On March 19, 2020, the American Heart Association released an interim guidance on resuscitation care in patients with known or suspected coronavirus disease 2019 (COVID-19).

This guidance for healthcare providers (HCPs) and first responders, aims to minimize the risk for transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the novel virus that causes COVID-19. The recommendations are primarily informed by guidelines from the United States Centers for Disease Control and Prevention.

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It is recommended that HCPs adopt standard and transmission-based precautions when caring for patients with known or suspected COVID-19, including adequate hand hygiene, and the use of personal protection equipment (ie, respirators or facemasks, eye protection, gloves and gowns) before entering a patient’s room or care area. In cases of gown shortages, this equipment should be prioritized for use during aerosol-generating procedures. Patients with known or suspected COVID-19 should be placed in single-person rooms with the door closed.

Aerosol-Generating Procedures

Aerosol-generating procedures, such as cardiopulmonary resuscitation, endotracheal intubation, and non-invasive ventilation, should be performed in airborne infection isolation rooms (AIIRs) with HCPs using adequate respiratory protection (ie, N95 respirators or those with a higher level of protection). A limited number of providers should be present for the procedure, and the AIIRs should be cleaned and disinfected after the procedure.

In patients requiring intubation, rapid sequence intubation should be adopted. Procedures including bag-valve mask, nebulizers and non-invasive positive pressure ventilation should be avoided, as these procedures may generate aerosols. In patients with acute respiratory failure, endotracheal intubation should be adopted directly to avoid the use of high-flow nasal oxygenation and mask continuous positive airway pressure, which may also generate aerosols.

Guidance for First Responders

It is recommended that emergency medical dispatchers determine whether the call is about an individual who may present with signs, symptoms, or risk factors for COVID-19.

If a patient needing emergency transport is suspected of having COVID-19, prehospital care providers and healthcare facilities should be notified in advance. Emergency medical service (EMS) clinicians should also follow standard precautions and use the aforementioned personal protection equipment. If information was not provided by the dispatcher to the EMS about the fact that the incoming patient may have COVID-19, the EMS clinician should exercise precautions when responding to patients with signs of respiratory infection, including, maintaining a distance of ≥6 feet, if possible.

Once in the transport vehicle, the patient should be separated from other individuals as much as possible, including from the driver who should be isolated from the patient compartment. Accompanying individuals should be urged not to ride in the transport vehicle, should wear a facemask if present in the vehicle. For aerosol-generating procedures needed to be conducted during EMS transport, bag-valve masks and other ventilator equipment should have high-efficiency particulate air filtration for expired air. It is recommended that the transport vehicle’s rear doors be opened and that the heating, ventilation and air conditioning system be on during aerosol-generating procedures, especially in transport vehicles without an isolated driver compartment.

Additional information and resources from the AHA on COVID-19 can be accessed here.

Reference

Interim guidance to reduce COVID-19 transmission during resuscitation care [press release]. Dallas, Texas: American Heart Association. https://newsroom.heart.org/news/interim-guidance-to-reduce-covid-19-transmission-during-resuscitation-care. Published March 19, 2020. Accessed March 24, 2020.