The Taskforce received feedback from hospital and community representatives citing a hesitation to commence resuscitation of people in cardiac arrest during the COVID-19 pandemic, stemming from concerns about infection risk for responders. There was a clear need to provide healthcare providers, healthcare workers and members of the community with clear, national consensus guidance on resuscitation principles during the COVID-19 pandemic and key changes in the management of cardiac arrest.
The flowcharts are intended to guide healthcare providers and healthcare workers so that they feel confident, supported and are prepared for the situation where a person with COVID-19 arrests in a hospital, primary care clinic or aged care facility. The guidance in the flowcharts will ultimately impact patients who are likely to have better outcomes if resuscitation efforts are not delayed.
The flowchart is intended for members of the public who are trained first responders so that they feel confident to commence resuscitation on people who arrest at home or in the community during the COVID-19 pandemic.
People who arrest are likely to have better outcomes if resuscitation efforts are not delayed.
In collaboration with the Infection Control Expert Group (ICEG), the Taskforce established a dedicated Cardiac Arrest Working Group with membership spanning Australian experts in emergency care, intensive care, anaesthetics, infectious diseases and retrieval. The working group drew on the infectious diseases and infection prevention and control expertise provided by ICEG.
A series of video conferences were held with the Working Group from June to September 2020 to consider existing guidance on CPR during the COVID-19 pandemic (national and international) and to develop an agreed set of national recommendations.
The Taskforce consulted broadly to ensure that the national guidance would be acceptable to all Taskforce member organisations while remaining consistent with national guidance on the use of Personal Protective Equipment (PPE) during the pandemic.
This guidance is for members of the public who are trained first responders. It was developed in collaboration with the Australian Resuscitation Council.
If you’ve done Basic Life Support (BLS) training and are willing to jump in to help save a life, then don’t hesitate. Our advice is to call for help, start chest compressions if you’re willing to do so, and get someone to fetch a defibrillator if one is handy.
The same DRSABCD principles apply during the COVID-19 pandemic with only a couple of modifications if you are concerned about getting COVID-19 from the person in arrest.
Points of difference if the person may have COVID-19:
The key message is to maximise staff safety but do not delay resuscitation.
Ongoing resuscitation involves aerosol-generating procedures and therefore contact, droplet & airborne precautions are required. Any first responders who do not have appropriate PPE must leave the area before any additional resuscitation techniques commence.
Preparedness of health care providers is critical. This means ensuring that the wishes of patients and their family in terms of treatment plans and advanced care directives are documented, understood and communicated; health care workers receive life support training incorporating PPE use; and resuscitation equipment is readily available together with appropriate PPE.
The Taskforce flowcharts contain consensus recommendations from resuscitation experts across Australia, representing metropolitan, regional, rural and remote settings. The guidance was developed with broad consultation, incorporating input from government, consumers and healthcare workers in hospitals, primary care and aged care facilities and all member organisations of the Taskforce. The flowcharts were developed in partnership with ICEG and are consistent with national advice regarding PPE.
The flowcharts have been developed with end users in mind, and are printable in A3 (healthcare setting flowcharts) and A4 (community flowchart) formats.
Unlike other guidelines, the Taskforce undertakes weekly surveillance for new evidence relating to areas of contention (such as whether chest compressions pose a risk with regard to disease transmission) and is committed to regular flowchart updates that reflect current knowledge.
Membership of the Working Group included experts in emergency, intensive care, anaesthetics and retrieval, representing metropolitan, regional, rural and remote settings across Australia. The flowcharts were developed in partnership with the Infection Control Expert Group (ICEG) providing specialist infectious diseases and infection prevention and control expertise, and have also drawn heavily from the basic and advanced life support guidance issued by the Australian Resuscitation Council.
In addition, existing CPR and infection control guidance from each of the following bodies was discussed by the Working Group and taken into consideration when developing the flowcharts:
There is currently very little experience in Australia of CPR for paediatric patients with COVID-19.
Guidance is different for children where, often, a parent or carer is the first responder and will have been exposed to the infected child already and will be more willing to resuscitate without hesitation. Whereas early defibrillation and compression-only CPR is advised for adults with confirmed COVID-19, defibrillation is rarely indicated for children and rescue breaths are essential.