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Interim life support guidance balances rescuer safety, patient needs during pandemic :

May 4, 2020

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Interim guidance has been issued on basic and advanced life support for children and neonatal patients that aims to address the challenges pediatricians may face when providing resuscitation to patients with suspected or confirmed COVID-19.

The AAP is a collaborator on the scientific statement from the American Heart Association Emergency Cardiovascular Care Committee and Get With the Guidelines Resuscitation Adult and Pediatric Task Forces. Published in Circulation, “Interim Guidance for Life Support for COVID-19” was reprinted today in Pediatrics.

“While children appear to have mild disease and/or may be asymptomatic, they still can transmit COVID-19,” said statement co-author Beena Kamath-Rayne, M.D., M.P.H., FAAP, vice president of AAP Global Newborn and Child Health. “Health care providers need to protect themselves during the provision of resuscitation interventions.”

The interim guidance includes three pediatric algorithms: a basic life support algorithm for a single rescuer, a basic life support algorithm for two or more rescuers, and a cardiac arrest algorithm. Each includes steps that are specific to the care of patients with suspected or confirmed COVID-19. There were no suggested COVID-related changes to the neonatal algorithm.

The guidelines attempt to balance the performance of timely and effective resuscitation with protecting health care providers who can be exposed to highly transmissible COVID-19. Aerosol-generating procedures that may be performed during resuscitation include positive pressure ventilation, endotracheal intubation and chest compressions.

Following are the main principles and strategies addressed in the COVID-19 steps to mitigate risk of transmission to health care providers:

  • Reduce provider exposure by donning personal protective equipment before entering the room and limiting the number of people present to the most essential personnel.
  • Prioritize oxygenation and ventilation strategies with lower aerosolization risk. Among considerations are use of high-efficiency particulate air (HEPA) filter; early intubation using cuffed tube; video laryngoscopy; T-piece for neonates or bag-mask device with HEPA filter and tight seal before intubation; and mechanical CPR devices for adolescents who meet height and weight criteria.
  • Consider the appropriateness of starting and continuing resuscitation, depending on patient’s goals of care.

The interim guidance also discusses situation- and setting-specific considerations for out-of-hospital, in-hospital and maternal cardiac arrest and neonatal resuscitation. For newborns, who usually are born in hospitals, the guidelines continue to stress that “Every newly born baby should have a skilled attendant prepared to resuscitate, irrespective of COVID-19 status.”

It is not clear whether newborns are infected or likely to be infectious when mothers have suspected or confirmed COVID-19. However, providers are urged to don personal protective equipment to protect themselves from potential aerosolization from the mother.

Local adaptation should be made on the basis of current disease burden and resource availability.

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