Before Performing CPR on Covid-19 Patients, It Is Important to Know the Signs and Symptoms of the Virus.

Coronavirus is an acute respiratory infection that can be transmitted from one person to another through contact or respiratory droplets from an infected person. The virus is highlycontiguous, and as the number of infected persons increase,performing CPR on Covid-19 patients is essential in preventing deaths.

COVID-19 has spread in most parts of the world affecting all major sectors. It is a pandemic that affects cultural, social and economic events all over theglobe.

It is believed that the virus came from a certain animal then transmitted to humans. When someone contracts SARS-CoV2, it will take 3-14 days for the manifestations to start appearing. Victims of this virus show flu like manifestations that range from normal to extreme.

Coronavirus patients have symptoms like dry coughs, fever, tiredness, sore throats body pains and sometimes, nasal congestion. Also, coronavirus victims may experience difficulty in breathing. Other signs of the virus are diarrhea, headaches, loss of taste and smell, blue lips and nausea.

People suffering from chronic diseases, hypertension or organ failure are at a higher risk of contracting the severe form of virus.  It is advised that you continue with your prescriptions if you have any of the mentioned conditions.

Countries have come up with diverse Corona management measures that include lockdowns, proper hygiene recommendations, social-distancing and keeping people in quarantine, both the sick and healthy.

Health workers and their assistants should make they sure they use efficient and most importantly, safe procedures when giving first aid to coronavirus patients.The coronavirus can easily infect people who come closethe infected victim.

When and How to Perform Safe Resuscitation Procedures on a Coronavirus Patient.

CPR is a medical procedure performed to remedy patients suffering from cardiac arrest. Coronavirus attacks the respiratory system causing hindrance of air supply in your body. When the covid-19 symptoms become severe, the victims find it hard to breathe.

Performing resuscitation, for example giving rescue breathes,can increase the chances of coronavirus patients surviving cardiac arrest.Some of theserious symptoms that require coronavirus victims to immediately seek medical attention are chest pains, blue like lips and difficulty in breathing.

It is impossible for the heart to pumping blood when you are unable to breath. Low oxygen supply to the brain can cause death or brain damage. That is why you shouldperform CPR on severely affected coronavirus patients to prevent them from dying.

Before starting the CPR process, you should call for medical help and if possible let them know if you suspect the person to have coronavirus.   

According to AHA reports onCPR guidelines to covid-19 patients, it is important to consider the age before administering resuscitation. Providers of both in and out of hospital resuscitation are under specific instructions to perform only the safe procedures.

On the other hand, according to the Sasson group, the first aid givers should consider whether a patient is worth saving before performing CPR on covid-19 Patients. Any bystanders who perform resuscitation procedures on patients withcoronavirus are also instructed to stick to hands-only resuscitation.

The Protective Measures to Take When Performing CPR On covid-19 Patients.

Did you know that the oxygen in human blood is enough to sustain you for up to sixty minutes? Administering CPR helps to keep someone alive because it enhances the flow of blood in the body.

Most bystanders and lay rescuers providing resuscitation procedures are not trained. Such CPR providers should perform resuscitation procedures involving only the hands and wear masks.

The safe methods to consider using during the resuscitation process are as follows;

  • Using A Proper Way to Identify If a Patient Is Undergoing Cardiac Arrest.

Do not listen to the heartbeats by putting your ear or face close to the covid-19 victim. You can detect whether the affected person needs CPR by observing if he/she is breathing abnormally.

Do not look for breathing by listening or feeling through placing your ear or cheek on the patient’s mouth. Instead, feel the victim’s carotid pulse, or an expert to do it. Another way is by calling or tapping them and seeing how they will react.

If you are sure that the person is suffering cardiac arrest, you should immediately call medical assistance and start chest compressions resuscitation.Notify the emergency response as much detail as you can remember concerning the victim including any potential manifestations of the coronavirus.

Also, if you suspect that the person might have coronavirus, you should cover your /their mouth and nose before starting the compressions.

Paramedics should carry out hands only CPR by utilizing mechanical resuscitation using devices such as the LUCASCPR machine. Such devices reduce the risk of a caregiver contracting the coronavirus when resuscitating an infected patient.

The LUCAS CPR device requires you to put it around the chest of a patient and set the compression and pressure rates. Once you do this, it can run autonomously and provide high quality chest compressions without breaks.

  • By Using Personal Protective Equipment during the Resuscitation Process.

Examples of personal protective equipment (PPE) are; masks, eye protectors, gloves, and gowns.  These are the materials that you use to prevent yourself from contracting Covid-19 when performing CPR.

After the resuscitation process, the CPR provider should remove the equipment and get rid of it appropriately. All resuscitation providers should always ensure that they have PPEbefore attending to any covid-19 victim.

Make use of protective materials and always make sure that there are no unnecessary people around the resuscitation scene.

Limiting the number of personnel around your CPR working area reduces the number of people exposed to this deadly virus. If the rescuer is new, the status of the covid-19 victim should be explained before reaching the CPR area.

  • By Following the Hygienic Practices That Help in Reducing Spreading of Coronavirus.

When performing CPR on covid-19 patients, you should be very careful not to expose yourself to the virus. One of the practices that minimizes chances of the first aid givers to contract this virus is washing or sanitizing hands after the whole process.

Typically, a high number of cardiac arrest cases occur out of hospital.If a coronavirus patient suffers cardiac arrest and nothing is done, they will die or suffer a permanent brain damage. It’s the reason they encourage performing CPR at home.

Anyone should be able perform CPR even when you are untrained. If you not trained, hands-only resuscitation will be your best option. However, a person who has CPR training will give better CPR thus increasing the survival chances of the patient.

  • By Giving Rescue Breaths alongside CPR.

Mouth to mouth resuscitation helps the victim to breath by supplying oxygen to the patient’s lungs. You should perform rescue breaths when a person stops, has shortage or difficulty in breathing.

Performing CPR together with mouth to mouth CPR helps the victim to stabilize. During the CPR process, the provider should alternatively give 30 compressions on the chest and 2 rescue breaths. The rate of the chest compressions should be 100-120 compressions in every minute.

You should repeat the above procedure until advanced health care arrives or the patient start to breath normally. After the first kiss of life, the patient’s chest should rise. If does not rise then it means that there is a hindrance in the air path of the victim.

If you realize that your rescue breaths are not unblocking the airway, then you should just continue with chest compressions.

Mouth to mouth resuscitation is risky when handling patients with coronavirus. You can easily get infected by just giving rescue breaths to a COVID-19 victim. Although for children, the interim guidance emphasized on using rescue breaths.

Procedures of Performing CPR on Children, Neonates, Adults and Pregnant Women Who Have Covid-19.

Due to recent robust resuscitation interventions, the survival rates of cardiac arrest has been high and steadyover the last 20 years. But since the outbreak and contingency nature of SARS-CoV2, the previous CPR processes need modifications.

A dilemma facing health systems and workers is how to administer CPR to SARS-CoV2 victims without exposing the rescuers tothe virus.That is why the AHA and other medical societies released the interim guidance to the rescuers perform resuscitation safely to all coronavirus victims.

CPR providers have a higher risk of contracting thisdeadlyvirus due to two main   reasons. These reasons are:

  1. The processes used to administer CPR involve many procedures that generate aerosols. Example of these procedures are chest compressions, pressure ventilation, and unblocking airways.

During such processes respiratory droplets from the victim can remain in the air and people nearby might inhale it. It is essential to note that the half-life of the virus is air is approximately 1 hour.

  1. Most resuscitation procedures requires the rescuers to keep a close distance with the patients. Chances of cross infection between the two parties is very high.

Out of Hospital Cardiac Arrest Procedures:

  • Performing CPR to adult covid-19 patients.

For OHCA Out of hospital cardiac arrest, the lay rescuers should perform only chest compressions. Considering that there less protective materials at home, the person performing CPR should cover their mouth and nose or wear a mask before starting the resuscitation.

If there is a defibrillator near you, you can use it to examine and treat patients out of hospital.

As mentioned earlier, you should give chest compressions ranging 100-120 compressions per minute. Always remember to disinfect your hands and dispose well the materials you used during a CPR procedure.

  • Administering CPR to children.

Since children are prone to respiratory arrests, rescuers should consider giving rescue breaths rather than just chest compressions. However, you should be careful not to breathe too hard into the victims instead use the pressure of their cheek sizes.

The procedure for performing chest compression CPR is same as the one for adults. What only differ is the pressure you apply, for kids the pressure should be less compared to that of adults.

Do not forget to cover your or/and the victim’s nose and mouth to prevent further chances of contracting the virus.

  • Neonatal and Maternal resuscitation.

When it comes to babies, it is very tricky to know whether they have the virus when their mothers test positive for COVID-19. Still, the health workers should wear protective equipment because the mother could be the source of the virus.

Initial neonatal resuscitation procedures like drying, examining heartbeats, electrocardiograph, and tactile stimulation are not aerosol-generating. After the delivery, avoid sucking the amniotic fluid from the airways since it is an aerosol-generating process.

Cases of amniotic fluid staining in a newborn’s airways are uncommon and that is why you can avoid suctioning process.You should use sealed incubators to provide intensive care to newborns, while observing proper distancing measures.

Pregnant women with coronavirus are more likely to suffer from acute decompensation due to physiological changes in the circulatory system. However, from the guidance, the principles of cardiac arrest for expectants remain the samefor women who have or are suspected to have coronavirus.

A Hospital Setting Cardiac Arrest Protocol for Patients with Coronavirus.

Even though they encourage out of hospital cardiac arrest resuscitation, administering CPR in a hospital will produce faster and high quality results. The resources and PPE found in a hospital are more effective and reliable compared to the ones used out of a hospital setting.

Also, using defibrillator and other resuscitation machines reduces the risks of more health workers contracting the virus. Other than spread control of the virus, these machines help promote distancing between the patient and rescuer; which is a very important aspect in fighting this pandemic.

For a pre-cardiac arrest patient, always make sure to check for any indications of health deterioration to avoid emergent intubation cases.

In case you suspect a SARS-CoV2 patient has a risk of having cardiac arrest, you should quickly move him/her to negative pressure unit. Remember to close the unit door to avoid contaminating the neighboring units by air.

In some instances, the patient may develop trouble in breathing, this calls for a medical care such as supplemental oxygen, which is often accompanied with other breathing treatments.

Administering of the oxygen must happen under controlled conditions. The patient must first undergo isolation and then they can receive the oxygen treatment according to the doctor’s recommendations.

Breathing treatments to open small blocked air passages, and/or reduce inflammation can be offered in the form of inhaled medications. If the patient recovers, they are released from the hospital or treatment center.

During the intubation process, minimize aerosol generation by putting the victim on a mechanical ventilator that is connected to a HEPA filter. Always switch off the ventilator after setting it to prevent the trigger from auto-starting due to chest compressions.

 Another thing you should not forget during intubation of a cardiac arrest patient is to adjust the rate of respiration. For adults it should be 10/min and for newborns 30/min.

Using Automated External Defibrillators (AED) On Covid-19 Victims.

AEDs are a type portable defibrillators used to revive the normal heartbeat of a person.  An AED functions by transmitting electric shocks to the heart of the patient. It is the shocks that help trigger the heart to beat in a normal way.

The good thing about these type of defibrillators is that they are available in most public places like social halls and malls. With the rapid increase cases of coronavirus, making use of such equipment to cardiac arrest victims will help save many lives.

Before you start giving first aid to coronavirus patients and using AEDs, call for help. Find the portable defibrillator and read the manual on how to use it effectively.

Most incidents of cardiac arrest are a result ofirregular heartbeats. Shocking coronavirus victims when their hearts are in an asystole mode will quickly bring their heartbeats back to normal.

AEDs come with specific guidelines that allow most users to operate them effectively even without any prior experience.  If you have some knowledge of CPR, then you can likely use an AED without incident.

During the defibrillation process, place the electrodes on the chest of the victim. The electrodes will aid in sending the shocks to the patient’s heart. When the medical help arrives, make sure you inform them if you used an AED.

Proper use of automated external defibrillators does not expose you directly to SARS-CoV2.As long as you use proper PPE and wash thoroughly after the CPR then you are unlikely to catch the virus

Ventilation and Oxygenation Strategies Which Reduce the Severity of SARS-Cov2

Proper ventilation and oxygenation are vital in ensuring survival of patients that are suffering from severe COVID-19. Accurate treatment starts with the correct diagnosis of the extent of the effect of the diseases on a patient.

Most CPR procedures involve procedures that generate aerosols. When the particles of coronavirus remain in the air, it is very dangerous because they remain alive for approximately one hour.  Intubation process is the most likely procedure to expose a person to covid-19 through aerosolization.

However, you can reduce the exposure by intubating a victim with an endotracheal tube that is cuffed then connect it to a ventilator containing HEPA sieve in the passage of breathed out air.HEPA sieves have the ability to trap virus particles within their filter system.

Ventilator come with a control interface, which contains the percentage of oxygen reaching the patient and the pressure of the air reaching the victim. Some modern ventilators allow for the recording and storage of patient statistical data.

Only highly trained medical specialists should carry out adjustments in ventilators. Such individuals can change the patient’s medication and location depending on the situation. Even though this is a critical situation, covid-19 patients can still fully recover from the disease.

You should be keen when attaching the HEPA filter and use video laryngoscopy to minimize exposing the intubator to any viral particles in the air. Since this is a sensitive procedure, ensure that you observe high levels of hygiene and sanitization.

Before starting the intubation process use a T-piece {for newborns} or a bag mask device having a firm seal and a HEPA sieve. Covering a NRFM mask that is passively oxygenated with a surgical mask will do for adults. If the intubation delays, use a manual ventilator with a bag mask equipment and HEPA filter.

Avoid any form of disconnections after closing the circuit to ensure minimal aerosol generation. To reduce the chances of failure in an intubation procedure, try to pause the chest compressions of the intubation machine.

Appropriate sedation is a necessary component of Ventilation especially during anylaryngoscopy techniques. Without sedation victims may involuntarily disconnect the ventilation tubes and mask when coughing or sneezing.

Ventilators are useful in treating the covid-19 patients, nonetheless, we need highly-trained ventilator operators to benefit from them. While we augment our inventory to supply more ventilators, we should remember that to train more operators if we want to witness its full potential.

Wrap Up.

COVID-19 is widely contiguous and as the number of the infected increase, one of the effective ways of saving lives is by performing CPR on covid-19 patients. The disease has spread in most parts of the world affecting its normal functions. It has been considered a global COVID -19 pandemic in the early stages of 2020.

As bystanders and medical professionals carry out CPR they need to be careful that they do not contract the virus. When it comes to coronavirus, prevention is the best option of avoiding the disease. By maintaining high levels of sanitizations and biosafety it is possible to care for COVID-19 patients.

Training is another critical component of any CPR procedure. Getting CPR accreditation can be an excellent way of learning how to conduct CPR on a coronavirus victim.