Year : 2020 | Volume
| Issue : 3 | Page : 365-369
Saudi heart association, national heart center and national cardiopulmonary resuscitation committee taskforce statement on cpr and resuscitation during COVID-19 pandemic
AbdulMajeed S Khan1, Abdullah M Kaki2, Abdulrahman R Bakhsh3, Ahmed S A. Hersi4, Jameel T AbuAlenain5, Jubara S Alallah6, Fayez A Bokhari7, Nasser AlQahtani8, Bandar M AlKabli9, Abdulrahman Al Qahtani10, Nawfal AlJerian11, Rashid AlOtaibi12
1 Department of Medicine, Heraa General Hospital, Makkah Al Mukarramah, Saudi Arabia
2 Department of Anesthesia and Critical Care, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
3 Consultant of Emergency Medicine, Ministry of Health Affairs, King Saud University, Riyadh, Saudi Arabia
4 Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia
5 Department of Emergency Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
6 Department of Pediatric, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
7 Consultant Cardiac Electrophysiologist, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
8 General Manager, National Heart Center, Saudi Health Council, Medina, Saudi Arabia
9 Consultant of Pediatric, Executive Director of Maternity and Children Hospital, Medina, Saudi Arabia
10 Consultant of Emergency Medicine, Supervisor General of Emergency Services, Ministry of Health, Saudi Arabia
11 Consultant of Emergency Medicine, Supervisor General of Dispatch System, Ministry of Health, Saudi Arabia
12 Consultant of Anesthesia, Director of Academic Affair, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
Dr. AbdulMajeed S Khan
Director of Academic Affairs and Training, Heraa General Hospital, Makkah Almukarramah - 24227
Source of Support: None, Conflict of Interest: None
|Date of Submission||29-Apr-2020|
|Date of Decision||29-Apr-2020|
|Date of Acceptance||30-Apr-2020|
|Date of Web Publication||30-May-2020|
Corona virus disease 2019 is a global pandemic, which affects around 2million individuals with a high death rate that exceeds 90,000 death cases across the globe. The Saudi Heart Association and the national cardiopulmonary resuscitation committee developed a taskforce to discuss the magnitude of clinical situation and CPR management on COVID-19 patients in a prehospital and in-hospital settings. Meanwhile, the taskforce aims to develop a nation-wide clinical guidance to be used by health care workers and untrained laypersons to resuscitate COVID-19 suspected and diagnosed patients.
Keywords: Corona virus; COVID-19; cardiopulmonary resuscitation; resuscitation
|How to cite this article:|
Khan AS, Kaki AM, Bakhsh AR, Hersi AS, AbuAlenain JT, Alallah JS, Bokhari FA, AlQahtani N, AlKabli BM, Qahtani AA, AlJerian N, AlOtaibi R. Saudi heart association, national heart center and national cardiopulmonary resuscitation committee taskforce statement on cpr and resuscitation during COVID-19 pandemic. Saudi J Anaesth 2020;14:365-9
|How to cite this URL:|
Khan AS, Kaki AM, Bakhsh AR, Hersi AS, AbuAlenain JT, Alallah JS, Bokhari FA, AlQahtani N, AlKabli BM, Qahtani AA, AlJerian N, AlOtaibi R. Saudi heart association, national heart center and national cardiopulmonary resuscitation committee taskforce statement on cpr and resuscitation during COVID-19 pandemic. Saudi J Anaesth [serial online] 2020 [cited 2020 Sep 20];14:365-9. Available from: http://www.saudija.org/text.asp?2020/14/3/365/285444
| Introduction|| |
Corona virus disease 2019 (COVID-19) is a global pandemic, which affects around 2million individuals with a high death rate that exceeds 90,000 death cases across the globe. The Saudi Heart Association (SHA) and the national cardiopulmonary resuscitation (NCPR) committee developed a taskforce to discuss the magnitude of clinical situation and CPR management on COVID-19 patients in a prehospital and in-hospital settings. Meanwhile, the taskforce aims to develop a nation-wide clinical guidance to be used by health care workers and untrained laypersons to resuscitate COVID-19 suspected and diagnosed patients. Also, to discuss the principles and governance scheme of life support training courses conducted in the SHA accredited centers in collaboration with the national heart center (NHC) – Saudi Health Council (SHC).
| General Recommendations|| |
Prevention of disease transmission to health care workers and the community is deemed a priority nowadays. Therefore, protective measures should be aligned with the entire collection of measures that the Saudi government has taken to combat the disease. A wide array of measures include strict quarantine, partial and full curfew, banning Umrah season, freezing public transportation activities, and limiting public mass gathering at sports gym, mosques, and other public places. In addition, the Saudi Center for Disease Prevention and Control (Saudi CDC) issues a couple of guidelines that assist healthcare providers dealing with COVID-19 pandemic situation.
COVID-19 is transmitted by droplets; however, airborne transmission is possible through aerosolization in the setting of high oxygen flow, bronchoscopy, open tracheal suctioning, intubation, extubation, non invasive positive pressure ventilation, endoscopy, cardiopulmonary resuscitation (CPR), and transesophageal echocardiography.
Keeping in mind that some asymptomatic patients may be a source of infection and transmission, all patients with severe emergent cardiovascular or respiratory diseases should be managed as suspected cases of COVID-19. Hence, all training courses delivered by the SHA accredited centers were postponed due to strict quarantine applied by the Saudi government.
| Training Courses|| |
Health care institutions who embrace accredited training centers still can run some training sessions for smaller groups of trainees from their own staff members. While conducting these sessions, the training center administration should take the following steps into consideration in order to minimize the risk of infection:
Involvement of infection control prevention department to help setting protocols for infection control in the training sites when a training session is ongoing. To ensure that all trainees are asymptomatic of flu-like illness or upper respiratory tract infection. Symptomatic trainees must be rescheduled to join another training session in the future after they get recovered. At least 1.5 meter-space distance should be kept between a trainee and another while classes or workshops are running or at food court. Force should do alcohol sanitization between workshops to disinfect equipment and surfaces.
During the basic life support (BLS) courses, there should be no need for active demonstration of mouth to mouth breathing through a barrier at any workshop only the techniques of bag-valve-mask respirator (resuscitator) is allowed.
Online BLS courses that include practical skills demonstration (e-learning module of SHA and the new Arabic and English videos) are preferred at the time of pandemic to cover emergent requirements by health care providers.
| Prehospital Cardiopulmonary Resuscitation|| |
The rescuer (layperson or bystanders) should cover the mouth and nose of the victim and avoid delivering breath. They should do only chest compressions as per the guidelines until medical assistance arrives [Figure 1], [Figure 2], [Figure 3]. Rescuer should keep in mind that saliva and vomitus are a source of infection and all secretions should be dealt with caution. The use of external mechanical compression devices is preferred when available. If return of spontaneous circulation (ROSC) has not been achieved after appropriate resuscitation efforts in the field, consider not transferring the victim to the hospital as to lower the risk of additional exposure to the providers.
|Figure 2: Algorithm of basic and advance cardiac support of adult COVID-19 patients|
Click here to view
|Figure 3: Resuscitation of COVID19 pediatric patients (Advance cardiac support)|
Click here to view
Emergency medicine service (EMS) personnel should avoid emergency intubation and effort should be planned to do elective intubation in a negative pressure room with strict airborne precaution, full personal protective equipment (PPE), and N95 fitted mask or similar devices. The assisted breathing should be done with a bag-valve-mask device/resuscitator connected to high efficiency particulate air (HEPA) filter. For adults, consider passive oxygenation with non rebreathing mask covered with surgical mask.
| In Hospital Cardiopulmonary Resuscitation|| |
All efforts should be performed to avoid emergency intubation by planning elective intubation in every sick patient in a negative pressure room with strict airborne precaution, full PPE and N95 mask should be use. If intubation is delayed, consider manual ventilation with a supraglottic airway or a bag-valve-mask device with HEPA filter. Once the patient is intubated with a closed circuit, minimum disconnection should be applied to reduce aerolization. The minimum number of expert staff should participate in the CPR and should enter the room only after wearing full airborne PPEs. The documentary recorder team member should stay outside the room. Rescuer should keep in mind that saliva and vomitus are a source of infection and all secretions should be dealt with caution. The use of external mechanical compression devices is preferred when available [Figure 1], [Figure 2], [Figure 3].
It is reasonable to consider age, comorbidities, and severity of illness in determining the appropriateness of resuscitation and balance the likelihood of success against the risk to rescuers and patients from whom resources are being diverted.
The prognosis of COVID19-related cardiac arrest is extremely poor and therefore considered to be futile by some experts.
Initially successful (ROSC achieved) in 13%. Only 2.9% survived for last 30 days, just one patient (0.7%) had a favorable neurological outcome at 30 days.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, et al
. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N
Engl J Med2020;382:1564-7. doi: 10.1056/NEJMc2004973 [epub ahead of print].
National Health Committee of the People's Republic of China. Chinese Clinical Guideline for COVID-19 Diagnosis and Treatment. 5th
ed. China: National Health Committee; 2020.
ILCOR Covid-19 Consensus on Science and Treatment Recommendation (CoSTR), (draft).
Edelson DP, Sasson C, Chan PS, Atkins DL, Aziz K, Becker LB,et al
. Interim Guidance for life support for COVID-19. Circulation 2020. doi: 10.1161/CIRCULATIONAHA.120.047463.
MacLaren G, Fisher D, Brodie D. Preparing for the most critically ill patients with COVID-19: The potential role of extracorporeal membrane oxygenation. JAMA 2020;323:1245-6.
Shao F, Xu S, Ma X, Xu Z, Lyu J, Ng M, et al
. In- hospital cardiac arrest outcomes among patients with COVID-19 pneumonia in Wuhan, China. Resuscitation 2020;151:18-23.
[Figure 1], [Figure 2], [Figure 3]