Guidance for Cardiopulmonary Resuscitation of Children With Suspected or Confirmed COVID-19

Author:

Morgan Ryan W.1,Atkins Dianne L.2,Hsu Antony3,Kamath-Rayne Beena D.4,Aziz Khalid5,Berg Robert A.1,Bhanji Farhan6,Chan Melissa7,Cheng Adam8,Chiotos Kathleen1,de Caen Allan9,Duff Jonathan P.9,Fuchs Susan10,Joyner Benny L.11,Kleinman Monica12,Lasa Javier J.13,Lee Henry C.14,Lehotzky Rebecca E.15,Levy Arielle16,McBride Mary E.17,Meckler Garth7,Nadkarni Vinay1,Raymond Tia18,Roberts Kathryn19,Schexnayder Stephen M.20,Sutton Robert M.1,Terry Mark21,Walsh Brian22,Zelop Carolyn M.23,Sasson Comilla15,Topjian Alexis1,

Affiliation:

1. aDepartment of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania

2. bStead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa

3. cDepartment of Emergency Medicine, St. Joseph Mercy Ann Arbor Hospital, Superior Township, Michigan

4. dGlobal Newborn and Child Health, American Academy of Pediatrics, Itasca, Illinois

5. eDepartment of Pediatrics, Division of Newborn Medicine, University of Alberta, Edmonton, Alberta, Canada

6. fDepartment of Pediatrics, McGill University, Montreal, Quebec, Canada

7. gDepartments of Pediatrics and Pediatric Emergency Medicine, British Columbia Children’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada

8. hDepartment of Paediatrics, Alberta Children’s Hospital, University of Calgary, Calgary, Alberta, Canada

9. iDepartment of Pediatrics, Division of Critical Care, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada

10. jDepartment of Pediatrics

11. kDepartments of Pediatrics, Anesthesiology & Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

12. lDepartment of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts

13. mCardiovascular ICU, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas

14. nDivision of Neonatology, Stanford University, Stanford, California

15. oECC Science & Innovation, American Heart Association, Dallas, Texas

16. pDepartments of Pediatrics and Pediatric Emergency Medicine, Sainte-Justine Hospital University Center, University of Montreal, Montreal, Quebec, Canada

17. qCardiology, and Critical Care Medicine, Northwestern University, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois

18. rDepartment of Pediatric Cardiac Critical Care, Medical City Children’s Hospital, Dallas, Texas

19. sCenter for Nursing Excellence, Education & Innovation, Joe DiMaggio Children’s Hospital, Hollywood, Florida

20. tDepartments of Critical Care Medicine and Emergency Medicine, Arkansas Children's Hospital, Springdale, Arkansas

21. uNational Registry of Emergency Medical Technicians, Columbus, Ohio

22. vRespiratory Care, Children’s Hospital Colorado, Aurora, Colorado

23. wDepartment of Obstetrics and Gynecology, NYU School of Medicine and The Valley Hospital, New York City, New York

Abstract

This article aims to provide guidance to health care workers for the provision of basic and advanced life support to children and neonates with suspected or confirmed coronavirus disease 2019 (COVID-19). It aligns with the 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular care while providing strategies for reducing risk of transmission of severe acute respiratory syndrome coronavirus 2 to health care providers. Patients with suspected or confirmed COVID-19 and cardiac arrest should receive chest compressions and defibrillation, when indicated, as soon as possible. Because of the importance of ventilation during pediatric and neonatal resuscitation, oxygenation and ventilation should be prioritized. All CPR events should therefore be considered aerosol-generating procedures. Thus, personal protective equipment (PPE) appropriate for aerosol-generating procedures (including N95 respirators or an equivalent) should be donned before resuscitation, and high-efficiency particulate air filters should be used. Any personnel without appropriate PPE should be immediately excused by providers wearing appropriate PPE. Neonatal resuscitation guidance is unchanged from standard algorithms, except for specific attention to infection prevention and control. In summary, health care personnel should continue to reduce the risk of severe acute respiratory syndrome coronavirus 2 transmission through vaccination and use of appropriate PPE during pediatric resuscitations. Health care organizations should ensure the availability and appropriate use of PPE. Because delays or withheld CPR increases the risk to patients for poor clinical outcomes, children and neonates with suspected or confirmed COVID-19 should receive prompt, high-quality CPR in accordance with evidence-based guidelines.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology and Child Health

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