2022 Interim CPR Guidance for Healthcare Professional Amid Evolving Pandemic

Dear AHA Training Network:

A guiding principle of the American Heart Association is that healthcare professionals are paramount to the health of communities, especially in a pandemic, and should be protected while performing resuscitation. Protecting the health and safety of healthcare personnel remains critical and includes ensuring the recommended personal protective equipment (PPE) is available and that healthcare personnel are trained to use it properly.

Based on evolving epidemiologic reports and emerging science, the AHA’s volunteer committee comprised of over 40 global resuscitation experts have prepared new CPR guidance to treat patients with suspected or confirmed COVID-19. The “2022 Interim Guidance to Health Care Providers for Basic and Advanced Cardiac Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19” published today in AHA’s journal, Circulation: Cardiovascular Quality and Outcomes. This new guidance updates previous interim guidance developed in the spring of 2021 that was published in Circulation: Cardiovascular Quality and Outcomes in October 2021.

Due to emerging, more highly contagious variants of the SARS-CoV-2 virus, also known as COVID-19, the new guidance emphasizes the need for protection. It states that in the event initial responders are not already wearing appropriate PPE, they should immediately don it and then begin CPR. As PPE recommendations change, healthcare providers should continue to follow the most-up-to-date recommendations from international, US, regional, and local health authorities and local institutions.

Please note this new guidance doesn’t impact CPR training.

Additional changes in the newly released guidance include:

  1. Incorporating the most recent World Health Organization (WHO) guidance: All healthcare professionals should wear a respirator (e.g. N95) along with other PPE (gown, gloves, and eye protection) for patients with suspected or confirmed COVID-19 infection, when performing aerosol-generating procedures (AGP)s or in a setting where such procedures are regularly performed. This includes wearing appropriate PPE (including a respirator) before performing the components of resuscitation that are aerosol generating, which include but are not limited to chest compressions, defibrillation, bag-mask ventilation, intubation, or positive-pressure ventilation.
  1. Reinforce resuscitation best practices: Cardiac arrest survival rates have decreased dramatically during the COVID-19 pandemic. Out-of-hospital cardiac arrest survival in 2020 also declined in regions/timeframes that did and did not have significant COVID infection rates. The reasons for this decline are both unclear and complex. Cardiac arrest survival is dependent on early initiation of CPR, including chest compressions as soon as it is safely possible. Patients with confirmed or suspected COVID-19 should receive the best resuscitative efforts possible.
  1. Ensure adequate PPE supply: At this time, all healthcare professionals should be following appropriate precautions and should have access to PPE in all clinical settings, regardless of the potential of encountering resuscitation events. Effective use of PPE is critical for the safety of healthcare providers performing resuscitations. Healthcare organizations should continue to secure appropriate PPE as available, ensure training regarding appropriate application and use of PPE, reinforce effective use of PPE, and create systems so that healthcare providers have immediate access to appropriate PPE when emergency care is required.

The AHA, a volunteer-led organization comprised of researchers, healthcare professionals, advocates, and lay persons, values the trust and confidence that healthcare professionals have in our organization. The AHA appreciates the feedback from the healthcare professional community and the opportunity to provide better guidance.

As the pandemic continues to evolve, volunteers will continually review the guidance and make updates as appropriate based on evidence at the time. Updates will continue to be provided on the AHA’s COVID-19 CPR Training and Resuscitation website.

We thank you for all that you do to contribute to our joint mission of saving lives.

American Heart Association

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