Best Practices in Managing Cardiac Arrest in the Emergency Department During the COVID-19 Pandemic

Abstract

Infection by severe acute respiratory syndrome coronavirus 2 has led to cardiac complications including an increasing incidence of cardiac arrest. The resuscitation of these patients requires a conscious effort to minimize the spread of the virus. We present a best-practice model based in four guiding principles: (1) reduce the risk of exposure to the entire health care team; (2) decrease the number of aerosol generating procedures; (3) use a small resuscitation team to limit potential exposure; and (4) consider early termination of resuscitative efforts.

Figure

The emergency department care team for an adult resuscitation is composed of: A, One to two physicians or advanced practice providers (determined in real time based on patient situation and available resources). B, One respiratory therapist. C, One nurse to administer medications and defibrillate. D, One nurse to record (consider use of telehealth device to facilitate this role outside the room). E, One individual to attach and monitor the mechanical cardiopulmonary resuscitation device (can be done by a nurse or emergency medical service provider already in the room). F, Runner to hand medications and equipment. G, Additional clinicians, pharmacist, lab service technicians/phlebotomists, and radiology technicians, chaplain, or social worker. H, Two additional providers may be necessary for pediatric resuscitations.