their near closeness to COVID patients when conducting CPR, healthcare workers are most at risk of getting sick. Hence it is important to explore whether they can do CPR on someone with COVID.  

Cardiogenic or distributive shock, hypoxia, and the use of QT-prolonging medications like azithromycin and hydroxychloroquine are all potential causes of cardiac arrest in Covid-19 patients. Cardiac arrest in COVID individuals is linked to bad consequences. Only 13.2% of COVID patients had recovery of spontaneous circulation after CPR, and only 2.9% of them were still alive after 30 days, according to a study from Wuhan, China, in a study of 136 patients. In contrast, another research found that among patients who did not have COVID, the incidence of recovery of spontaneous circulation was 35.5%, and the rate of hospital discharge was 9.1%.

Considerations Before Performing CPR on Someone with COVID

When a patient with proven or potential COVID arrives at the clinic, the necessity for advance directives should be discussed with the patient and should be updated when the patient’s detailed medical status evolves. To avoid peri-intubation cardiac arrest, patients in respiratory distress require an immediate decision for intubation.

To reduce the risk of infection transmission to healthcare professionals when performing CPR, deteriorating patients should be moved preferentially into negative pressure rooms. In facilities treating individuals with COVID, mechanical stimulation equipment for CPR should be kept on hand. PPE should also be readily available for providers appointed to a resuscitation team, and its components should have been checked before the shift begins.

Even if it hinders services, all healthcare professionals should put on PPE before stepping into the room in the event of cardiac arrest. Those providers with designated roles should enter the room, and the number of caregivers should be kept to a minimum. If the staff needs assistance with prescriptions or equipment, additional caregivers should be waiting out of the room with a team member wearing safety equipment.

Additional Consideration from AHA About Performing CPR on Someone with COVID

The American Heart Association (AHA) stated in a guideline update that prompt CPR on cardiac arrest patients with confirmed or potential COVID should take priority over resuscitators wearing personal protective equipment (PPE) like gloves, mask, gown, and face shield. 

This is a change from the initial COVID-specific recommendations that the AHA released in March 2020, when the epidemic started spreading in the United States. Before starting any procedures on patients with known or suspected COVID, the previous advice recommended to caregivers was to put on PPE.

Application of the finest resuscitation science available must be once again evaluated and prioritized in the context of expanding scientific understanding, a more secure personal protective equipment (PPE) supply chain, and immunization of frontline healthcare workers and the general population.

Additionally, the AHA group advises that in cases of agonal breathing, it should be considered passive oxygenation until HEPA-filtered ventilation can be delivered. This is performed by firmly attaching a HEPA filter to any ventilation device and ventilation with a bag. 

Next, choosing an incubator with the best likelihood of succeeding on the first try is recommended. If video laryngoscopy is available and staff is trained, consider using it.

Maximize the chest compression fraction and only pause to intubate when necessary. Reduce the amount of given treatment endotracheally to prevent the production of aerosols. Reduce the number of disconnected closed ventilation circuits. Adhere to moral and scientifically sound rules for ending resuscitation.

Out of Hospital Settings

When performing CPR on someone with covid in non-hospital surroundings, healthcare professionals should also take ventilation and pollution into account.

Providers should limit pollution by shutting doors at the expense of ventilation when contamination occurs in neighboring rooms. Providers should increase airway circulation to lower the possibility of COVID-19 transmission if there is no danger of contamination to others.

According to Comilla Sasson, MD, PhD, of the AHA, during the pandemic, survival rates for in-hospital opens in new tab or window and out-of-hospital cardiac arrest patients have both declined in the United States.

If you’re not CPR Certified, Hands-Only Compressions Will do the Job. It’s important to protect yourself while also helping the person suffering a cardiac arrest. 

The emergency medical services (EMS) system should be contacted, and high-quality chest compressions should be administered to the victim by pushing forcefully and quickly into the victim’s chest.

It is essential to move as quickly and decisively as possible.

According to Dr Comilla Sasson, vice president for science and innovation at the American Heart Association, “the likelihood of survival is reduced by 10% for every minute without CPR.” In many circumstances, there is a 10-minute window before death. 

You can extend those 10 minutes if you can start putting your hands on the chest and doing compressions straight quickly.  It delays the situation and gives the person more time to summon assistance.

The Importance of Delivering Fast Response With CPR on Someone with COVID

The ARC Chair and Working Group Member, Professor Peter Morley, emphasized how important it is for qualified first-aid providers to feel comfortable giving compression-only CPR.

Professor Morley stated that basic life support should be started immediately, and assistance should be requested right away since patient outcomes can worsen as a result of delays. 

The important variations from standard CPR for someone who may have COVID-19 are to use a mask, watch for chest movements that indicate breathing, but avoid putting your face or hands too close to the person’s mouth or nose, and only conduct chest compressions while beginning CPR. The reason why rescue breathing is no longer recommended for those untrained is that it takes time away from time that may be better spent performing efficient chest compressions.

Post-Arrest Considerations

To determine if it is acceptable to continue resuscitation, it is necessary to take into account the patient’s comorbidities and state at the moment of cardiac arrest.

Extracorporeal membrane oxygenation in COVID-19 patients experiencing cardiac arrest is not backed by enough evidence. It is not advised to perform the surgery on these people since they are poor candidates.

Individuals with COVID get similar post-cardiac arrest treatment to other patients, with an emphasis on reducing cross-infection and proper resource allocation. It is crucial to adhere to the institute’s infection control procedures when transferring these patients, and all non-disposable equipment should be disinfected following these procedures. 

What We Learned About Performing CPR on Someone with COVID

In conclusion of our discussion about if you can perform CPR on Someone with COVID, whether the cardiac arrest is believed to be caused by a cardiac or hypoxic etiology, compression-only CPR should be started. Hands-on CPR can only be done when a COVID-19 patient experiences an out-of-hospital cardiac arrest. Since bystander CPR can help save many lives, even in uncertain times like the pandemic, it’s important to know the basics and how to protect oneself. Getting CPR training is highly beneficial for increasing someone’s chances of survival.