CODE BLUE-19: Proposal to Mitigate COVID-19 Transmission in the Emergency Department for Out-of-hospital Cardiac Arrest

Abstract

Resuscitation of cardiac arrest in coronavirus disease 2019 (COVID-19) patients places the healthcare staff at higher risk of exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Unfortunately, COVID-19 status is unknown in most patients presenting to the emergency department (ED), and therefore special attention must be given to protect the healthcare staff along with the other patients. This is particularly true for out-of-hospital cardiac arrest patients who are transported to the ED. Based on the current data available on transmissibility of SARS-CoV-2, we have proposed a protocolized approach to out-of-hospital cardiac arrests to limit risk of transmission.

Figure 1

Illustrative diagram of code team and responsibilities to mitigate COVID-19 transmission.

Figure 2

“Dump sheet” for cardiac arrest COVID-19 response. Medications most commonly used in cardiac arrest resuscitation and a defibrillator are pre-positioned by the code team on a sheet. Its purpose is to avoid contaminating the crash cart.

Figure 3

Cardiac arrest aerosol mitigation bag for cardiac arrest COVID-19 response. This bag includes a supraglottic airway device, bag valve mask, viral filter, end tidal carbon dioxide monitoring adapter, and a plastic drape used to cover patient.

Figure 4

Plastic drape for cardiac arrest COVID-19 response. Used to cover patient during transport from ambulance bay to the resuscitation room. The drape has two vertical slits on top allowing the operator to access the airway and one horizontal slit below allowing for chest compressions or for further access as needed without having to remove the drape.