CPR in COVID-19

CPR in COVID-19

1. CPR IN COVID-19 Patient Dr Awadhesh Sharma LPS Institute of Cardiology Kanpur

2. Dr. Awadhesh Kumar Sharma is a young, diligent and dynamic interventional cardiologist. He did his graduation from GSVM Medical College Kanpur and MD in Internal Medicine from MLB Medical College Jhansi. Then he did his super specilization (Doctoral) degree DM in Cardiology from Atal Bihari Vajpai institute of medical sciences & DR Ram Manohar Lohia Hospital New Delhi. He had excellent academic record with Gold medal in MD . He was also awarded chief minister’s medal in 2009 for his academic excellence by former chief minister of UP Hon. Km Mayawati in 2009.He is also receiver of GEMS international award. He had many national & international publications. He had special interest in both invasive & non invasive cardiology. He had performed more than 10000 invasive cardiac intervention procedures successfully till date including coronary angiography, simple & complex angioplasty, peripheral vessels angiography & angioplasty, carotid angiography & angioplasty, ASD ,PDA device closures, Mitral & pulmonary valvotomy . He is also in editorial board of many national & international journal- Journal of clinical medicine & research(JCMR),Clinical cardiology update, United Journal of Cardiology and Cardiovascular Medicine ,EC Pulmonology and Respiratory Medicine,EC Cardiology. He is also active member of reviewer board of many journals. He is also trainee fellow of American college of cardiology. He is active member of many professional bodies including Indian Medical Association, Cardiological Society of India, APVIC, ICC,API. He had worked in NABH Approved the Gracian Superspeciality Hospital Mohali as Consultant Cardiologist since 2014-2016. Currently he is working as Assistant Professor of cardiology at LPS Institute of Cardiology, GSVM Medical college, Kanpur(UP)under Govt of UP. He was awarded with prestigious fellowships of American college of cardiology(FACC) and FSCAI. He is actively involved in creating public awareness on different health issues pertaining to heart via his You tube channel-Happy & Healthy Heart.

3. COVID-19 12-19% of COVID positive patients – require hospitalization 3-6% - critically ill 2-3% - die

4. Why not routine CPR The administration of CPR involves performing numerous aerosol-generating procedures, including chest compressions, positive pressure ventilation and establishment of an advanced airway. During those procedures, viral particles can remain suspended in the air with a half-life of approximately 1 hour and be inhaled by those nearby.

5. Reduce provider exposure to COVID-19 All rescuers should don personal protective equipment (PPE) before entering a scene to protect against both airborne and droplet particles. Personnel on the scene should be limited only to those essential for patient care. Rescuers should consider replacing manual chest compressions with mechanical CPR for patients who meet the manufacturer’s height and weight criteria. COVID-19 status should be communicated to any new providers before arrival on the scene or when transferring the patient to a second setting.

6. Rules of CPR in COVID-19 Do NOT check for breathing. Only Check for pulse, if absent in an unconscious patient call for CPR. Check the rhythm. Give D/C Shocks, but DO NOT do chest compression yet. Do not start Chest compression as normal, UNTIL you have “FULL” PPE Protection. Meantime , You can give Electric shocks with “Standard” Corona PPE (Personal Protective Equipment” Chest compression can cause “Aerosol” droplets, therefore do it only after you got “FULL” Corona PPE. Write the name and time on the gown of all resuscitators, so it is obvious who is who and the time CPR started. Use closed circuit ventilations and suctioning. BMV ( Ambu - bag ), CPAP and Non-invasive ventilation are not recommended, because they spread droplets. If intubation( vedio - laryngoscopy assisted via trained personnel) is decided, good relaxation is recommended (as needed) to prevent coughing. Drug regimens unchanged. Maximum attendance of CPR should be no more than 4 persons.

7. Prioritize oxygenation and ventilation strategies with lower aerosolization risk If a patient is intubated with a cuffed endotracheal tube connected to a ventilator with a high-efficiency particulate air (HEPA) filter in the path of exhaled gas and an in-line suction catheter, the resultant closed circuit will have less risk for particle aerosolization than other forms of positive-pressure ventilation.

8. Prioritize oxygenation and ventilation strategies with lower aerosolization risk If available, attach a HEPA filter in the path of any exhaled gas for manual or mechanical ventilation devices before administering any breaths. Before intubation, use a bag-mask device with a HEPA filter and tight seal. For adults, consider passive oxygenation with non rebreathing face mask covered by a surgical mask. Consider manual ventilation, if intubation is delayed, with a supra- glottic airway or bag-mask device with a HEPA filter.

9. Prioritize oxygenation and ventilation strategies with lower aerosolization risk Intubation should be performed by the most qualified individual ( eg , anesthesiologist) since delayed intubation with multiple attempts may prolong dispersion and place the patient at risk of a respiratory arrest. The ventilator and ventilator circuitry should be ready in advance with preplanned settings already entered so that as soon as the ETT is placed and confirmed with capnography , it can be connected directly to the ETT without additional manual bagging . The expiratory limb on the ventilator should have a HEPA filter to decrease contamination of the ventilator and environment and protect staff when changing limb circuitry.

10. Consider the appropriateness of starting and continuing resuscitation It is reasonable to consider age, comorbidities, and severity of illness in determining the appropriateness of resuscitation and balance the likelihood of success against the risk to rescuers and patients from whom resources are being diverted

11. Thanks