#15,165
One of the realities of life during a pandemic is that the standards of care normally afforded in our society to people in medical distress can change - even for those who are not infected with the virus. Hospitals are going to be overwhelmed, ICU beds will be in short supply, and hospital staff and 1st responders are going to be overworked and spread very thin.
To put it bluntly, this is a very bad time to have a heart attack, get into a car accident, need dialysis or cancer treatment, or suffer any sort of acute medical emergency.Previously we've looked at standards of care concerns in:
JAMA: A Framework for Rationing Ventilators & ICU Beds During the COVID-19 Pandemic
HHS ASPR-TRACIE: COVID-19 Crisis Standards of Care Resources
Contemplating A Different `Standard of Care'Yesterday, multiple media outlets in New York City reported that local EMS will no longer `work' a cardiac arrest on the way to the hospital. If an adult cardiac arrest patient cannot be revived on the scene, they will be pronounced dead by the EMS team, and a mortuary removal service will transport the body.
This report from NYC PIX II:
New EMT directive limits some hospital transports as NYC hospitals fill with COVID-19 patients
Posted: 5:39 AM, Apr 02, 2020
Unlike on TV and in the movies, most unwitnessed, out-of-hospital cardiac arrests don't survive. And many of those that are `revived' initially end up dying hours or days later. Even inside a hospital, a good outcome following a cardiac arrest is far from guaranteed.
With hospital Emergency Departments clogged with the sick, the injured, and the worried well - there simply aren't enough resources available to devote to what is probably a lost cause.And if the cardiac arrest patient is infected with the virus, doing a full `code' on them at the hospital will likely aerosolize their virus and could infect many others. Not only would a large portion of the Emergency Department become contaminated, so would the EMS rig that transported the patient, which would take both out of service for decontamination.
Recently, the American Heart Association released new guidelines on doing CPR and resuscitation of suspected or known COVID-19 patients. Similar concerns were raised in the following BMJ (British Medical Journal) report published late last week:
Despite the risks and the low probability of success, I personally would not hesitate to do CPR on a loved one in cardiac arrest, but I would probably opt for a `safer' procedure, such as depicted in the graphic below. First, calling for help, then doing compressions only, while placing some kind of cloth barrier lightly over the nose and mouth of the victim.
Covid-19: Doctors are told not to perform CPR on patients in cardiac arrest
BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m1282 (Published 29 March 2020)
Elisabeth Mahase, Zosia KmietowiczAuthor affiliations
Healthcare staff in the West Midlands have been told not to start chest compressions or ventilation in patients who are in cardiac arrest if they have suspected or diagnosed covid-19 unless they are in the emergency department and staff are wearing full personal protective equipment (PPE).
The guidance from the University Hospitals Birmingham NHS Foundation Trust says that patients in cardiac arrest outside the emergency department can be given defibrillator treatment if they have a “shockable” rhythm. But if this fails to restart the heart “further resuscitation is futile,” it says.
(Continue . . . )
Despite the risks and the low probability of success, I personally would not hesitate to do CPR on a loved one in cardiac arrest, but I would probably opt for a `safer' procedure, such as depicted in the graphic below. First, calling for help, then doing compressions only, while placing some kind of cloth barrier lightly over the nose and mouth of the victim.
During a pandemic, our standards of care will inevitably decline, particularly for some critically ill patients. We can take some solace from the fact that even had they been afforded full medical interventions, many would not have survived.
But the reality is, some salvageable patients will be lost to this pandemic - not because they were infected with the virus - but because of the pandemic's strain on our healthcare system.
But the reality is, some salvageable patients will be lost to this pandemic - not because they were infected with the virus - but because of the pandemic's strain on our healthcare system.
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