CPR in the COVID-19 Era: What's Changed?

The COVID-19 pandemic has brought significant changes to various aspects of our lives, including how we respond to medical emergencies. CPR, a critical life-saving technique, has also seen modifications to ensure the safety of both rescuers and patients in the context of COVID-19. In this blog post, we will explore the adjustments made to cardiopulmonary resuscitation protocols, the use of personal protective equipment (PPE), and the importance of staying informed about the latest guidelines during this challenging time.

1. Updates in CPR Guidelines

Recognizing the unique challenges posed by COVID-19, leading health organizations have updated CPR guidelines to adapt to the pandemic. Revisions emphasize the sequence of chest compressions and airway management to maximize the effectiveness of CPR, suggesting that initiating compressions sooner can significantly improve a patient's chance of survival. These revisions consider the risk of viral transmission during resuscitation efforts and provide recommendations for minimizing exposure while ensuring effective life-saving measures. Key updates include:

• Emphasis on minimizing direct contact between rescuers and patients.

• Adjusted protocols for healthcare and community settings.

• Enhanced focus on the use of personal protective equipment (PPE) during resuscitation.

Specific Guideline Changes:

• Compression-Only CPR: Encouraging the use of hands-only CPR to reduce the need for mouth-to-mouth resuscitation. The most recent CPR guidelines emphasize hands-only CPR to enhance survival rates by prioritizing chest compressions over rescue breathing.

• Ventilation Adjustments: Recommending the use of barrier devices like face shields or bag-valve masks with HEPA filters if ventilations are necessary.

• Increased Use of AEDs: Promoting the early use of Automated External Defibrillators (AEDs) to improve survival rates while minimizing the need for close contact.

2. Hands-Only CPR Emphasis

During the pandemic, there has been a shift towards emphasizing hands-only CPR for bystanders and rescuers, highlighting the importance of performing CPR and starting chest compressions promptly. Hands-only CPR involves chest compressions without mouth-to-mouth breaths, reducing the risk of direct contact with the patient’s mouth and airways. This method is recommended for both lay rescuers and professionals when the rescuer is untrained or unwilling to perform rescue breaths due to concerns about COVID-19.

Steps for Hands-Only CPR:

1. Ensure Safety: Ensure the scene is safe for both the rescuer and the patient.

2. Check for Responsiveness: Gently shake the person and shout to see if they respond.

3. Call for Help: Dial emergency services immediately and, if possible, put the phone on speaker mode to receive guidance from the dispatcher.

4. Deliver Chest Compressions: Push hard and fast in the center of the chest at a rate of 100-120 compressions per minute, aiming for a depth of at least 2 inches (5 cm). Emphasize the importance of delivering chest compressions at an appropriate speed to ensure sufficient blood flow to the brain and proper functioning of the heart.

Advantages of Hands-Only CPR:

• Reduces Contact Risk: Minimizes potential exposure to respiratory droplets.

• Simplicity: Easier to perform, especially for untrained bystanders.

• Effectiveness: Studies show hands-only CPR can be as effective as conventional CPR in the first few minutes of an out-of-hospital cardiac arrest by ensuring sufficient blood flow to the brain.

3. Personal Protective Equipment (PPE) for Rescuers

In the COVID-19 era, personal protective equipment (PPE) has become a crucial component of CPR procedures. Rescuers are advised to wear face masks, gloves, and eye protection when providing assistance to a patient, reducing the risk of viral transmission during resuscitation efforts.

Recommended PPE for Rescuers:

• Face Masks: Surgical masks or N95 respirators to protect against respiratory droplets.

• Gloves: Disposable gloves to prevent contact with blood or bodily fluids.

• Eye Protection: Goggles or face shields to shield from splashes or sprays during resuscitation.

• Gowns: Optional in high-risk settings to protect clothing and skin from contamination.

Best Practices for PPE Use:

• Donning and Doffing: Learn the correct procedures for putting on and removing PPE to avoid self-contamination.

• Hand Hygiene: Practice frequent handwashing or use hand sanitizer before and after wearing PPE.

• Regular Training: Ensure all potential rescuers are trained in the use of PPE specific to CPR situations.

Considerations for Aerosol-Generating Procedures and Rescue Breathing

Certain CPR procedures, such as bag-valve-mask ventilation and intubation, are considered aerosol-generating procedures that can increase the risk of viral spread. These procedures are crucial for managing airway and breathing, especially in the context of the CAB (Compressions, Airway, Breathing) sequence. Healthcare providers and trained rescuers need to be mindful of these considerations and take appropriate precautions.

Safety Measures for Aerosol-Generating Procedures:

• HEPA Filters: Use HEPA filters with bag-valve masks to reduce aerosol dispersion.

• Negative Pressure Rooms: Perform procedures in negative pressure rooms when available to contain airborne particles.

• Limiting Personnel: Minimize the number of individuals present during aerosol-generating procedures to reduce exposure risks.

• Use of Intubation Boxes: Consider using aerosol containment devices such as intubation boxes or barriers.

5. CPR in Healthcare Settings

In healthcare settings, where COVID-19 patients may require CPR, additional precautions are taken to safeguard healthcare providers. These include:

• Negative Pressure Rooms: To contain airborne particles and prevent contamination of surrounding areas.

• High-Efficiency Particulate Air (HEPA) Filters: Used in ventilation systems to purify the air and reduce contamination.

• Specialized PPE: Full-body suits, N95 masks, and face shields to provide maximum protection against infection.

• Advanced Training: Ongoing training for healthcare workers on updated CPR protocols, emphasizing the importance of maintaining adequate blood pressure through effective chest compressions to ensure sufficient blood supply to vital organs, particularly the brain, and proper PPE usage.

Protocol Adjustments in Healthcare:

• Code Blue Protocols: Modification of Code Blue procedures to include PPE requirements and limited personnel involvement.

• Dedicated Equipment: Use of dedicated CPR equipment for COVID-19 patients to prevent cross-contamination.

• Post-Event Procedures: Thorough cleaning and disinfection of the area and equipment after resuscitation efforts.

6. Public Awareness and Training

CPR training and public awareness campaigns have been instrumental in educating communities about CPR modifications during the pandemic. Online resources, virtual training sessions, and social media campaigns play a crucial role in disseminating updated CPR guidelines and ensuring that individuals are prepared to respond effectively during emergencies.

Key Points for Public Training:

• Promote Hands-Only CPR: Simplify training for broader reach and to minimize risk of viral transmission.

• Virtual Training Platforms: Utilize online tools for widespread education, ensuring accessibility while adhering to social distancing guidelines.

• Regular Updates: Keep the public informed about any changes in guidelines through continuous education and communication efforts.

7. Mental Health and Rescuer Well-Being

The pandemic has placed significant emotional and psychological stress on rescuers and healthcare providers, especially when dealing with sudden cardiac arrest cases. Special attention is given to the mental health and well-being of those involved in resuscitation efforts to ensure they can cope with the challenges they face during this unprecedented time.

Support Measures for Rescuers:

• Counseling Services: Providing access to mental health professionals and counseling services.

• Peer Support Groups: Facilitating discussions among colleagues to share experiences and coping strategies.

• Stress Management Resources: Offering training in stress reduction techniques such as mindfulness, meditation, and relaxation exercises.

• Debriefing Sessions: Conducting post-resuscitation debriefing sessions to allow rescuers to process their experiences and emotions.

The COVID-19 pandemic has necessitated adjustments to CPR protocols to prioritize the safety of both rescuers and patients. Hands-only CPR, the use of personal protective equipment (PPE), and considerations for aerosol-generating procedures are among the modifications implemented. Staying informed about the latest CPR guidelines is essential for rescuers and healthcare providers to respond effectively and safely during this challenging time. By adapting to the changing landscape of the COVID-19 era, we can continue to save lives while protecting the health of those involved in resuscitation efforts.

In these uncertain times, staying informed, prepared, and compassionate is key to navigating the complexities of providing CPR during the COVID-19 pandemic. Ensuring that rescuers are well-equipped, both physically and emotionally, will contribute significantly to their ability to perform life-saving measures effectively and safely.