Monash Health, Melbourne, VIC.
Monash University, Melbourne, VIC.
Med J Aust. 2020 Aug;213(3):126-133. doi: 10.5694/mja2.50699. Epub 2020 Jul 12.
The global pandemic of coronavirus disease 2019 (COVID-19) has caused significant worldwide disruption. Although Australia and New Zealand have not been affected as much as some other countries, resuscitation may still pose a risk to health care workers and necessitates a change to our traditional approach. This consensus statement for adult cardiac arrest in the setting of COVID-19 has been produced by the Australasian College for Emergency Medicine (ACEM) and aligns with national and international recommendations.
In a setting of low community transmission, most cardiac arrests are not due to COVID-19. Early defibrillation saves lives and is not considered an aerosol generating procedure. Compression-only cardiopulmonary resuscitation is thought to be a low risk procedure and can be safely initiated with the patient's mouth and nose covered. All other resuscitative procedures are considered aerosol generating and require the use of airborne personal protective equipment (PPE). It is important to balance the appropriateness of resuscitation against the risk of infection. Methods to reduce nosocomial transmission of COVID-19 include a physical barrier such as a towel or mask over the patient's mouth and nose, appropriate use of PPE, minimising the staff involved in resuscitation, and use of mechanical chest compression devices when available. If COVID-19 significantly affects hospital resource availability, the ethics of resource allocation must be considered.
The changes outlined in this document require a significant adaptation for many doctors, nurses and paramedics. It is critically important that all health care workers have regular PPE and advanced life support training, are able to access in situ simulation sessions, and receive extensive debriefing after actual resuscitations. This will ensure safe, timely and effective management of the patients with cardiac arrest in the COVID-19 era.
2019 年冠状病毒病（COVID-19）的全球大流行造成了全球范围内的严重破坏。尽管澳大利亚和新西兰受影响的程度不如其他一些国家那么严重，但复苏仍可能对医护人员构成威胁，需要改变我们的传统方法。这份针对 COVID-19 背景下成人心脏骤停的共识声明是由澳大利亚急诊医师学院（ACEM）制定的，与国家和国际建议一致。
在社区传播水平较低的情况下，大多数心脏骤停并非由 COVID-19 引起。早期除颤可挽救生命，且不被认为是产生气溶胶的程序。单纯胸外按压心肺复苏术被认为是一种低风险的程序，可以在患者的口鼻被覆盖的情况下安全地开始。所有其他复苏程序都被认为是产生气溶胶的程序，需要使用空气传播个人防护设备（PPE）。平衡复苏的适当性和感染的风险非常重要。减少 COVID-19 医院内传播的方法包括在患者的口鼻上覆盖毛巾或口罩等物理屏障、适当使用 PPE、尽量减少参与复苏的人员数量，以及在有条件时使用机械胸外按压设备。如果 COVID-19 严重影响医院资源的可用性，必须考虑资源分配的伦理问题。
本文件中概述的变化需要许多医生、护士和护理人员进行重大调整。至关重要的是，所有医护人员都应定期配备 PPE 和高级生命支持培训，能够进行现场模拟训练，并在实际复苏后接受广泛的汇报。这将确保在 COVID-19 时代安全、及时和有效地管理心脏骤停患者。
