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Table of Contents
GUIDELINE
Year : 2020  |  Volume : 9  |  Issue : 1  |  Page : 3-5

Iranian heart association task force on cardiopulmonary resuscitation guidelines on the COVID-19 outbreak


1 Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
2 Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
3 Department of Internal Medicine, Firoozgar Hospital, Iran University of Medical Science, Tehran, Iran
4 Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
5 Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran

Date of Submission05-Apr-2020
Date of Decision06-Apr-2020
Date of Acceptance07-Apr-2020
Date of Web Publication24-Apr-2020

Correspondence Address:
Dr. Mohammadreza Baay
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Ave., Tehran 1996911101
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/rcm.rcm_10_20

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How to cite this article:
Barati S, Garjani K, Payandemehr P, Totonchi Z, Zanganehfar ME, Sadeghipour P, Amin A, Akhondi V, Javadi AM, Sadeghipour P, Baay M. Iranian heart association task force on cardiopulmonary resuscitation guidelines on the COVID-19 outbreak. Res Cardiovasc Med 2020;9:3-5

How to cite this URL:
Barati S, Garjani K, Payandemehr P, Totonchi Z, Zanganehfar ME, Sadeghipour P, Amin A, Akhondi V, Javadi AM, Sadeghipour P, Baay M. Iranian heart association task force on cardiopulmonary resuscitation guidelines on the COVID-19 outbreak. Res Cardiovasc Med [serial online] 2020 [cited 2020 Jun 5];9:3-5. Available from: http://www.rcvmonline.com/text.asp?2020/9/1/3/283155




  Necessity Top


Healthcare precautions during an epidemic constitute a formidable challenge that requires profound consideration. For instance, some common procedures for cardiopulmonary resuscitation (CPR) known as aerosol-generating procedures (AGPs) highly increase the risk of transmission and infection with COVID-19 in healthcare workers and treatment environments.[1]

Treating patients in need of CPR and protecting them against COVID-19 while preventing the infection from spreading to other patients and their relatives, as well as the hospital staff, require an accurate set of predictions and preparations.[1],[2]


  Objectives Top


The guidelines presented herein aim to inform healthcare workers of the prerequisites and considerations to be taken heed of during and after CPR until the end of the COVID-19 pandemic. [Table 1] the standard CPR guidelines seeking to enhance the conduct of safe CPR by all healthcare workers (if need be), and [Table 2] contains recommendations on the conduct of more secure intubation by anesthesia specialists, residents, and technicians.
Table 1: Resuscitation guidelines for patients with known or suspected coronavirus disease 2019

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Table 2: Intubation-specific recommendations for anesthesiologists

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  Target Audience Top


The exigencies of epidemic-specific care necessitate swift, but calculated changes. To that end, the present guidelines endeavor to impart the significance of such objectives to all healthcare workers involved in CPR, whether directly (e.g., physicians and nurses) or indirectly (e.g., nurse aides, technicians, infection control committee, hospital housekeepers, and security staff).


  Utility Top


  • All patients presenting with cardiorespiratory arrest to the emergency departments should be considered suspicious cases and be administered CPR on the basis of the present guidelines
  • All patients presenting with cardiorespiratory arrest to health centers, clinics, and similar treatment facilities should be considered suspicious cases and be administered CPR on the basis of the present guidelines
  • All patients needing CPR in specific or suspected wards for COVID-19 should be resuscitated in accordance with the present guidelines
  • All patients needing CPR with suspected symptoms for COVID-19 in other hospital wards should be resuscitated in accordance with the present guidelines.



  Additional Suggestions Top


  • We urge that different centers, commensurate with their equipment and human resources, apply the maximum principles of the present guidelines
  • We recommend that treatment centers' directors attach due significance to the presentation and teaching of the present guidelines, as well as other essential guides and directives, to their personnel
  • We suggest that the main table of the present guidelines be printed and placed in full view of the staff involved in the CPR process
  • We advocate “prone CPR” provided that CPR personnel have the benefit of previous experience in this regard and the situation is appropriate with a view to lessening the risk for aerosol transmission. In brief, the patient is positioned prone for cardiac compression to be applied at the midthoracic vertebrae (T7 level), between the two scapulae. Compression can be bolstered with a stiff board placed between the patient's chest and the mattress. If defibrillation is needed, one pad should be placed at the left midaxillary line and the other on the right scapula.



  Other Essential Guides Top


Next to the present guidelines, we recommend that the following guides be available in healthcare centers in order that necessary educational programs can be devised:

  • Standard CPR guidelines
  • Instructions for wearing and removing personal safety equipment
  • Handwashing tutorials.[6]


Review Committee

Majid Haghjoo, MD; Mohammad Jalili, MD; Majid Kyavar, MD; Alireza Mahoori, MD; Majid Maleki, MD; Feridoun Noohi, MD; Mohamad Mehdi Peighambari, MD; Seyed Abdolhosein Tabatabaei, MD

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Infection Prevention and Control of Epidemic-and Pandemic Prone acute Respiratory Infections in Health Care. WHO Guidelines; 2014. Available from: https://www.who.int/csr/bioriskreduction/infection_control/publication/en/. [Last accessed on 2020 Apr 04].  Back to cited text no. 1
    
2.
Resuscitation Council UK Statement on COVID-19 in Relation to CPR and Resuscitation in Healthcare Settings. Version. 2. Published; 24 March, 2020. Available from: https://www.resus.org.uk/media/statements/resuscitation-council-uk-statements-on-covid-19-coronavirus-cpr-and-resuscitation/covid-healthcare/. [Last accessed on 2020 Apr 04].  Back to cited text no. 2
    
3.
World Health Organization. Report of the WHO-China Joint Commission on Coronavirus Disease 2019. World Health Organization; 2020.  Back to cited text no. 3
    
4.
Public Health England.COVID-19: Guidance for Infection Prevention and Control in Healthcare Settings. Version 1.0. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/874316/Infection_prevention_and_control_guidance_for_pandemic_coronavirus. [Last accessed on 2020 Apr 04].  Back to cited text no. 4
    
5.
AHA Guidance for CPR, Emergency CV Care Amid COVID-19 Medscape; 23 March, 2020.  Back to cited text no. 5
    
6.
Orser BA. Recommendations for endotracheal intubation of COVID-19 patients. Anesthesia Analgesia 2020;130:5.  Back to cited text no. 6
    



 
 
    Tables

  [Table 1], [Table 2]


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Multidisciplinary Cardiovascular Annals. 2020; In Press(In Press)
[Pubmed] | [DOI]



 

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