Management of adult cardiac arrest in the COVID-19 era: consensus statement from the Australasian College for Emergency Medicine

doi:10.5694/mja2.50699

. 2020 Aug;213(3):126-133.

doi: 10.5694/mja2.50699. Epub 2020 Jul 12.

Management of adult cardiac arrest in the COVID-19 era: consensus statement from the Australasian College for Emergency Medicine

Simon Craig^{1

2}, Mya Cubitt^{3

4}, Ashish Jaison⁵, Steven Troupakis^{1

6}, Natalie Hood^{1

7}, Christina Fong^{1

6}, Adnan Bilgrami¹, Peter Leman^{8

9}, Juan Carlos Ascencio-Lane^{10

11}, Guruprasad Nagaraj^{12

13}, John Bonning^{14

15}, Gabriel Blecher^{2

16}, Rob Mitchell^{2

5}, Ellen Burkett^{17

18}, Sally M McCarthy^{13

19}, Amanda M Rojek^{3

4}, Kim Hansen^{20

21}, Helen Psihogios¹, Peter Allely^{9

22}, Simon Judkins²³, Lai Heng Foong^{24

25}, Stephen Bernard²⁶, Peter A Cameron^{2

5}

Affiliations

¹ Monash Health, Melbourne, VIC.
² Monash University, Melbourne, VIC.
³ Royal Melbourne Hospital, Melbourne, VIC.
⁴ Centre for Integrated Critical Care, University of Melbourne, Melbourne, VIC.
⁵ Emergency and Trauma Centre, Alfred Health, Melbourne, VIC.
⁶ Epworth HealthCare, Melbourne, VIC.
⁷ Surf Life Saving Australia, Sydney, NSW.
⁸ Fiona Stanley Hospital, Perth, WA.
⁹ University of Western Australia, Perth, WA.
¹⁰ Royal Hobart Hospital, Hobart, TAS.
¹¹ University of Tasmania, Hobart, TAS.
¹² South Western Emergency Research Institute, Liverpool Hospital, Sydney, NSW.
¹³ University of New South Wales, Sydney, NSW.
¹⁴ Australasian College for Emergency Medicine, Melbourne, VIC.
¹⁵ Council of Medical Colleges of Aotearoa New Zealand, Wellington, New Zealand.
¹⁶ Monash Medical Centre, Melbourne, VIC.
¹⁷ Princess Alexandra Hospital, Brisbane, QLD.
¹⁸ Clinical Excellence Queensland, Brisbane, QLD.
¹⁹ Prince of Wales Hospital and Community Health Services, Sydney, NSW.
²⁰ St Andrew's War Memorial Hospital, Brisbane, QLD.
²¹ Prince Charles Hospital, Brisbane, QLD.
²² Sir Charles Gairdner Hospital, Perth, WA.
²³ Austin Hospital, Melbourne, VIC.
²⁴ Bankstown-Lidcombe Hospital, Sydney, NSW.
²⁵ University of Western Sydney, Sydney, NSW.
²⁶ Centre for Research and Evaluation, Ambulance Victoria, Melbourne, VIC.

PMID: 32656798
PMCID: PMC7405166
DOI: 10.5694/mja2.50699

Management of adult cardiac arrest in the COVID-19 era: consensus statement from the Australasian College for Emergency Medicine

Simon Craig et al. Med J Aust. 2020 Aug.

. 2020 Aug;213(3):126-133.

doi: 10.5694/mja2.50699. Epub 2020 Jul 12.

Authors

Affiliations

¹ Monash Health, Melbourne, VIC.
² Monash University, Melbourne, VIC.
³ Royal Melbourne Hospital, Melbourne, VIC.
⁴ Centre for Integrated Critical Care, University of Melbourne, Melbourne, VIC.
⁵ Emergency and Trauma Centre, Alfred Health, Melbourne, VIC.
⁶ Epworth HealthCare, Melbourne, VIC.
⁷ Surf Life Saving Australia, Sydney, NSW.
⁸ Fiona Stanley Hospital, Perth, WA.
⁹ University of Western Australia, Perth, WA.
¹⁰ Royal Hobart Hospital, Hobart, TAS.
¹¹ University of Tasmania, Hobart, TAS.
¹² South Western Emergency Research Institute, Liverpool Hospital, Sydney, NSW.
¹³ University of New South Wales, Sydney, NSW.
¹⁴ Australasian College for Emergency Medicine, Melbourne, VIC.
¹⁵ Council of Medical Colleges of Aotearoa New Zealand, Wellington, New Zealand.
¹⁶ Monash Medical Centre, Melbourne, VIC.
¹⁷ Princess Alexandra Hospital, Brisbane, QLD.
¹⁸ Clinical Excellence Queensland, Brisbane, QLD.
¹⁹ Prince of Wales Hospital and Community Health Services, Sydney, NSW.
²⁰ St Andrew's War Memorial Hospital, Brisbane, QLD.
²¹ Prince Charles Hospital, Brisbane, QLD.
²² Sir Charles Gairdner Hospital, Perth, WA.
²³ Austin Hospital, Melbourne, VIC.
²⁴ Bankstown-Lidcombe Hospital, Sydney, NSW.
²⁵ University of Western Sydney, Sydney, NSW.
²⁶ Centre for Research and Evaluation, Ambulance Victoria, Melbourne, VIC.

PMID: 32656798
PMCID: PMC7405166
DOI: 10.5694/mja2.50699

Abstract

Introduction: The global pandemic of coronavirus disease 2019 (COVID-19) has caused significant worldwide disruption. Although Australia and New Zealand have not been affected as much as some other countries, resuscitation may still pose a risk to health care workers and necessitates a change to our traditional approach. This consensus statement for adult cardiac arrest in the setting of COVID-19 has been produced by the Australasian College for Emergency Medicine (ACEM) and aligns with national and international recommendations.

Main recommendations: In a setting of low community transmission, most cardiac arrests are not due to COVID-19. Early defibrillation saves lives and is not considered an aerosol generating procedure. Compression-only cardiopulmonary resuscitation is thought to be a low risk procedure and can be safely initiated with the patient's mouth and nose covered. All other resuscitative procedures are considered aerosol generating and require the use of airborne personal protective equipment (PPE). It is important to balance the appropriateness of resuscitation against the risk of infection. Methods to reduce nosocomial transmission of COVID-19 include a physical barrier such as a towel or mask over the patient's mouth and nose, appropriate use of PPE, minimising the staff involved in resuscitation, and use of mechanical chest compression devices when available. If COVID-19 significantly affects hospital resource availability, the ethics of resource allocation must be considered.

Changes in management: The changes outlined in this document require a significant adaptation for many doctors, nurses and paramedics. It is critically important that all health care workers have regular PPE and advanced life support training, are able to access in situ simulation sessions, and receive extensive debriefing after actual resuscitations. This will ensure safe, timely and effective management of the patients with cardiac arrest in the COVID-19 era.

Keywords: COVID-19; Infectious diseases; Respiratory tract infections; Resuscitation.

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References

1. Falconer R. Australia and New Zealand reopen after coronavirus cases plummet. Axios News 2020; 14 May. https://www.axios.com/coronavirus-australia-new-zealand-reopen-lockdown-... (viewed May 2020).
1. Chan‐Yeung M. Severe acute respiratory syndrome (SARS) and healthcare workers. Int J Occup Environ Health 2004; 10: 421–427. - PubMed
1. Christian MD, Loutfy M, McDonald LC, et al. Possible SARS coronavirus transmission during cardiopulmonary resuscitation. Emerg Infect Dis 2004; 10: 287–293. - PMC - PubMed
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[1] Falconer R. Australia and New Zealand reopen after coronavirus cases plummet. Axios News 2020; 14 May. https://www.axios.com/coronavirus-australia-new-zealand-reopen-lockdown-... (viewed May 2020).

[2] Falconer R. Australia and New Zealand reopen after coronavirus cases plummet. Axios News 2020; 14 May. https://www.axios.com/coronavirus-australia-new-zealand-reopen-lockdown-... (viewed May 2020).

[3] Chan‐Yeung M. Severe acute respiratory syndrome (SARS) and healthcare workers. Int J Occup Environ Health 2004; 10: 421–427. - PubMed

[4] Chan‐Yeung M. Severe acute respiratory syndrome (SARS) and healthcare workers. Int J Occup Environ Health 2004; 10: 421–427. - PubMed

[5] Christian MD, Loutfy M, McDonald LC, et al. Possible SARS coronavirus transmission during cardiopulmonary resuscitation. Emerg Infect Dis 2004; 10: 287–293. - PMC - PubMed

[6] Christian MD, Loutfy M, McDonald LC, et al. Possible SARS coronavirus transmission during cardiopulmonary resuscitation. Emerg Infect Dis 2004; 10: 287–293. - PMC - PubMed

[7] Loeb M, McGeer A, Henry B, et al. SARS among critical care nurses, Toronto. Emerg Infect Dis 2004; 10: 251–255. - PMC - PubMed

[8] Loeb M, McGeer A, Henry B, et al. SARS among critical care nurses, Toronto. Emerg Infect Dis 2004; 10: 251–255. - PMC - PubMed

[9] Wang J, Zhou M, Liu F. Reasons for healthcare workers infected with novel coronavirus disease 2019 (COVID‐19) in China. J Hosp Infect 2020; 105: 100–101. - PMC - PubMed

[10] Wang J, Zhou M, Liu F. Reasons for healthcare workers infected with novel coronavirus disease 2019 (COVID‐19) in China. J Hosp Infect 2020; 105: 100–101. - PMC - PubMed

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Management of adult cardiac arrest in the COVID-19 era: consensus statement from the Australasian College for Emergency Medicine

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Management of adult cardiac arrest in the COVID-19 era: consensus statement from the Australasian College for Emergency Medicine

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