2021 Interim Guidance to Health Care Providers for Basic and Advanced Cardiac Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19

Antony Hsu¹, Comilla Sasson², Peter J Kudenchuk³, Dianne L Atkins⁴, Khalid Aziz⁵, Lance B Becker⁶, Robert A Berg⁷, Farhan Bhanji⁸, Steven M Bradley⁹, Steven C Brooks¹⁰, Melissa Chan¹¹, Paul S Chan¹², Adam Cheng¹³, Brian M Clemency¹⁴, Allan de Caen¹⁵, Jonathan P Duff¹⁵, Dana P Edelson¹⁶, Gustavo E Flores¹⁷, Susan Fuchs¹⁸, Saket Girotra¹⁹, Carl Hinkson²⁰, Benny L Joyner Jr²¹, Beena D Kamath-Rayne²², Monica Kleinman²³, Javier J Lasa²⁴, Eric J Lavonas²⁵, Henry C Lee²⁶, Rebecca E Lehotzky², Arielle Levy²⁷, Mary E Mancini²⁸, Mary E McBride²⁹, Garth Meckler¹¹, Raina M Merchant³⁰, Vivek K Moitra³¹, Ryan W Morgan⁷, Vinay Nadkarni⁷, Ashish R Panchal³², Mary Ann Peberdy³³, Tia Raymond³⁴, Kathryn Roberts³⁵, Michael R Sayre³⁶, Stephen M Schexnayder³⁷, Robert M Sutton⁷, Mark Terry³⁸, Brian Walsh³⁹, David S Wang^{31

40}, Carolyn M Zelop⁴¹, Alexis Topjian⁷

Affiliations

¹ Department of Emergency Medicine, St. Joseph Mercy Ann Arbor Hospital, Ypsilanti, MI (A.H.).
² ECC Science & Innovation, American Heart Association, Dallas, TX (C.S., R.E.L.).
³ Department of Medicine/Division of Cardiology (P.J.K.), University of Washington, Seattle.
⁴ Stead Family Department of Pediatrics (D.L.A), Carver College of Medicine, University of Iowa.
⁵ Division of Newborn Medicine, Department of Pediatrics, University of Alberta, Edmonton, Canada (K.A.).
⁶ Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, NY (L.B.B.).
⁷ Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine (R.A.B., R.W.M., V.N., R.M.S., A.T.).
⁸ Department of Pediatrics, McGill University, Montreal, QC, Canada (F.B.).
⁹ Minneapolis Heart Institute, Healthcare Delivery Innovation Center, MN (S.M.B.).
¹⁰ Department of Emergency Medicine, Queen's University, Kingston, ON, Canada (S.C.B.).
¹¹ Department of Pediatrics and Department of Pediatric Emergency Medicine, BC Children's Hospital, University of British Columbia, Vancouver, Canada (M.C., G.M.).
¹² Department of Internal Medicine, Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City (P.S.C.).
¹³ Department of Paediatrics, Alberta Children's Hospital, University of Calgary, Canada (A.C.).
¹⁴ Department of Emergency Medicine, University at Buffalo, NY (B.M.C.).
¹⁵ Division of Critical Care, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Canada (A.d.C., J.P.D.).
¹⁶ Section of Hospital Medicine, University of Chicago, IL (D.P.E.).
¹⁷ Emergency and Critical Care Trainings, San Juan, Puerto Rico (G.E.F.).
¹⁸ Division of Emergency Medicine (S.F.), Department of Pediatrics, Northwestern University/Ann & Robert H. Lurie Children's Hospital, Chicago, IL.
¹⁹ Department of Internal Medicine and Division of Cardiovascular Diseases (S.G.), Carver College of Medicine, University of Iowa.
²⁰ Respiratory Care, Providence Regional Medical Center, Everett, WA (C.H.).
²¹ Departments of Pediatrics, Anesthesiology & Social Medicine, University of North Carolina at Chapel Hill (B.L.J.).
²² Global Newborn and Child Health, American Academy of Pediatrics, Itasca, IL (B.D.K.-R.).
²³ Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, MA (M.K.).
²⁴ Cardiovascular Intensive Care Unit, Texas Children's Hospital, Baylor College Of Medicine, Houston (J.J.L.).
²⁵ Department of Emergency Medicine, Denver Health and Hospital Authority, CO (E.J.L.).
²⁶ Division of Neonatology, Stanford University, CA (H.C.L.).
²⁷ Department of Pediatrics and Department of Pediatric Emergency Medicine, Sainte-Justine Hospital University Center, University of Montreal, QC, Canada (A.L.).
²⁸ College of Nursing, University of Texas at Arlington (M.E. Mancini).
²⁹ Divisions of Cardiology and Critical Care Medicine (M.E. McBride), Department of Pediatrics, Northwestern University/Ann & Robert H. Lurie Children's Hospital, Chicago, IL.
³⁰ Department of Emergency Medicine, University of Pennsylvania, Philadelphia (R.M.M.).
³¹ Department of Anesthesiology, Division of Critical Care Medicine, Columbia University Irving Medical Center, New York, NY (V.K.M., D.S.W.).
³² Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus (A.R.P.).
³³ Division of Cardiology, Virginia Commonwealth University, Richmond (M.A.P.).
³⁴ Department of Pediatrics and Pediatric Cardiac Critical Care, Medical City Children's Hospital, Dallas, TX (T.R.).
³⁵ Center for Nursing Excellence, Education & Innovation, Joe DiMaggio Children's Hospital, Hollywood, FL (K.R.).
³⁶ Department of Emergency Medicine (M.R.S.), University of Washington, Seattle.
³⁷ Departments of Critical Care Medicine and Emergency Medicine, Arkansas Children's Hospital, Little Rock (S.M.S.).
³⁸ National Registry of Emergency Medical Technicians, Columbus, OH (M.T.).
³⁹ Respiratory Care, Children's Hospital Colorado, Aurora (B.W.).
⁴⁰ Department of Obstetrics and Gynecology, New York, NY (D.S.W.).
⁴¹ NYU School of Medicine, New York, NY and The Valley Hospital, Ridgewood, NJ (C.M.Z.).

PMID: 34641719
PMCID: PMC8522336
DOI: 10.1161/CIRCOUTCOMES.121.008396

2021 Interim Guidance to Health Care Providers for Basic and Advanced Cardiac Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19

Antony Hsu et al. Circ Cardiovasc Qual Outcomes. 2021 Oct.

. 2021 Oct;14(10):e008396.

doi: 10.1161/CIRCOUTCOMES.121.008396. Epub 2021 Oct 13.

Authors

Affiliations

¹ Department of Emergency Medicine, St. Joseph Mercy Ann Arbor Hospital, Ypsilanti, MI (A.H.).
² ECC Science & Innovation, American Heart Association, Dallas, TX (C.S., R.E.L.).
³ Department of Medicine/Division of Cardiology (P.J.K.), University of Washington, Seattle.
⁴ Stead Family Department of Pediatrics (D.L.A), Carver College of Medicine, University of Iowa.
⁵ Division of Newborn Medicine, Department of Pediatrics, University of Alberta, Edmonton, Canada (K.A.).
⁶ Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, NY (L.B.B.).
⁷ Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine (R.A.B., R.W.M., V.N., R.M.S., A.T.).
⁸ Department of Pediatrics, McGill University, Montreal, QC, Canada (F.B.).
⁹ Minneapolis Heart Institute, Healthcare Delivery Innovation Center, MN (S.M.B.).
¹⁰ Department of Emergency Medicine, Queen's University, Kingston, ON, Canada (S.C.B.).
¹¹ Department of Pediatrics and Department of Pediatric Emergency Medicine, BC Children's Hospital, University of British Columbia, Vancouver, Canada (M.C., G.M.).
¹² Department of Internal Medicine, Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City (P.S.C.).
¹³ Department of Paediatrics, Alberta Children's Hospital, University of Calgary, Canada (A.C.).
¹⁴ Department of Emergency Medicine, University at Buffalo, NY (B.M.C.).
¹⁵ Division of Critical Care, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Canada (A.d.C., J.P.D.).
¹⁶ Section of Hospital Medicine, University of Chicago, IL (D.P.E.).
¹⁷ Emergency and Critical Care Trainings, San Juan, Puerto Rico (G.E.F.).
¹⁸ Division of Emergency Medicine (S.F.), Department of Pediatrics, Northwestern University/Ann & Robert H. Lurie Children's Hospital, Chicago, IL.
¹⁹ Department of Internal Medicine and Division of Cardiovascular Diseases (S.G.), Carver College of Medicine, University of Iowa.
²⁰ Respiratory Care, Providence Regional Medical Center, Everett, WA (C.H.).
²¹ Departments of Pediatrics, Anesthesiology & Social Medicine, University of North Carolina at Chapel Hill (B.L.J.).
²² Global Newborn and Child Health, American Academy of Pediatrics, Itasca, IL (B.D.K.-R.).
²³ Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, MA (M.K.).
²⁴ Cardiovascular Intensive Care Unit, Texas Children's Hospital, Baylor College Of Medicine, Houston (J.J.L.).
²⁵ Department of Emergency Medicine, Denver Health and Hospital Authority, CO (E.J.L.).
²⁶ Division of Neonatology, Stanford University, CA (H.C.L.).
²⁷ Department of Pediatrics and Department of Pediatric Emergency Medicine, Sainte-Justine Hospital University Center, University of Montreal, QC, Canada (A.L.).
²⁸ College of Nursing, University of Texas at Arlington (M.E. Mancini).
²⁹ Divisions of Cardiology and Critical Care Medicine (M.E. McBride), Department of Pediatrics, Northwestern University/Ann & Robert H. Lurie Children's Hospital, Chicago, IL.
³⁰ Department of Emergency Medicine, University of Pennsylvania, Philadelphia (R.M.M.).
³¹ Department of Anesthesiology, Division of Critical Care Medicine, Columbia University Irving Medical Center, New York, NY (V.K.M., D.S.W.).
³² Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus (A.R.P.).
³³ Division of Cardiology, Virginia Commonwealth University, Richmond (M.A.P.).
³⁴ Department of Pediatrics and Pediatric Cardiac Critical Care, Medical City Children's Hospital, Dallas, TX (T.R.).
³⁵ Center for Nursing Excellence, Education & Innovation, Joe DiMaggio Children's Hospital, Hollywood, FL (K.R.).
³⁶ Department of Emergency Medicine (M.R.S.), University of Washington, Seattle.
³⁷ Departments of Critical Care Medicine and Emergency Medicine, Arkansas Children's Hospital, Little Rock (S.M.S.).
³⁸ National Registry of Emergency Medical Technicians, Columbus, OH (M.T.).
³⁹ Respiratory Care, Children's Hospital Colorado, Aurora (B.W.).
⁴⁰ Department of Obstetrics and Gynecology, New York, NY (D.S.W.).
⁴¹ NYU School of Medicine, New York, NY and The Valley Hospital, Ridgewood, NJ (C.M.Z.).

PMID: 34641719
PMCID: PMC8522336
DOI: 10.1161/CIRCOUTCOMES.121.008396

No abstract available

Keywords: COVID-19; SARS-CoV-2 infection; advanced cardiac life support; cardiopulmonary resuscitation; heart arrest.

PubMed Disclaimer

Figures

**Figure 1.**
**Summary of adjustments to cardiopulmonary resuscitation (CPR) algorithms in patients with suspected or confirmed coronavirus disease 2019 (COVID-19).^–** AGP indicates aerosol generating procedure; HEPA, high efficiency particulate air; PPE, personal protective equipment; and SARS-CoV-2, severe acute respiratory syndrome coronovirus 2.

**Figure 2.**
**Frequently asked questions.** AGP indicates aerosol generating procedure; and COVID-19, coronavirus disease 2019.

**Figure 3.**
Adult basic life support algorithm for health care providers for suspected or confirmed coronavirus disease 2019 (COVID-19).

**Figure 4.**
Adult cardiac arrest algorithm for patients with suspected or confirmed coronavirus disease 2019 (COVID-19; VF/pVT/asystole/PEA).

**Figure 5.**
Cardiac arrest in pregnancy in-hospital Advanced Cardiac Life Support (ACLS) algorithm for patients with suspected or confirmed coronavirus disease 2019 (COVID-19).

**Figure 6.**
Pediatric basic life support algorithm for health care provider—single rescuer for suspected or confirmed coronavirus disease 2019 (COVID-19).

**Figure 7.**
Pediatric basic life support algorithm for health care providers—2 or more rescuers for suspected or confirmed coronavirus disease 2019 (COVID-19).

**Figure 8.**
Pediatric cardiac arrest algorithm for patients with suspected or confirmed coronavirus disease 2019 (COVID-19).

See this image and copyright information in PMC

References

1. Merchant RM, Topjian AA, Panchal AR, Cheng A, Aziz K, Berg KM, Lavonas EJ, Magid DJ; Adult Basic and Advanced Life Support, Pediatric Basic and Advanced Life Support, Neonatal Life Support, Resuscitation Education Science, and Systems of Care Writing Groups. Part 1: executive summary: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020; 142(16 suppl 2):S337–S357. doi: 10.1161/CIR.0000000000000918 - PubMed
1. Edelson DP, Sasson C, Chan PS, Atkins DL, Aziz K, Becker LB, Berg RA, Bradley SM, Brooks SC, Cheng A, et al. ; American Heart Association ECC Interim COVID Guidance Authors. Interim guidance for basic and advanced life support in adults, children, and neonates with suspected or confirmed COVID-19: from the Emergency Cardiovascular Care Committee and Get With The Guidelines-resuscitation adult and pediatric task forces of the American Heart Association. Circulation. 2020; 141:e933–e943. doi: 10.1161/CIRCULATIONAHA.120.047463 - PMC - PubMed
1. Chan PS, Girotra S, Tang Y, Al-Araji R, Nallamothu BK, McNally B. Outcomes for out-of-hospital cardiac arrest in the United States during the coronavirus disease 2019 pandemic. JAMA Cardio. 2021; 6:296–303. doi: 10.1001/jamacardio.2020.6210 - PMC - PubMed
1. Baert V, Jaeger D, Hubert H, Lascarrou JB, Debaty G, Chouihed T, Javaudin F; GR-RéAC. Assessment of changes in cardiopulmonary resuscitation practices and outcomes on 1005 victims of out-of-hospital cardiac arrest during the COVID-19 outbreak: registry-based study. Scand J Trauma Resusc Emerg Med. 2020; 28:119. doi: 10.1186/s13049-020-00813-x - PMC - PubMed
1. Baldi E, Sechi GM, Mare C, Canevari F, Brancaglione A, Primi R, Palo A, Contri E, Ronchi V, Beretta G, et al. ; all the Lombardia CARe Researchers. Treatment of out-of-hospital cardiac arrest in the COVID-19 era: a 100 days experience from the Lombardy region. PLoS One. 2020; 15:e0241028. doi: 10.1371/journal.pone.0241028 - PMC - PubMed

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2021 Interim Guidance to Health Care Providers for Basic and Advanced Cardiac Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19

Affiliations

2021 Interim Guidance to Health Care Providers for Basic and Advanced Cardiac Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19

Authors

Affiliations

Figures

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

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