Cardiopulmonary Resuscitation in Intensive Care Unit patients with COVID-19

Cheruku, Sreekanth; Dave, Siddharth; Goff, Kristina; Park, Caroline; Ebeling, Callie; Cohen, Leah; Styrvoky, Kim; Choi, Christopher; Anand, Vikram; Kershaw, Corey

Cardiopulmonary resuscitation (CPR) in SARS-CoV-2-associated disease (COVID-19) patients poses a unique challenge to health care providers due to the risk of viral aerosolization and disease transmission. This has caused some centers to modify existing CPR procedures, limit the duration of CPR or consider avoiding CPR altogether. In this review, we propose a procedure for CPR in the ICU that minimizes the number of personnel in the immediate vicinity of the patient and conserves the use of scarce personal protection equipment (PPE). Highlighting the low likelihood of successful resuscitation in high risk patients may prompt them to decline CPR. We recommend the preemptive placement of central venous lines in high risk patients with intravenous tubing extensions that allow medication delivery from outside the patients’ rooms. During CPR, this practice can be used to deliver critical medications without delay. The use of a mechanical compression system for CPR further reduces the risk of infectious exposure to health care providers. ECMO should be reserved for patients with few comorbidities and a single failing organ system. Reliable teleconferencing tools are essential to facilitate communication between providers inside and outside of the patient's room. General principles regarding the ethics and peri-resuscitative management of COVID-19 patients are also discussed.