The COVID-19 pandemic has changed the norm in most aspects of human life. The coronavirus, which started with just a few cases, has now affected millions leaving over one million others dead. Since the outbreak, researchers and health practitioners have embarked on research on how to stop the spread of the virus.
Cases of the virus are still on the rise, and anyone could be infected. Due to the nature of their work, healthcare workers are at a higher risk of transmission. Statistics by the world health organization (WHO) show that about 12% of the total COVID-19 infections are healthcare workers. Therefore, it becomes critical for these persons to take utmost precautions to avoid possible exposure to the virus. Relaxation of these measures could be a loss to the fight against the virus that has brought the world to a stand-still.
Risk of Transmission of COVID-19?
COVID-19 virus results from the SARS-CoV-2 virus and is easily transmitted among people in close contact through sneezing, coughing, talking, singing, and breathing. The transmission is through aerosol and respiratory droplet particles released from infected persons. The virus entry points are mucosal cavities such as the mouth, nose, and eyes.
- Infection is likely to occur when persons are in close contact with one meter.
- An infected person can infect as many people as they come into contact with, and these infections are also more likely to occur in crowded places where people spend a lot of time.
- The virus has a half-life of one hour, during which it remains suspended in the air with a likelihood of causing infection.
- Whenever an infected person coughs, they release the virus particles suspended in the air. These virus particles can land on surfaces and stay active for days. Anyone who touches an infected surface can transfer the virus to their mouth, eyes, and nose.
Symptoms of Coronavirus Disease
Infected persons can have symptoms, but in most cases, those infected don't show these symptoms. However, whether symptomatic or asymptomatic, they can infect others. The most common symptoms of COVID-19 patients include:
- Feeling of tiredness
- Dry cough
Other less common symptoms include:
- Rash and discoloration of toes and fingers
- Loss of smell
- Loss of appetite
- Sore throat
Some patients who develop severe symptoms experience:
- Shortness of breath
- Difficulty breathing
- Inability to talk or move
- Chest pain
From the time of infection, victims take between six and fourteen days to show symptoms.
Precautions When Giving CPR
Cardiopulmonary Resuscitation is a critical lifesaving procedure for cardiac arrest victims. However, it is high aerosol-generating procedure and can put first aid responders and health care workers at an increased risk of infection. Certain factors place healthcare workers and rescuers at an increased risk of infection:
- CPR involves teams working closely together
- The procedure is high aerosol-generating procedure
- Cardiac arrest exerts a lot of pressure on those involved and could lead to compromise to recommended standards
Covid-19 patients commonly develop cardiopulmonary arrest and cardiorespiratory problems. In these cases, the victim requires basic life support and advanced life support. Whether or not to provide Cardiopulmonary Resuscitation depends on certain factors which determine the chances of survival of the victim, such as the victim's age and underlying illnesses and health conditions.
Guidelines for Performing CPR to COVID-19 Patients
It is crucial to ensure the safety of healthcare providers while providing the utmost care to the victim. Therefore, the American heart association, alongside other bodies, has provided interim guidance when performing CPR on Covid-19 victims:
- With the prevalence of COVID-19, health care professionals are reluctant to provide CPR to cardiac arrest victims. However, it is essential to note that not every cardiac arrest victim is infected with Covid-19.
- For basic life support, prioritize chest compressions. Hands-only CPR is safer. However, health care workers should wear full personal protective equipment.
- Cover the victim's mouth and nose with a cloth or towel when performing CPR. For in-hospital cardiac arrest, Covid-19 patients should be resuscitated and defibrillated.
- Use the AED as soon as it is available to improve the in-hospital cardiac arrest outcomes among patients. Studies show that the AED doesn't increase aerosol generation.
- Don't leave anything at risk with the use of personal protective equipment. PPE is critical for healthcare providers or rescuers taking care of COVID-19 patients. Before accessing the scene, all healthcare personnel should wear the recommended PPE per the interim guidance for emergency cardiovascular care.
- Mechanical ventilation and mechanical compression devices should be used to reduce the number of health care professionals required to attend to a specific patient.
- The healthcare personnel performing resuscitation procedures and those entering isolation rooms should be minimized. It helps in the reduction of the rate of exposure to the virus.
- The AHA recommends that doors remain closed during resuscitation to minimize the spread of the virus to the surrounding space.
- New healthcare providers arriving at the scene should be made aware of the Covid-19 status of the victim. Communication should be made with all health workers working in the facility. When calling for emergency response teams, the responder should also notify them if the patient has been found to have the infection.
- To reduce aerosolizing effects, intubated patients should remain in mechanical ventilators with HEPA filters. It helps reduce the effects of aerosolization and maintains a closed circuit.
- The ventilation should be adjusted to pressure control mode. The fraction of inspired oxygen (FiO2) should also be adjusted to 0.1. The pressure should also be adjusted to allow for the necessary chest rise in adults to 6Ml/kg and 4-6Ml/kg for neonatal.
- Intubation procedures are highly aerosol generating. Therefore, the health care provider should use a cuffed endotracheal tube connected to a ventilator with a HEPA filter in the exhaled gas path and an inline suction catheter. The resulting circuit is safer and less likely to generate aerosol.
To achieve this, you need to:
- Ensure the HEPA filter is secured to the ventilation. See the device before the administration of breaths.
- After assessing rhythm and defibrillation, the patient should be immediately intubated with a cuffed tube and the endotracheal tube attached to a ventilator with a HEPA filter.
- Video laryngoscopy reduces the exposure of aerosolized particles to the incubator.
- Before intubation, consider a T piece in neonates or a bag-mask device with a tight seal and HEPA filter. For adults, use passive oxygenation and a nonbreathing mask protected by a surgical mask.
- In case of delayed intubation, use manual ventilation with a bag mask, HEPA filter, or a supraglottic airway.
- Minimize disconnections once the circuit is closed to reduce aerosolization.
The decision-making process
The decision to continue or stop resuscitation is not an easy one. At some point, healthcare workers have to make this critical decision. A lot of teamwork is required in the CPR procedure. A single case of CPR might draw attention from other patients. The coronavirus pandemic has increased the need for CPR stretching health facilities and healthcare workers beyond their capacity. The rates of deaths due to illnesses are on the rise, and some risk factors are based on age and comorbidity. Healthcare workers should assess the chances of survival of the victim as they try to determine whether or not to continue the resuscitation process.
It is important to address care needs with the patient and family. Institutions should provide guidelines and procedures to assist healthcare workers in deciding when to stop resuscitation for COVID-19 patients. The policies should be based on the risk factors and the chances of survival and communicated to the victim's family beforehand.
Covid-19 has increased the need for CPR certification. CPR classes are the best way to acquire CPR skills. Without the necessary training, pulling together the confidence required to save a life would be challenging. The quality of CPR provided determines the chances of survival of the victim.
CPR classes also provide knowledge on recognizing the signs of cardiac arrest early enough to give the required assistance and save the victim's life. Most organizations require CPR certification, especially during this COVID-19 pandemic. CPR skills are not only basic for healthcare workers but also for other professions. The skills apply in CPR are easy to follow, even for non-professionals. The training is also open for anyone interested in joining, regardless of their levels of education and age.