Resuscitation: Hospital Management of Cardiopulmonary arrest (COVID-19) was adapted from the newly revised Resuscitation: Hospital Management of Cardiopulmonary arrest CPG. It will be considered for Statewide endorsement on 18 June – NSW are unable to endorse it as it does not match their State guidance.
NB Text in italics relates to CPR in the context of COVID-19. This applies to any child in whom COVID-19 is suspected or confirmed . Given the current low prevalence of COVID-19 in Australia (May 2020), particularly in children, resuscitation of children should be as per usual protocols. Individual State policies should be followed.
Key Points
- Cardiac arrest should be suspected in an infant or child who is unresponsive and not breathing normally – pulse check should not delay cardiopulmonary resuscitation (CPR)
- CPR should be commenced if cardiac arrest is suspected
- Ongoing management should be directed by the cardiac rhythm identified
- Effective resuscitation relies on a coordinated team and good communication
- Children appear to be less likely to transmit COVID-19 to healthcare workers than adults
- CPR may cause aerosolisation of virus; airborne precautions(PPE including N95 mask) must be initiated as soon as possible and management must occur in the highest level of isolation available. This should be discussed with a senior clinician and/or ICU
- Ideally, CPR should not be delayed for donning of airborne precautions PPE; decisions on providing airway support in the absence of PPE need to be made with the understanding that there may be a small but as yet undefined risk of COVID-19 exposure
- If arrest is anticipated, PPE should be donned in advance. If arrest is unanticipated, initial resuscitation, including airway opening, bag valve mask (BVM) ventilation and chest compressions, may be provided by a first responder wearing a mask, gloves and eye protection (at minimum), who should hand over to a staff member in airborne precautions PPE as soon as possible
- Staff at increased risk from COVID-19 should consider not working in the resuscitation room