When the pandemic hit in early 2020, health care organizations scrambled to find ways to deliver care to patients while keeping their workers as safe as possible. The American Heart Association (AHA) took the lead in developing guidelines for the delivery of basic and advanced life support to patients with suspected or confirmed COVID-19 and updated that guidance over the ensuing months as conditions on the ground changed and new information surfaced on what worked and what didn’t.
The latest guidance, which was spearheaded by the AHA’s Emergency Cardiovascular Care Committee and Get With the Guidelines-Resuscitation Adult and Pediatric Task Forces, was published on Oct. 13 by Circulation: Cardiovascular Quality and Outcomes. The AARC collaborated on the document along with the American Academy of Pediatrics, American College of Emergency Physicians, American Society of Anesthesiologists, and the Society of Critical Care Anesthesiologists.
Former AARC President Brian Walsh, PhD, RRT, RRT-ACCS, RRT-NPS, RPFT, AE-C, FAARC, represented respiratory therapists in the development of the guidance.
A unique and valued perspective
“Since the COVID pandemic started we have been actively following the literature to monitor for best practices,” said Dr. Walsh. “As one can imagine, the literature has matured as the pandemic as gone on. This has led us to evaluate the latest guidelines through the lens of the pandemic to see where the modifications should be made or where the guidelines hold true.”
The AHA requested that the AARC provide a liaison to help ensure a multidisciplinary approach to the guideline creation, he continued, noting that the organization seeks to develop expert committees to advance cardiovascular health for all and recognizes the expertise of respiratory therapists in achieving that mission.
“By being at the table we provide a unique and valued perspective,” said Dr. Walsh. “Our role is instrumental in furthering the cause.”
Dr. Walsh believes these are the key take-aways for respiratory therapists from the new guidance —
Risk reduction to the health care provider — COVID-19 vaccines and associated boosters.
Timely care while reducing exposure to the provider.
- Proper PPE
- Limit exposure to unprotected providers while not delaying care.
COVID-19 resuscitation strategies.
- For agonal breathing, consider passive oxygenation until a HEPA-filtered BVM can be provided.
- Ventilate with a HEPA-filtered BVM or mechanical ventilator.
- Ensure the highest first pass intubation, if required.
- Minimize ventilator circuit disconnects.
The latest document is the third iteration of AHA guidance on basic and advanced life support for patients with suspected or confirmed COVID-19 since the pandemic began, but is it not likely to be the last. Brian Walsh advises RTs to stay tuned.
“The interim guidelines are identified as best practices by a multidisciplinary group of experts to date and will continue to provide a wonderful guidance until further research identifies otherwise or becomes the standard of practice,” he said. “The group continues to monitor the research available and will issue updates as necessary.”
Please take some time to read the 2021 Interim Guidance to Health Care Providers for Basic and Advanced Cardiac Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19.
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