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MARCH 23, 2020 — The American Heart Association (AHA) has issued interim guidance for CPR and emergency cardiovascular care for patients with known or suspected coronavirus (COVID-19) infection to help reduce the risk for transmission of SARS-CoV-2, the virus that causes COVID-19.

“Health care providers need to focus on helping people during this challenging time and the American Heart Association is doing everything it can to make it easier,” Comilla Sasson, MD, PhD, vice president for emergency cardiovascular care science and innovation at the AHA, said in a statement.

“The information we are providing is drawn primarily from the US Centers for Disease Control and World Health Organization recommendations. It includes information about caring for patients and guidance for EMS and other first responders,” said Sasson, an emergency medicine physician at University of Colorado Hospital, Denver.

The AHA advises standard and transmission-based precautions be used when caring for patients with suspected or confirmed COVID-19. Among the specific guidance included in the three-page document:

  • When gowns are in short supply, they should be prioritized for aerosol-generating procedures, care activities where splashes and sprays are anticipated, and high-contact patient care activities that provide opportunities for transfer of pathogens to the hands and clothing of providers.

  • If possible, avoid procedures which generate aerosols, such as bag-valve mask, nebulizers and non-invasive positive pressure ventilation.

  • Consider proceeding directly to endotracheal intubation in patients with acute respiratory failure. Avoid the use of high-flow nasal oxygenation and mask CPAP or bilevel CPAP due to greater risk of aerosol generation.

  • Among the specific advice for EMS and other first responders:

  • Emergency medical dispatchers should ask callers about the possibility of COVID-19 in the patient. The query process should not supersede the provision of prearrival instructions to the caller when immediate lifesaving interventions are needed.

  • Prehospital care providers and healthcare facilities should be notified when COVID-19 is suspected in a patient requiring emergency transport.

  • EMS clinician practices should be based on the most up-to-date COVID-19 clinical recommendations and information from appropriate public health authorities and EMS medical direction.

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