In response to the emergence of the highly transmissible Omicron variant of SARS-CoV-2, the American Heart Association (AHA), working with the American Academy of Pediatrics, the American Association for Respiratory Care, the Society of Critical Care Anesthesiologists, and the American Society of Anesthesiologists, have issued updated interim guidance for basic and advanced cardiac life support in adults, children, and neonates with suspected or confirmed SARS-CoV-2 infection.

“Based on evolving epidemiologic reports, emergence of new and more transmissible strains of the coronavirus, declining vaccine effectiveness, as well as recent feedback from the healthcare provider community, it became clear that the guidance developed in the spring of 2021 and published in October 2021 needed to be updated to emphasize fully protecting healthcare providers who perform resuscitation,” the guideline panel says.

The updated “2022 Interim Guidance to Health Care Professionals for Basic and Advanced Cardiac Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19,” was published online January 24 in Circulation: Cardiovascular Quality and Outcomes.

Updates in the interim guidance focus on three tenets:

1. Incorporating the most recent CDC and WHO guidance
   All healthcare providers should wear a respirator (e.g., N95) along with other PPE (gown, gloves, and eye protection) for patients with suspected or confirmed COVID-19 infection when performing aerosol-generating procedures (AGPs) or in a setting where such procedures are regularly performed.

   This includes wearing appropriate PPE (including a respirator) before performing the components of resuscitation that are aerosol-generating, which include but are not limited to chest compressions, defibrillation, bag-mask ventilation, intubation, and positive-pressure ventilation.

   In the event initial responders are not already wearing appropriate PPE, they should immediately don it and then begin CPR.

    

2. Reinforcing resuscitation best practices
   Cardiac arrest survival is dependent on early initiation of CPR, and performing chest compressions as soon as it is safely possible is recommended. Patients with confirmed or suspected COVID-19 should receive the best resuscitative efforts possible.

    

3. Ensuring adequate PPE supply
   Effective use of PPE is critical for the safety of healthcare providers performing resuscitations, and at this time, all healthcare providers should be following appropriate precautions and should have access to PPE in all clinical settings, regardless of the potential of encountering resuscitation events.

   This updated guidance reflects recommendations issued recently from both the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC).

“Healthcare professionals are paramount to the health of communities around the world, especially during a pandemic, and they should be protected while performing healthcare procedures, including resuscitation,” Dianne Atkins, MD, pediatric cardiologist and lead author of the new interim guidance, said in a news release.

“Protecting the health and safety of healthcare professionals remains critical and includes ensuring the recommended personal protective equipment is available and that healthcare professionals are trained to use it properly,” added Atkins, who chairs the AHA emergency cardiovascular care committee.

This research had no specific funding. Disclosures for the guideline panel are available with the original article.

Circ Cardiovasc Qual Outcomes. Published online January 24, 2022. Full text

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