- Hospitals are already discussing new resuscitation protocols for critically ill patients with COVID-19 who may experience cardiac arrest as their case worsens.
- Some healthcare professionals are seeking universal do-not-resuscitate orders for coronavirus patients, which could prevent infection by medical personnel and other patients, as well as freeing up personnel and retaining valuable protective equipment.
- Performing CPR on a COVID-19 patient requires a team of doctors and nurses, as well as personal protective equipment, which could delay the response.
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We are less than 10,000 patients from an incredibly sad milestone for the new coronavirus: 500,000 confirmed cases. By the time countries around the world finish reporting Thursday's statistics, we will have exceeded that number by several thousand people. More than 22,000 people died fighting COVID-19 disease. The staggering 353,000 active cases still need medical attention. That means many of them will require regular hospitalization or check-ups at home. Most people who get the new disease may not experience severe symptoms, and most people will recover and develop some immunity to the new virus. But it is the elderly and people with other health problems who are most likely to experience life-threatening cases of COVID-19. They will need oxygen, ventilators, and an ICU bed. And some of them can suffer cardiopulmonary arrest, which turns out to be a big problem not only for the patient whose heart has just stopped, but for the entire team that needs to perform CPR and for other patients.
Except for a do not resuscitate (DNR) order, all hospitals are required to do whatever it takes to save a patient who is coding. But applying the usual CPR maneuvers to a patient infected with the new coronavirus will be problematic due to the nature of these procedures. When a person codes in a hospital, an entire team rushes to perform various maneuvers in an effort to restart the heart and stabilize the patient. But a COVID-19 patient needs to be treated differently. He or she could infect doctors and nurses trying to perform CPR and endanger the lives of all other patients. This is because the drops containing the virus could spread everywhere in the room during CPR. The virus is highly contagious and can survive for days on surfaces.
That's not the only problem with COVID-19 patients who are coding. Doctors and nurses should get into protective gear as quickly as possible to prevent infection, before rushing to save the patient. By the time they reach someone who codes, that person could be beyond saving. In addition, the more COVID-19 patients experience cardiac arrest, the more resources will be consumed, and hospitals are quickly running out of protective equipment.
That is why several hospitals in the US USA They are already considering universal orders not to resurrect, The Washington Post reports, which could simplify logistics, especially in hot areas where hospitals have to deal with an increasing number of serious cases of COVID-19.
Northwestern Memorial Hospital in Chicago is an example where a general DNR order for COVID-19 is being considered. The hospital would still have to seek help from Illinois Governor J.B. Pritzker on the matter to see if state law can allow such a policy change. Richard Wunderink, one of the hospital's intensive care medical directors, said that the medical condition of critically ill patients with COVID-19 generally experiences a steady decline, not sudden accidents. That gave doctors time to discuss the risk of resuscitation with families and how the need to wear protective gear reduces the chances of saving someone's life. Many family members have agreed to sign DNR orders.
George Washington University Hospital has had similar conversations, but they still resuscitate all COVID-19 patients at the moment. Their solution is to use a plastic sheet to create a barrier between the patient and the doctors. They have also been reducing the number of people caring for a patient who is coding.
The report notes that other hospitals, including Atrium Health in the Carolinas, Geisinger in Pennsylvania, and Kaiser Permanente regional networks are also seeking guidelines that could allow doctors to override the patient's or family's wishes. But they would stop imposing a DNR on all coronavirus patients. Doing nothing, on the other hand, runs counter to everything medical professionals have been taught. But hospitals will soon have to devise clear policies on how to deal with CPR in critically ill patients with coronavirus while ensuring that first responders are not infected.
Many hospitals are considering a new protocol for deciding whether or not to resuscitate a patient, devised by bioethicist Scott Halpern of the University of Pennsylvania. He says two doctors, including the one caring for the patient and the one who is not, must sign the orders not to resuscitate. They would have to document the reasoning and the family must be informed, but it is not mandatory that they accept.
If there is a key conclusion to all of this, it is that everyone can help hospitals not have to make such drastic decisions. The longer we stay home and avoid contact with others, the faster we will flatten the curve and give doctors and nurses more time to save their patients, including the people they will eventually code.