Latest public information video from the NHS on COVID-19
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Whenever CPR is carried out, particularly on an unknown victim, there is some risk of cross infection, associated particularly with giving rescue breaths. Normally, this risk is very small and is set against the inevitability that a person in cardiac arrest will die if no assistance is given. The first things to do are shout for help and dial 999.
Watch what to do in an emergency.
Resuscitation Council UK Guidelines 2015 state “If you are untrained or unable to do rescue breaths, give chest compression-only CPR (i.e. continuous compressions at a rate of at least 100–120 min-1)”.
Because of the heightened awareness of the possibility that the victim may have COVID-19, Resuscitation Council UK offers this advice:
Paediatric advice
We are aware that paediatric cardiac arrest is unlikely to be caused by a cardiac problem and is more likely to be a respiratory one, making ventilations crucial to the child’s chances of survival. However, for those not trained in paediatric resuscitation, the most important thing is to act quickly to ensure the child gets the treatment they need in the critical situation.
For out-of-hospital cardiac arrest, the importance of calling an ambulance and taking immediate action cannot be stressed highly enough. If a child is not breathing normally and no actions are taken, their heart will stop and full cardiac arrest will occur. Therefore, if there is any doubt about what to do, this statement should be used.
It is likely that the child/infant having an out-of-hospital cardiac arrest will be known to you. We accept that doing rescue breaths will increase the risk of transmitting the COVID-19 virus, either to the rescuer or the child/infant. However, this risk is small compared to the risk of taking no action as this will result in certain cardiac arrest and the death of the child.
Further reading:
Updated 13 May 2020
]]>DALLAS, TX-- It’s inappropriate to consider blanket do-not-resuscitate orders for COVID-19 patients because adequate data is not yet available on U.S. survival rates for in-hospital resuscitation of COVID-19 patients and data from China may not relate to U.S. patients, according to a new article published today in Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal.
There is a presumption that COVID-19 patients have a low survival rate after resuscitation, based on a recent study from Wuhan, China, that found an overall survival of 2.9% in 136 COVID-19 patients who underwent cardiopulmonary resuscitation for in-hospital cardiac arrest. However, that prognosis should not be applied to the U.S., said Saket Girotra, M.D., S.M., assistant professor of medicine in the division of cardiovascular diseases at the University of Iowa Carver College of Medicine, on behalf of the American Heart Association’s Get With The Guidelines®-Resuscitation (GWTG-R) investigators.
In the study, “Survival After In-Hospital Cardiac Arrest In Critically Ill Patients: Implications For Covid-19 Outbreak?,” investigators report data from the GWTG-R registry of in-hospital cardiac arrest patients. They examined data from 2014-2018 on patients similar to the COVID-19 population: 5,690 adult patients who underwent CPR for in-hospital cardiac arrest while being treated in an intensive care unit (ICU) for pneumonia or sepsis and were receiving mechanical ventilation at the time of cardiac arrest.
While researchers noted an overall survival rate of only 12.5% in the U.S. simulation, there were many variables that could affect survival and neurologic outcomes. The probability of survival without severe neurological disability ranged from less than 3% to more than 22%, across key patient subgroups. The probability of mild to no disability ranged from about 1% to 17% across key patient subgroups.
While survival rates were low in older and sicker patients in whom the initial heart rhythm was non-shockable, survival rates were much higher (more than 20%) in younger patients with an initial shockable rhythm who were not being treated with vasopressor medications prior to the cardiac arrest. Vasopressor medications are generally used to improve blood pressure and cardiac output in emergency situations such as septic shock or cardiac arrest.
“Such large variation in survival rates suggests that a blanket prescription of do-not-resuscitate orders in patients with COVID-19 may be unwarranted. Such a blanket policy also ignores the fact that early experience of the pandemic in the U.S. reveals that about a quarter of COVID-19 patients are younger than 50 years of age and otherwise healthy. Cardiac arrest in such patients will likely have a different prognosis,” the researchers said.
The article concludes that “... in a cohort of critically ill patients on mechanical ventilation, survival outcomes following in-hospital resuscitation were not uniformly poor. These data may help guide discussions between patients, providers and hospital leaders in discussing appropriate use of resuscitation for COVID-19 patients.”
SOURCE: American Heart Association
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If PFA certificate requalification training is prevented for reasons associated directly with coronavirus (COVID-19), or by complying with related government advice, the validity of current certificates can be extended by up to 3 months. This applies to certificates expiring on or after 16 March 2020. If, exceptionally requalification training is still unavailable, a further extension is possible to no later than 30 September 2020. If asked to do so, providers should be able to explain why the first aider hasn’t been able to requalify and demonstrate what steps have taken to access the training. Employers or certificate holders must do their best to arrange requalification training at the earliest opportunity.
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