UKH

Assuming there's going to be a background of Corona infection in the population for some while to come, what would be considered best practice in the event that one encountered a situation where CPR needed to be administered? 

Is there any firm consensus on the balance of not exposing the potential administer to the possibility of infection against the probability of death for the administee?

Assuming a mouth guard from a 1st Aid Kit isn't available, would there be any merit in trying to fashion some sort of barrier - say a t-shirt across the mouth - or would this be a waste of time?

Best just to give chest compression and leave out the rescue breaths. 

On the last course (biker down) I did the advice was to drop the breaths and just Do compressions. The logic being that it would still get some air in, most people would be put off breaths anyway due to snot, blood etc. and it meant that people would go ahead and do something rather than nothing..

There's people at a much higher level on here than me but this is a good place to start:

https://www.resus.org.uk/media/statements/resuscitation-council-uk-statemen...

(Updated four days ago)

The resus council advices is good.

In summary.

- If at all worried that the danger from Covid-19 infection is too high (will be a personal desision) wait for the professionals in PPE. Remember look after yourself first then casualty.

- Compression only CPR and cover casualties face to catch any aerosols.

-  Step away when the professionals get there as they my preform aerosol generating procedures.

- Remember to clean hand etc after.

I last did a first aid training about 10 years ago, even than the advice was that compressions alone were an acceptable alternative if you didn't have a mask (or mouth guard) available.

Was just about to post that link myself.  They're rather sitting on the fence: 'If there is a perceived risk of infection...attempt compression only CPR'

I always have a mouth-to-mouth shield in my wallet, although I'm not sure how much virus protection that might give (in a real, messy CPR situation, I doubt it'd be very much).  I think this is probably one of those things you would need to decide for yourself, at the time. 

For me, the small chance that the patient might have it, along with the small chance that it would affect me very much even if I did get it*, balanced against the real advantage of rescue breaths alongside CPR**, means I would most probably go ahead, but others will certainly find that assessment leads them to a different conclusion.

* I'm 99% certain I've already had it, which tips me even further to giving the rescue breaths

** varies massively - rescue breaths are much more important if it's a suffocation-type situation like drowning, rather less so if it's a cardiac arrest where the blood was well oxygenated before the heart stopped

The guidance and protocols for Mountain rescue etc are on the government page I've linked to previously. 

Essentially it's still DRABC. From my reading :

0) if you don't have PPE, consider end of life protocols. Wear goggles / faceshield, masks and waterproofs. Double glove. 

0.1) keep kit several metres away from patient. 

0.3) keep bystanders away as far as possible

0.5) if someone wise is already performing cpr, do not take over. Coach from the side lines of you are qualified to do so. 

1) Do not work from the head end, but only from the side

2) looks for signs of breathing, but not not get your face close to the casualty to feel for breathing or look down body line. 

3) Cover patients face/nose with a towel or if available, surgical mask. Turn face away from rescuer. 

3.5) compressions only at the normal rate. Only one rescuer, do not swap in/out. Get defib on ASAP if available. 

4) no rescue breaths, either mouth to mouth with or without protection (face shield/pocket mask) or ventilation using bvm or supraglottic airway. No high flow oxygen

5) no suction, use natural drainage only if casualty is sick. 

6) let pros take over when they arrive. Move away and do not try to assist. 

7) be very careful with doffing processes and clean  as soon as possible 

If I've got something wrong, please do correct me. 

Thanks all. The Resuscitation Council statement seems straightforward enough. I'd like to think I'd be willing to give breaths in the unlikely event that I actually needed to, but it's good to know that compressions alone are considered okay.

Id give rescue breaths to my family, if im confident they aren't c19+. Anyone else, not so much. You are potentially getting a massive viral load.

The survival chances of someone having b had cpr are fairly low. From about 4%, depending on what was used and when. That means that it is not unlikely the patient will die. I'd very carefully consider the benefits of doing rescue breaths vs the risks to you. 

Some years ago I had to do CPR/Mouth to mouth for real. The poor bloke had a mouth full of vomit. Plus, he was known to have psoriasis although I was subsequently assured that it's not infectious

Not a pleasant experience. Sadly the chap died.

Even in hospital we don’t do chest compressions unless in full PPE. Chest compressions generate a fair bit of air movement and you will be less than one meter away which ever direction you face. 
 Mouth to mouth with any emergency mouth cover is I think a no. 
We only ventilate by any means when in full kit . Yes to leads on and defibrillate If appropriate and if you are an advanced responder . 
I think it’s down to your judgment if out of hospital , but essentially you could receive a huge viral load. 

If it's a bog standard arrest, there's no point doing the breaths as there's enough O2 in the blood already, your job is to keep the organs oxygenated by doing CPR until an emergency crew can get there.

Also, you are not obliged to do anything, especially if you think that will put you in danger.

I'll admit it's been a few years since I did a first aid course and I probably wouldn't be the first person you'd want trying CPR on someone.

However if someone was literally dieing on the floor in front of you and CPR would likely save them it seems reasonable to take the chance. 

The odds will vary depending on the exact situation and people involved but typically the odds of a random person having CV19 are fairly low and the odds of a fit and healthy person dieing from a Covid19 infection are extremely low, the odds of both happening are tiny. When compared to the near certain death of someone who's in need of CPR the risk to ones self seems insignificant in my view.

No one has mentioned the more recent update to first aid training, the much wider availability of community defibrillators.  Assuming you are not completely in the middle of nowhere most villages have one and most towns have several. 

Easy to read poster here based on this advice.

https://www.lbc.co.uk/hot-topics/coronavirus/cpr-during-the-covid-19-pandem...

Unfortunately, cpr does not 'Likely save people' . Sadly, most people still die. At best it's a holding pattern until defibrillation and then advanced/ hospital intervention. 

Survival chances statistically drop something about 10% per minute.

I think that you have also made the error of thinking that the events of c19-wellness and recovery are unrelated, please correct me if in wrong. Only when the events are unrelated can you combine them like you have. The risks of large viral load from cpr to rescuer are known . Large viral load leads to much worse outcomes.  C19 is a systemic disease and will probably accentuate any underlying health conditions, such as heart disease. 

The resus council have changed their guidelines and the first responders such MREW etc have also changed their protocols. This is why we are not being asked to do rescue breaths etc, to only do cpr with PPE. 

V handy of its close by. Trying to find the buggers and access them can be an issue.  Probably adds about 12%-20% to survival chances... Up from about 4% of cpr only. 

A fair point I guess, I'd still say in most cases it would be worth the risk for most people.

Like I said though the odds will vary depending on the people involved. If the casualty was suffering CV19 symptoms prior to collapse and the person doing CPR was 70 with health conditions then maybe the odds would not stack up.

Obviously it can be your choice. All I ask is people really consider the guidelines seriously. 

I deleted a previous reply because it was a bit unnecessary, didn't fancy turning a genuine post into another argument, haven't had to do CPR since the COVID-19 guidance came in, and quite honestly, still a student and there's far, far more qualified people on here than me.

However, whatever you seem to be convinced of regarding risk, the Resus Council, various NHS trusts and ambulance services are not going to change their guidelines like this without good reason.

Resus council are advocating compression only cpr with a tea towel over the head, yours or the patients

The reality of community cardiac arrests is that less than 5% will survive and make a good recovery to an independent standard of living. If the cardiac arrest is secondary to respiratory failure or sepsis then the chance of recovery drop pretty much to zero.

Up to you to weigh that up against whether you take the risk of potential exposure to a high viral load of Covid.

I had this very situation last night with a mother and son combo. It's more common than you think and very sad to see.

A 70 year old male doing CPR is as effective as you could imagine, but you do the best you can in a horrible situation for your family no matter how old you are.

As for a cardiac arrest in a Post Corona Virus world, please assume that all cardiac arrests are Covid19 related because A&E road staff do.

If you do step up to the plate, understand that doing chest compressions alone will expell particles into the air around your head. And those particles will most likely have the Corona virus among them. The virus will enter your body through your eyes, nose and mouth.

Placing a cloth over the face will stop the larger sized body fluids leaving the casualty however the cloth will NOT Stop the particles that you can not see but will be in the air around your head.

If you want to crack on, then every credit for trying, however if you have reservations about attempting CPR then there is no shame in that and I would never question or judge your actions.

Is it worth trying the defib without chest compressions or is that futile?

Pretty much similar to the list you have
. 
Additional: Where appropriate and available use a rescue mask to limit any aerosol dispersion from the casualty (but do not use for rescue breaths)

4. Interesting it talks about 'no high flow oxygen' if you are using O2 on an arrest it is to fill the reserve bag on the BVM...its indirect so flow rate has nothing to do with what the casualty gets (in ventilation however the problem is the ventilation pressure being damaging to the tissues in the lungs.



 

Worth a try.

The out of hospital arrest:  
'compressions only' has long been advised for bystander CPR as the outcomes are BETTER and is certainly the case (exposure risk) now regardless of whether you 'think' breaths will help...
(numerous papers: all typically meta analysis, with the std measure for survival rate as hospital discharge, consistently show Bystander 'Chest only' ~ 11% 'Chest and Rescue breaths' ~9%...those ratios from 1 paper as example but pretty typical .. So basically they have a poor survival outcome out of hospital e.g. ~10% survival (as we know early AED is critical) there a is ~20% improved outcome in compressions only over Compressions and breaths. (all this is a lot lower i.e. below 5% where early defib is delayed). (The main exception  is drowning and  Kids who benefit from a kick start on the their SATS).

Reasons:
a) Coming off the chest is more deterimental (we know good quality chest compressions and early defib are the key) than the marginal gains in oxygenation from expelled air rescue breaths (17% expelled 02 versus 24% from BVM versus 100% from BVM with Cylinder 02 and The increase in CO2 of expelled air to 4% makes breaths hypercarbic and hypoxic.)
b) Bystander rescue breaths with and with and without a rescue mask are generally poor quality (casualty's are rarely from Laerdral school of anatomy)

So basically no hero breaths ...its worse.

compressions until the defib is on...off the chest for it to analyse  and when shock advised and then straight back on the chest unless shock successful...is what you are aiming for ...but as cpr isn't the thing that will bring them back defib only is not without merit

As lemming says...no shame in not attempting cpr...unless you have it pre-wired in your head and response doing it and dealing with an often inevitable unfavourable outcome can be difficult. 

Hi Simon

SLSGB  use o2 direct into pocket mask, or direct into igel. We don't use bvm, As the training overhead to be good with lay responders was felt to be too high.

Not sure if that makes a difference, but think it would as there is constant flow out of or across patient face, and obviously  with a pocket mask or igel used this way nothing really happens too much unless you breathe into casualty too. 

Please don't just rely on the defib.  CPR is a massive part of the chain of survival.  Perhaps you get an AED on straight away but perhaps it doesn't convert or maybe the patient re-fibrillates.  If you can apply quality CPR as much as possible then it gives the patient the best possible chance of survival.  CPR and defibrillators go hand-in-hand.  

Performing chest compressions to increase the chance of success with a defibrillator went out a long time ago. If you have one , and I guess your talking about out of hospital arrest , then use it . It is the only thing that will save someone with VF. 
For someone with a none shockable rhythm, CPR then thinking about why they have it and doing something about it is the course of action.  But , as ALS guidelines say , don’t unless you are sure the patient does not have Covid. 
Chest compression only CPR places you at risk. 
Any airway device ( later posts ) massively increases your risk. We only do it in full kit. That’s the recommendations. 

(yeah operator on BVM is a drill skill)
ah interesting on flow though...  i guess you are mainly dealing with submersion/drowning so a constant 02 flow will help get those sats up in lieu initial rescue breaths? Then anything else is a bonus.

I have the choice not to put myself and my family at risk. As a first aider and not a professional the outcome of the patient isn't my only concern.  My training was very clear that we start by assessing risk to ourselves and that in some circumstances starting CPR isn't the right thing to do.  

I can't say what choice I would make if it actually happened because unlike others on here I don't deal with this stuff on a daily basis.  

However I think it is useful to have these discussions without the stress of being in the situation.  

We're dropping all airway work in line with MREW; I tried to describe what we used to do previously.  O2 into pocket mask and then rescue breaths too. Or the same with I gel. Sorry if I wasn't/am not  clear. 

Initial rescue breaths were done in conjunction with the o2. I think mostly it was the kit list problem and training problem. What can we carry on our back when they're are just two lifeguards and one may be rescuing the patient from the water.

For now, I we can save the 5kg tin the bad as no need for cylinder. 

That's wat they advise now anyway I think.