- Hospitals are already discussing new resuscitation protocols for critical COVID-19 patients who may experience cardiac arrest as their cases worsen.
- Some healthcare professionals are looking at universal orders for resuscitation of coronavirus patients, which can prevent infection of medical personnel and other patients, as well as freeing up staff and preserving expensive protective equipment.
- Performing CPR on a COVID-19 patient requires a team of doctors and nurses, as well as personal protective equipment, which can delay the response.
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Excluding a DNR order, all hospitals must do everything necessary to save a patient who is coding. However, using the usual CPR maneuvers on a patient infected with the new coronavirus will be problematic because of the nature of these procedures. When a person codes in a hospital, an entire team rushes over to perform multiple maneuvers in an attempt to restart the heart and stabilize the patient. But a COVID-19 patient needs to be treated differently. He or she can infect physicians and nurses who try to perform cardiovascular and pulmonary movement and endanger the lives of all other patients. This is because droplets containing the virus can spread throughout the room during CPR. The virus is highly contagious and can survive for several days on surfaces.
COVID-19 patients are not the only problem coding. Doctors and nurses must get into protective equipment as soon as possible to avoid infection before rushing to rescue the patient. When they do it to someone who codes, that person can be beyond saving. The more COVID-19 patients undergo cardiac arrest, the more resources will be consumed – and hospitals are rapidly dispensing with protective equipment.
That is why several hospitals in the United States are already considering universal orders for resuscitation, The Washington Post reports, which can simplify logistics, especially in hot zones where hospitals have to deal with an increasing number of serious COVID-19 cases.
Northwestern Memorial Hospital in Chicago is one example where a blanket DNR order for COVID-19 is being considered. The hospital would still need to seek help from Illinois Gov. J.B. Pritzker on the matter to see if state law can allow such a policy shift. Richard Wunderink, one of the hospital’s medical directors for intensive care, said the medical condition for critical COVID-19 patients usually experiences stable declines, not sudden crashes. It gave doctors time to discuss with families the risk of resuscitation and how the need to use protective equipment reduces the chance of saving someone’s life. Many family members have agreed to sign DNR orders.
George Washington University Hospital has had similar conversations, but they are still resetting all COVID-19 patients at present. Their solution is to use a plastic sheet to create a barrier between the patient and the doctors. They have also reduced the number of people who shot a patient coding.
The report notes that other hospitals, including Atrium Health in the Carolinas, Geisinger in Pennsylvania and regional Kaiser Permanente networks, are also looking at guidelines that may allow doctors to override patient or family wishes. But they would stop introducing a DNR for all coronavirus patients. Doing nothing, on the other hand, is contrary to everything that doctors have learned. But hospitals may soon have to develop a clear policy on how to manage CPR on critical coronavirus patients while preventing the first responders from becoming infected.
Many hospitals are considering a new protocol to decide whether to revive a patient or not, thought by bioethicist Scott Halpern at the University of Pennsylvania. He says two doctors, including one who is caring for the patient and one who is not, should log out of non-resuscitation orders. They must document the reasoning and the family must be informed but do not have to agree to it.
If there is an important takeaway in all this, it is that everyone can help hospitals not having to make such drastic decisions. The more we stay home and avoid contact with others, the faster we flatten the curve and give doctors and nurses more time to save their patients, including people who will eventually code.