Overcoming Fears to Save Lives
2020; Lippincott Williams & Wilkins; Volume: 142; Issue: 13 Linguagem: Inglês
10.1161/circulationaha.120.048909
ISSN1524-4539
Autores Tópico(s)Disaster Response and Management
ResumoHomeCirculationVol. 142, No. 13Overcoming Fears to Save Lives Free AccessArticle CommentaryPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessArticle CommentaryPDF/EPUBOvercoming Fears to Save LivesCOVID-19 and the Threat to Bystander CPR in Out-of-Hospital Cardiac Arrest Sarah M. Perman Sarah M. PermanSarah M. Perman Sarah M. Perman, MD, MSCE, Associate Professor of Emergency Medicine, University of Colorado, School of Medicine, Academic Office 1, 12631 E 17th Ave, Aurora, CO 80045. Email E-mail Address: [email protected] University of Colorado, School of Medicine, Aurora. Originally published10 Jul 2020https://doi.org/10.1161/CIRCULATIONAHA.120.048909Circulation. 2020;142:1233–1235Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: July 10, 2020: Ahead of Print The world continues to be entrenched in the coronavirus disease 2019 (COVID-19) pandemic, which has significantly affected our daily interpersonal interactions, including community response to public emergencies that require bystander cardiopulmonary resuscitation (bCPR). For healthcare workers on the front line of COVID-19 care, our reality is a spectrum of disease that ranges from the mildly symptomatic patient to the critically ill, hypoxic, crashing patient. The public reality is stay-at-home orders or newly implemented safer-at-home plans, job losses, and coping with the illness and death of family and friends. These events predominate daily routines in this new normal, as does a profound sense of fear: fear for the community and for healthcare providers. As a cardiac arrest outcomes researcher, I fear how this viral pandemic will threaten our altruistic societal approach to helping individuals with cardiac arrest. bCPR is an essential physical maneuver proven to impart better survival and neurological recovery for individuals with cardiac arrest. CPR requires bystanders to come into close proximity with another individual, sometimes even a stranger, at a time when the message is to socially distance and fears about severe acute respiratory syndrome coronavirus 2 transmission predominate.Our generation has faced similar fears before in the community and among healthcare providers. In 1981, the US Centers for Disease Control and Prevention advised the public about a new infectious disease, initially causing pneumonia in homosexual men. This marked the beginning of the HIV pandemic, now a historical memory for many, but at the time the events shocked society and produced overwhelming fear. Misconceptions about disease transmission were prevalent, and discrimination against people living with HIV became pervasive. Exaggerated fears that touching someone with HIV might result in transmission of disease became ostracizing, and unsubstantiated fears of acquiring the disease by way of casual contact or touch became as endemic as the disease. We are all presently experiencing a similar fear, with pervasive underpinnings anchored on avoidance and anxiety. Similar to HIV, COVID-19 is heavily affecting disenfranchised communities (eg, those with low socioeconomic status, racial/ethnic minorities, those undomiciled, and others) that are already prone to poor access to health care, lower rates of bCPR, and delayed response from emergency medical services.1,2 Confounding preexisting disparities in rates of bCPR with the fear of an infectious virus that is aerosolized during CPR could have devastating results.Early findings reported from 4 Italian provinces heavily affected by COVID-19 were reported in the New England Journal of Medicine.3 Compared with the previous year, Baldi et al3 reported that the incidence of out-of-hospital cardiac arrest increased by 58%. This is in stark contrast to the provision of bCPR, which decreased by 15.6% in a region that had previously reported a bCPR rate of 47%. If we translate similar findings to the United States, where rates of bCPR are variable and neighborhoods with lower socioeconomic status observe considerably less, we will undoubtedly see a devastating effect. Data from Washington showed that in the midst of the pandemic, ≈10% of individuals with cardiac arrest responded to by emergency medical services were COVID-19 positive. Assuming a transmission rate of 10% without personal protective equipment, after treating 100 patients, 1 rescuer may become infected.4 Rates of OHCA have been increasing during COVID-19, but those arrests may not be caused primarily by the virus, and limiting bystander resuscitative measures to protect the rescuer will undoubtedly result in death caused by cardiac arrest, not necessarily COVID-19.The American Heart Association has issued an interim guideline on basic life support during COVID-19.5 Recommendations previously endorsed bCPR by the public for individuals with cardiac arrest, and in 2010 rescue breaths were removed from the basic life support algorithm in favor of a hands-only approach. That being said, even hands-only CPR can result in aerosolization of respiratory droplets and potential fomite transmission of severe acute respiratory syndrome coronavirus 2. Although evidence is sparse, current COVID-19 recommendations include taking caution while still performing bCPR. When CPR is performed on an unresponsive person, all efforts should be made to cover the face of the individual with cardiac arrest with a cloth to minimize the dispersion of respiratory droplets, and the rescuer also should have a face covering if possible for increased protection. Rescue breaths should not be provided, and the rescuer should administer guideline-concordant chest compressions and placement of an automated external defibrillator as soon as possible. Additional rescuers should remain at a distance, away from the victim's airway and face, until they are needed to assume CPR when the initial rescuer fatigues. These suggested precautions and the early data on the risk of transmission must be relayed to the public immediately, and educational programs for bCPR should be amended to include this information as a means of keeping the rescuer safe while continuing to encourage bystander provision of basic life support to save lives.Given the real and potential threat of viral inoculation perceived by the public, rates of bCPR will decline, undoubtedly resulting in more loss of life. There are many reasons why the public fears providing bCPR to an unresponsive person; the threat of contracting a deadly viral disease will undoubtedly enter the list of reasons not to render aid. Previous goals to improve rates of bCPR in the community are now in jeopardy as our new normal threatens to reduce current US bCPR rates. Declining rates of bCPR are a reality; addressing this issue before it results in more deaths or neurological disabilities is paramount. CPR saves lives. It saved lives before this pandemic, and it will save lives after this pandemic. Our task is to clearly understand the risk to operators, to train the public in best practices to maintain one's personal safety, and to allay fears once we are safe to do so (Figure). Waiting for rates of bCPR to drop is too late. We must be prepared to educate and empower rescuers in our new normal.Download figureDownload PowerPointFigure. Suggested best practices for bystander cardiopulmonary resuscitation (CPR) during coronavirus disease 2019 (COVID-19).AED indicates automated external defibrillator.DisclosuresDr Perman is supported by K23 HL138164 from the National Heart, Lung, and Blood Institute. The views expressed in this manuscript represent those of the author and do not necessarily represent the official views of the National Heart, Lung and Blood Institute.FootnotesThe opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.https://www.ahajournals.org/journal/circSarah M. Perman, MD, MSCE, Associate Professor of Emergency Medicine, University of Colorado, School of Medicine, Academic Office 1, 12631 E 17th Ave, Aurora, CO 80045. Email sarah.perman@cuanschutz.eduReferences1. Sasson C, Magid DJ, Chan P, Root ED, McNally BF, Kellermann AL, Haukoos JS; CARES Surveillance Group. Association of neighborhood characteristics with bystander-initiated CPR.N Engl J Med. 2012; 367:1607–1615. doi: 10.1056/NEJMoa1110700CrossrefMedlineGoogle Scholar2. Kleindorfer DO, Lindsell CJ, Broderick JP, Flaherty ML, Woo D, Ewing I, Schmit P, Moomaw C, Alwell K, Pancioli A, et al. Community socioeconomic status and prehospital times in acute stroke and transient ischemic attack: do poorer patients have longer delays from 911 call to the emergency department?Stroke. 2006; 37:1508–1513. doi: 10.1161/01.STR.0000222933.94460.ddLinkGoogle Scholar3. Baldi E, Sechi GM, Mare C, Canevari F, Brancaglione A, Primi R, Klersy C, Palo A, Contri E, Ronchi V, et al; Lombardia CARe Researchers. Out-of-hospital cardiac arrest during the Covid-19 outbreak in Italy.N Engl J Med. 2020; 383:496–498. doi: 10.1056/NEJMc2010418CrossrefMedlineGoogle Scholar4. Sayre MR, Barnard LM, Counts CR, Drucker CJ, Kudenchuk PJ, Rea TD, Eisenberg MS. Prevalence of COVID-19 in out-of-hospital cardiac arrest: implications for bystander CPR [published online June 4, 2020].Circulation. doi: 10.1161/CIRCULATIONAHA.120.048951 https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.048951?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmedLinkGoogle Scholar5. Edelson DP, Sasson C, Chan PS, Atkins DL, Aziz K, Becker LB, Berg RA, Bradley SM, Brooks SC, Cheng A, et al; American Heart Association ECC Interim COVID Guidance Authors. Interim guidance for basic and advanced life support in adults, children, and neonates with suspected or confirmed COVID-19: from the Emergency Cardiovascular Care Committee and Get With The Guidelines–Resuscitation Adult and Pediatric Task Forces of the American Heart Association.Circulation. 2020; 141:e933–e943. doi: 10.1161/CIRCULATIONAHA.120.047463LinkGoogle Scholar eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetailsCited By Leung K, Chu C and Lui C (2023) Exposure-response relationship between COVID-19 incidence rate and incidence and survival of out-of-hospital cardiac arrest (OHCA), Resuscitation Plus, 10.1016/j.resplu.2023.100372, 14, (100372), Online publication date: 1-Jun-2023. Husain A, Rai U, Sarkar A, Chandrasekhar V and Hashmi M (2023) Out-of-Hospital Cardiac Arrest during the COVID-19 Pandemic: A Systematic Review, Healthcare, 10.3390/healthcare11020189, 11:2, (189) Kim Y, Lee S, Lim H and Hong W (2023) Impact of COVID-19 on Out-of-Hospital Cardiac Arrest in Korea, Journal of Korean Medical Science, 10.3346/jkms.2023.38.e92, 38:12 Lim S, Toh C, Fook-Chong S, Yazid M, Shahidah N, Ng Q, Ho A, Arulanandam S, Leong B, White A and Ong M (2022) Impact of COVID-19 on barriers to dispatcher-assisted cardiopulmonary resuscitation in adult out-of-hospital cardiac arrests in Singapore, Resuscitation, 10.1016/j.resuscitation.2022.10.012, 181, (40-47), Online publication date: 1-Dec-2022. Fazel M, Mohamad M, Sahar M, Juliana N, Abu I and Das S (2022) Readiness of Bystander Cardiopulmonary Resuscitation (BCPR) during the COVID-19 Pandemic: A Review, International Journal of Environmental Research and Public Health, 10.3390/ijerph191710968, 19:17, (10968) Queiroga A, Dunne C, Manino L, van der Linden T, Mecrow T and Bierens J (2022) Resuscitation of Drowned Persons During the COVID-19 Pandemic, JAMA Network Open, 10.1001/jamanetworkopen.2021.47078, 5:2, (e2147078) Masuda Y, Teoh S, Yeo J, Tan D, Jimian D, Lim S, Ong M, Blewer A and Ho A (2022) Variation in community and ambulance care processes for out-of-hospital cardiac arrest during the COVID-19 pandemic: a systematic review and meta-analysis, Scientific Reports, 10.1038/s41598-021-04749-9, 12:1 Talikowska M, Ball S, Tohira H, Bailey P, Rose D, Brink D, Bray J and Finn J (2021) No apparent effect of the COVID-19 pandemic on out-of-hospital cardiac arrest incidence and outcome in Western Australia, Resuscitation Plus, 10.1016/j.resplu.2021.100183, 8, (100183), Online publication date: 1-Dec-2021. 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September 29, 2020Vol 142, Issue 13 Advertisement Article InformationMetrics © 2020 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.120.048909PMID: 32795100 Originally publishedJuly 10, 2020 Keywordscardiopulmonary resuscitationCOVID-19PDF download Advertisement SubjectsCardiopulmonary Arrest
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