Background
Key intervention strategies of the COVID-19-specific adult BLS guidelines and updates | |
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Precaution strategies to reduce healthcare providers’ risks from SARS-CoV-2 | Resuscitation strategies to reduce healthcare providers’ exposures to SARS-CoV-2 and provide timely care |
• Relieve initial resuscitation personnel with providers wearing appropriate PPE [12] | |
• Doff all PPE safely, avoiding self-contamination after CPR [3] | |
• Clean, disinfect, or dispose of all the used equipment and nearby surfaces according to local guidelines after resuscitation [3] | |
Education strategies for healthcare providers to minimize the potential risks of SARS-CoV-2 transmission | Specific additional resuscitation strategy updates include |
• Undergo self-directed web-based e-learning and virtual skill e-training [10] | • Defibrillate as soon as possible if healthcare providers are wearing appropriate PPE for AGPs [5] |
• Learn to self-protect against CPR equipment and procedure-related infections [10] | |
• Learn to use CPR-related equipment or procedures [10] | |
• Practice CPR procedures with consideration for using PPE [10] |
Do’s of the COVID-19 adult BLS guideline protocols to reduce exposures to SARS-CoV-2 | Don’ts of the COVID-19 adult BLS guideline protocols to avoid protocol deviations and errors |
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Start CPR without donning appropriate transmission-based precautionary PPE [10] | |
Practice hand hygiene [17] before donning appropriate PPE | |
Use minimum airborne-precaution PPE or droplet-precaution PPE [10] if unavailable | Delay in early defibrillation [11] due to AED retrieval delay or changing an old battery with poor functional quality |
Check and attempt to clear the patient’s airway [3] in proximity and/or touch the patient’s body fluids or discharge | |
Listen and feel near the patient’s mouth to check for breathing [3] in proximity | |
When no cervical spine injury is suspected, open the airway with a head-tilt/chin-lift [3] maneuver | Perform mouth-to-mouth or mouth-to-nose rescue breathing [10] |
Provide positive pressure ventilation without wearing appropriate PPE [3] | |
Perform BVM ventilation without a HEPA filter between the mask and the bag [10] | |
Perform BVM ventilation by a single rescuer with a single hand holding the mask, resulting in inadequate sealing, and another hand squeezing the bag [3] | |
Continue chest compressions if exhausted or if the rescuer develops “CPR-induced over-performing syndromes,” such as shortness of breath, hyperventilation, and chest pain [23] | |
Touch the mucosae of the eye, nose, and mouth with a hand during the doffing of used PPE [40] | |
Doff all the used PPE in the appropriate sequence and apply hand hygiene after CPR [3] | Discard used disposable PPE in an open bin without disinfection |
Clean and disinfect appropriately all the used BLS-related equipment [3] | Forget to clean and disinfect the environment [16], such as the used BLS-related equipment, the bio-waste bin, and/or the surfaces and air in the CPR room |
Current evidence of CPR-associated SARS-CoV-2 aerosol transmission
The COVID-19-specific adult BLS guideline strategies for chiropractors and other healthcare providers
Precaution strategies
Resuscitation strategies
Prioritizing defibrillation
Prioritizing oxygenation and ventilation
Emphasizing the high quality of chest compression-only CPR
Optimizing chest compression rate, depth, recoil, and fraction
Attenuating the impact of wearing PPE on the quality of manual chest compression-only CPR
Education strategies
Transitioning to the COVID-19 BLS web-based e-education and e-training
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“Infection prevention and control in the context of COVID-19,” available at https://openwho.org/courses/COVID-19-IPC-EN.
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“COVID-19: How to put on and remove personal protective equipment,” available at https://openwho.org/courses/IPC-PPE-EN.