Considering the challenge of the Covid-19 pandemic,
is there a need to adapt the guidelines for basic life support resuscitation?
The world is facing a pandemic involving the Covid-19. One potential Certain medical interventions currently used by out of hospital consequence of such crisis is the possibility of contamination of a team in our network, such as BVM and intubation (in 70% of cases in bystander or a rescuer during resuscitation. Indeed, early cardiopul- our network), may generate aerosol that can allow airborne monary resuscitation (CPR) is a key factor in out-of-hospital cardiac transmission to those closely involved in the procedure. arrest (OHCA). Careful execution of infection control measures is necessary with The risk of COVID-19 transmission outbreak may impact personal protective equipment (PPE) (fluid-resistant gown, gloves, negatively the willingness of laypersons to provide bystander eye protection, full face shield) and it is probably desirable to favor cardiopulmonary resuscitation (CPR), just like for other viruses such disposable BVM. as HIV, SARS, MERCOV or EBOLA.1 Hand hygiene must be performed after the reanimation. Alcohol The rate of resuscitation by layperson in the Northern French Alps hand gel is recommended if soap and water is not available. Emergency Network is close to 40% each year and this rate could drop In conclusion, we believe that clear guidelines for the protection of dramatically with the epidemic.2 bystanders and rescuers are crucial in the context of this pandemic, ILO/WHO have provided guidelines for first responders in case of and that their impact should be evaluated using existing OHCA public health emergency (https://www.ilo.org/wcmsp5/groups/pub- registers. lic/—ed_protect/—protrav/—safework/documents/publication/ wcms_633233.pdf), however there is a lack of guidelines for resuscitation performed by laypersons. As much as possible, we may recommend first responders not to Conflicts of interest perform rescue breaths or mouth-to-mouth ventilation, limiting themselves to chest compressions only, particularly on an unknown None declared. victim, even if the cause of the OHCA is primary respiratory arrest. Concerning rescuers, because of the heightened awareness of the possibility that victim may have COVID-19, to recognize cardiac arrest REFERENCES
they should not listen or feel breathing by placing their ear and cheek close to the patient's mouth. Taking into account the possibility that the victim may carry 1. Christian MD, Loutfy M, McDonald LC, et al. Possible SARS coronavirus COVID-19, rescuers should not listen or feel breathing by placing their transmission during cardiopulmonary resuscitation. Emerg Infect Dis 2004;10:287 93. ear and cheek close to the patient's mouth in order to recognize 2. Ageron FX, Debaty G, Gayet-Ageron A, et al. Impact of an emergency cardiac arrest. medical dispatch system on survival from out-of-hospital cardiac arrest: Moreover, in the current guideline, lay rescuers are recommended a population-based study. Scand J Trauma Resusc Emerg Med to use mouth-to-mouth ventilation (MMV), while healthcare profes- 2016;24:53. sionals provide bag-valve-mask ventilation (BMV) in a 30:2 ratio for 3. Perkins GD, Handley AJ, Koster RW, et al. European resuscitation adult patients in the absence of an advanced airway, with and without council guidelines for resuscitation 2015: section 2. Adult basic life supplementary oxygen.3 support and automated external defibrillation. Resuscitation 2015;95:8199. The MMV realization shouldn’t be recommended in the current context. Dominique Savarya,b,* Other devices like the mouth-to-face-shield ventilation or mouth- a Département de Médecine d’Urgence, Centre Hospitalier to-pocket-mask may seem more reasonable because they prevent Universitaire d’Angers, Université de Santé d’Angers, 4 rue Larrey, contact with the victim, but we lack perspective on the efficacy and 49933 Angers Cedex 9, France safety. RESUSCITATION 152 (2020) 50 51 51
b UNIV Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset, Alexis Descatha Institut de recherche en santé, environnement et travail UNIV Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset, UMR_S1085, CAPTV CDC, F-49000 Angers, France Institut de recherche en santé, environnement et travail UMR_S1085, CAPTV CDC, F-49000 Angers, France François Morin Département de Médecine d’Urgence, Centre Hospitalier * Corresponding author at: Chef de service des Urgences, Universitaire d’Angers, Université de Santé d’Angers, 4 rue Larrey, Département de Médecine d’Urgences, Centre Hospitalier 49933 Angers Cedex 9, France Universitaire, 4 rue Larrey 49100 ANGERS, France. E-mail address: dsavary74@gmail.com (D. Savary). Marc Fadel Occupational Health Unit, Poincaré University Hospital, AP-HP (Paris Received 18 March 2020 Hospital) UVSQ, Garches, France
Pierre Metton http://dx.doi.org/10.1016/j.resuscitation.2020.03.010
J.C. Richard Réanimation Médicale, Centre Hospitalier Universitaire d’Angers, Université de Santé d’Angers, 4 rue Larrey, 49933 Angers Cedex 9, France
Use of High-Flow Nasal Cannula Oxygen Therapy To Prevent Desaturation During Tracheal Intubation of Intensive Care Patients With Mild-to-Moderate Hypoxemia
