Hospitals Protecting Doctors form Cardiopulmonary Resuscitation Techniques Amid Corona

Cardiopulmonary resuscitation is the act of reviving a patient from apparent death or unconsciousness by administering chest compressions, rescue breaths among other complex procedures. You have to make contact with the victim to administer it—which was no problem until coronavirus came.

The coronavirus is an airborne infection that spreads through the air and when one comes into contact with an infected person’s body fluids—e.g. when they cough.

The concern for bystanders, doctors, nurses and other medical personnel now is that a willing lifesaver could accidentally contract coronavirus (if the victim was infected). So now the big question is; do we issue Cardiopulmonary resuscitation or not?

The hospitals at the forefront of dealing with the global covid-19 pandemic have indulged in heated private discussions over the best ways to go about Cardiopulmonary resuscitation. Their goal is to ensure that lifesavers are not exposed to the danger of contracting the infection while saving the lives of the patients.

This is a hard decision to make, especially by medical professionals who must operate within laws, and still protect themselves and the general public from such a contagious disease.

Sacrificing one Life to Save More?

It is not easy to choose between rescuing a dying patient and watching out for a deadly contagious disease. The catch, therefore, is to decide on whether to chip in and save a life when a patient has “coded” and stopped breathing or their heart stops or not.

Hospitals such as the Northwestern Memorial Hospital in Chicago have been working on DNR policy for all corona infected patients, regardless of anything, including the patient’s wish and their family members.

This is a hard and spraining decision, which means prioritizing the lives of many over one person’s life. While the move is agonizing for both the patients and their family members, it will is projected to ensure a more conducive working condition for the nurses and doctors in the first line in the battle against the covid-19 pandemic.

One of the medical directors in the Northwestern Memorial Hospital in Chicago, Richard Wunderink said that the hospital administration had to ask the government of Illinois whether the state law would permit the policy to be shifted.

They then contacted Governor, Gove. J.B. Pritzker, who said that. It’s a major concern for everyone. “This is something we have discussed with families, and I think they are well aware of the grave circumstances.”

Richard Wunderink also added that most critically ill corona virus patients do not get a sudden crash, but a steady decline for around twelve days. This allows the medical personnel to communicate with family members and inform them of the importance of a protective gear when attending to patients. However, this also delays the lifesaving process reducing the chances of its effectiveness.

So far, the talks ended in the painful decision to sign the ‘do-not-resuscitate’ form, which many family’s struggles with, according to Richard Wunderink.

Hospitals take Different Approaches to The Cardiopulmonary resuscitation Issue.

A similar discussion went on at the George Washington University Hospital, which sits in the same district. The officials in the hospital decided to continue to resuscitate corona virus patients with advanced procedures.

They opted to use procedures such as putting plastic sheeting over the corona virus patient who is to be resuscitated to create a barrier between the patient and the medical personnel.

Seattle is one of the corona virus hotspots in the country.  One facility in the area, the University of Washington Medical Center, has been solving the problem via ensuring that only a few responders are responding to a patient in cardiac or respiratory arrest.

Due to the risk to both doctors and nurses and the shortage reliable protective materials, several large systems in hospitals such as the Geisinger in Pennsylvania, Carolinas’ Atrium Health, and the regional Kaiser Permanente networks, are looking for guidelines that will allow both doctors and nurses to supersede the wishes of both the corona virus patients and their family members in such cases.

These conversations, are aimed at safeguarding the lives of the medical personnel, have brought together both doctors, medical experts, and ethicists.

The officials are even sharing the drafts of the policies derived by their colleagues in different medical institutions to make more informed decisions, according to the president of the Society of Critical Care Medicine, Lewis Kaplan.

“We are now on the brink of a crisis. What you take as first-come, first-served, no-holds-barred, everything-that-is-available-should-be-applied medicine is not where we are. We are now facing some difficult choices in how we apply medical resources — including staff.” Said Lewis Kaplan.

According to R. Alta Charo, a University of Wisconsin-Madison bioethicist, while withholding treatments could be disturbing, it is realistic because there will be no benefit to anyone if the doctors and nurses are affected and unable to take care of the patients.

Most doctors are not willing to participate in medical procedures that send virus-laced droplets from the airways of a patient to everywhere in the room. Such medical procedures include bronchoscopies, endoscopies, or any other procedure that involves sending a tube or a camera down the throat, which are routine in the ICUs when examining the inside of lungs or looking for bleeds.

The Dilemma & More Creative Remedies.

The elimination or changing such medical procedures is a direct cause of a decrease in survival chances to some patients. Even so, most doctors, nurses, and hospitals administration members argue that it is very necessary because it will help saving many lives at the expense of one.

One of the ICU doctors in the Midwest described resuscitation as very risk in terms of infections because it involves a lot of body fluids. She however didn’t mention her name because she isn’t authorized to speak by her hospital.

Fred Wyese, an ICU nurse in Muskegon, Michigan, describes it as a storm because a team of over eight doctors and nurses have to rush in, and in most cases they could be around thirty personnel in that room.

They then, according to Fred Wyese, start the chest compressions which are part of cardiopulmonary resuscitation (CPR), with others puncturing both the neck and the arms to put new intravenous lines to the blood cells.

Health expersts also restart the patient’s heart using several lifesaving medications, and equipment materials such as epinephrine injectors, a defibrillator, among others. A breathing tube is also placed down the patient’s throat, and is immediately hooked to a mechanical ventilator.

Soon after, a breathing tube is placed down the throat and the person is hooked to a mechanical ventilator. Even in the best of times, a patient who is coding presents an ethical maze; there’s often no clear cut answer for when there’s still hope and when it’s too late. This procedure requires a quick response and lots of protective equipment, which could be hardly done amid the covid-19 pandemic.

A chief medical officer at George Washington University Hospital, Bruno Petinaux, argues that “observing the situation from a safety position, the safest thing to do is nothing.”

 He adds that he doesn’t believe whether with the current situations it is necessary to use the right approach.

Bruno Petinaux also adds that they have chosen not to use the right approach, which is resuscitation, to corona virus patients due to the risk which could come along with it.

He states that what they are doing is what can be safely done. He also said that the decision could be based on the resources and manpower at hand in each hospital, and every hospital can evaluate itself when it comes to such decisions.

The GW is using a different approach in dealing with coding corona virus patients by using a certain machine named the Lucas Cardiopulmonary resuscitation device to deliver chest compressions.

This machine, which looks like a bumper, help to minimize the incidences of holding the patient’s body, and the hospital has only two of them which aren’t readily accessible at all times. The doctors are advised to spread a plastic sheet over the patient’s body which help in reducing the spread of droplets as they continue with the chest compressions.

Final Words

When deciding whether to maintain or eliminate the safe at all cost code, it is important for the hospital to consider its resources both now and in the near future, its number of both nurses and doctors, and its working conditions.

 This decision should be made with the keenest considerations, to avoid risking the lives of the doctors and nurses. This is because their families, the nation, and the world needs them in the fight against the covid-19 pandemic.

Medical institutions must not force their doctors and nurses to take part in such Cardiopulmonary resuscitation procedures.  The number of corona virus patients who are coding per day or week is also a great point to be considered. This is because the higher the number, the higher the risk of infection to the medical personnel while conducting the procedure.

Doctors should also be given an opportunity to give their opinions and fears, which should be well addressed. If the doctors disagree on whether to resuscitate a coding corona virus patient or not, then the process should be made optional. And those who opt to risk their lives to save a life are must be taken care throughout the medical procedures.