Alavi-Moghaddam (2020)44. Alavi-Moghaddam M. A novel coronavirus outbreak from Wuhan city in China, rapid need for emergency departments preparedness and response; a letter to editor. Arch Acad Emerg Med [Internet]. 2020 [cited 2020 Mar 27];8(1):e12. Available from: https://dx.doi.org/10.22037/aaem.v8i1.565 https://dx.doi.org/10.22037/aaem.v8i1.56...
; Glauser (2020).1616. Glauser, W. Proposed protocol to keep COVID-19 out of hospitals. CMAJ [Internet]. 2020 [cited 2020 Apr 11];192(10):264-5. Available from: https://dx.doi.org/10.1503/cmaj.1095852 https://dx.doi.org/10.1503/cmaj.1095852...
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I |
General recommendations on site surveillance, emphasizing environmental safety. |
Early recognition and immediate isolation of patients suspected with COVID-19. Testing and monitoring of suspects at home to reduce overcrowding in emergency departments and the spread of COVID-19 infection. |
Guimarães et al. (2020).2323. Guimarães HP, Timerman S, Rodrigues RR, Corrêa TD, Freitas AP, et al. Recomendações para ressuscitação cardiopulmonar (RCP) de pacientes com diagnóstico ou suspeita de COVID-19 - 2020 [Internet]. Arq Bras Cardiol [Internet]. 2020 [cited 2020 Apr 17];114(6):1078-87. Available from: https://dx.doi.org/10.36660/abc.20200548 https://dx.doi.org/10.36660/abc.20200548...
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I |
General recommendations for the implementation of a rapid response system and immediate alertness with patients at risk of CPR, so that they are quickly attended. |
Patients suspected or with COVID-19 who are at higher risk of CPR should receive more attention by the Rapid Response Team (RRT). |
Nam et al. (2017).1818. Nam H, Yeon M, Park JW, Hong J, Son JWO. Healthcare worker infected with middle east respiratory syndrome during cardiopulmonary resuscitation in Korea, 2015. Epidemiol Health [Internet]. 2017 [cited 2020 Apr 11];39:e2017052. Available from: https://dx.doi.org/10.4178/epih.e2017052 https://dx.doi.org/10.4178/epih.e2017052...
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II |
Rapid CPA recognition - assess responsiveness, breathing/gasping, pulse within 10 seconds. |
Patients should be isolated during CPA and CPR identification. |
Thomas-Ruddel et al. (2020)2020. Thomas-Ruddel D, Winning J, Dickmann P, Ouart D, Kortgen A, Janssens U, et al. Coronavirus disease 2019 (COVID-19): update for anesthesiologists and intensivists March 2020. Anaesthesist [Internet]. 2020 [cited 2020 Apr 15];69:225-35. Available from: https://dx.doi.org/10.1007/s00101-020-00758-x https://dx.doi.org/10.1007/s00101-020-00...
; Resuscitation Council UK (2020)2424. Resuscitation Council UK. Guidance for the resuscitation of adult COVID-19 patients in acute hospital settings [Internet]. Reino Unido. 2020 [cited 2020 Apr 21]. Available from: https://www.gmmh.nhs.uk/download.cfm?doc=docm93jijm4n7140.pdf&ver=9678 https://www.gmmh.nhs.uk/download.cfm?doc...
; Jones et al. (2020)1717. Jones RM, Bleasdale SC, Maita D, Brosseau LM. A systematic risk-based strategy to select personal protective equipment for infectious diseases. Am J Infect Control [Internet]. 2020 [cited 2020 Apr 11];48(1):46-51. Available from: https://dx.doi.org/10.1016/j.ajic.2019.06.023 https://dx.doi.org/10.1016/j.ajic.2019.0...
; Wax and Christian (2020)2121. Wax RS, Christian MD. Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients. Can J Anesth [Internet]. 2020 [cited 2020 Apr 15];67,568-76. Available from: https://dx.doi.org/10.1007/s12630-020-01591-x https://dx.doi.org/10.1007/s12630-020-01...
; Shin et al. (2017)1919. Shin H, Oh J, Lim TH, Kang H, Song Y, Lee S. Comparing the protective performances of 3 types of N95 filtering facepiece respirators during chest compressions: A randomized simulation study. Medicine [Internet]. 2017 [cited 2020 Apr 11];96(42):e8338. Available from: https://dx.doi.org/10.1097/MD.0000000000008338 https://dx.doi.org/10.1097/MD.0000000000...
Wiboonchutikul et al. (2016)2222. Wiboonchutikul S, Manosuthi W, Likanonsakul S, Sangsajja C, Kongsanan P, Nitiyanontakij R, et al. Lack of transmission among healthcare workers in contact with a case of Middle East respiratory syndrome coronavirus infection in Thailand. Antimicrob Resist Infect Control [Internet]. 2016 [cited 2020 Apr 17];5(21):2-5. Available from: https://dx.doi.org/10.1186/s13756-016-0120-9 https://dx.doi.org/10.1186/s13756-016-01...
; Casanova, Rutala, Weber and Sobsey (2010).1212. Casanova L, Rutala WA, Weber DJ, Sobsey MD. Coronavirus survival on healthcare personal protective equipment. Infect Control Hosp Epidemiol [Internet]. 2010 [cited 2020 Apr 06];31: 560-1. Available from: https://dx.doi.org/10.1086/652452 https://dx.doi.org/10.1086/652452...
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Emergency team activation. |
During CPR, do not ignore PPE, which must be available in crash carts or at the storage location, avoiding problems with attire. Airway management must be optimized; keep a small team. To avoid contamination, N95 face masks, waterproof aprons, eye protection and gloves should be used when handling patients. Professionals should properly adjust and use appropriately N95 filter face mask respirators. Powered air purifying respirators (PAPR) offer greater protection and are more comfortable during CPR. Furthermore, the team should not reuse PPE. |
Wax and Christian (2020)2121. Wax RS, Christian MD. Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients. Can J Anesth [Internet]. 2020 [cited 2020 Apr 15];67,568-76. Available from: https://dx.doi.org/10.1007/s12630-020-01591-x https://dx.doi.org/10.1007/s12630-020-01...
; Chung et al. (2014).1515. Chung JS, Ling ML, Seto WH, Ang BSP, Tambyah PA. Debate on MERS-CoV respiratory precautions: surgical mask or N95 respirators? Singapore M J [Internet]. 2014 [cited 2020 Apr 11];55(6):294-7. Available from: https://dx.doi.org/10.11622/smedj.2014076 https://dx.doi.org/10.11622/smedj.201407...
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III |
For patients without advanced airway - immediate and high-quality CPR with a frequency of 100 to 120 per min., depth of 5 to 6 centimeters. Offer two ventilations with a Bag-Valve-Mask device, lasting 1 second each every 30 compressions, causing chest elevation. |
Interventions such as valve ventilation, non-invasive ventilation and intubation allow the formation of aerosols, allowing airborne transmission. PAPR offers greater protection, is more comfortable; however, it can increase the number of contaminations during removal and its cost is high when compared to an N95 mask. |
Christian et al. (2004)1414. Christian MD, Loutfy M, Mcdonald LC, Martinez KF, Ofner M, Wong T, et al. Possible SARS coronavirus transmission during cardiopulmonary resuscitation. Emerg Infect Dis [Internet]. 2004 [cited 2020 Apr 08];10(2):287-93. Available from: https://dx.doi.org/10.3201/eid1002.030700 https://dx.doi.org/10.3201/eid1002.03070...
; Guimarães et al. (2020).2323. Guimarães HP, Timerman S, Rodrigues RR, Corrêa TD, Freitas AP, et al. Recomendações para ressuscitação cardiopulmonar (RCP) de pacientes com diagnóstico ou suspeita de COVID-19 - 2020 [Internet]. Arq Bras Cardiol [Internet]. 2020 [cited 2020 Apr 17];114(6):1078-87. Available from: https://dx.doi.org/10.36660/abc.20200548 https://dx.doi.org/10.36660/abc.20200548...
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III |
For patients with advanced airway - immediate and high-quality CPR with a frequency of 100 to 120 per min., depth of 5 to 6 centimeters. Offer ventilation with a Bag-Valve-Mask device, lasting 1 second each, every 5 seconds. |
It is recommended to use a Bag-Valve-Mask with bacterial filter. The Bag-Valve-Mask device should not be used in patients suspected or diagnosed with COVID-19 due to the high potential for contamination. |
American Heart Association (2015).1111. American Heart Association. Destaques da American Heart Association 2015: atualização das diretrizes de RCP e ACE. AHA [Internet]. 2015 [cited 2020 Apr 06]. Available from: https://eccguidelines.heart.org/wp-content/uploads/2015/10/2015-aha-guidelines-highlights-portuguese.pdf https://eccguidelines.heart.org/wp-conte...
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IV |
Defibrillation should occur as soon as possible, taking priority over other interventions. |
Defibrillation should be performed quickly and effectively as well as identification of shockable rhythms. |
Cook et al. (2020).1313. Cook TM, El-Boghdadly K, McGuire B, McNarry AF, Patel A, Higgs A. Consensus guidelines for managing the airway in patients with COVID-19. Anaesthesia [Internet]. 2020 [cited 2020 Apr 08];75:785-99. Available from: https://dx.doi.org/10.1111/anae.15054 https://dx.doi.org/10.1111/anae.15054...
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V |
Advanced life support with vasopressor drug administration as indicated. |
Intubation should be done quickly and efficiently. Airway monitoring should follow the standards of the Association of Aesthesthists, especially continuous waveform capnography. At risk of cardiovascular instability, ketamine 1-2 mg for anesthesia induction and rocuronium 1.2 mg for neuromuscular blockade is suggested. If suxamethonium is used, the dose of 1.5 mg is indicated. Before proceeding with intubation, it is necessary to make sure that the patient is properly unconscious. |
Wax and Christian (2020)2121. Wax RS, Christian MD. Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients. Can J Anesth [Internet]. 2020 [cited 2020 Apr 15];67,568-76. Available from: https://dx.doi.org/10.1007/s12630-020-01591-x https://dx.doi.org/10.1007/s12630-020-01...
; Alavi-Moghaddam (2020).44. Alavi-Moghaddam M. A novel coronavirus outbreak from Wuhan city in China, rapid need for emergency departments preparedness and response; a letter to editor. Arch Acad Emerg Med [Internet]. 2020 [cited 2020 Mar 27];8(1):e12. Available from: https://dx.doi.org/10.22037/aaem.v8i1.565 https://dx.doi.org/10.22037/aaem.v8i1.56...
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V |
Post-CPR care performing emergency coronary angiography, body temperature control, systemic blood pressure control. |
It is recommended to use Continuous Positive Airway Pressure (CPAP)/BI-level Positive Airway Pressure (BiPAP). Mechanical ventilation in patients infected with hypoxemic respiratory failure is advised. |