PHILIPPINE HEART ASSOCIATION

Council of Cardiopulmonary Resuscitation

BASIC AND ADVANCED

CARDIAC LIFE SUPPORT
for Suspected or Confirmed
Cases of COVID-19

Updated 29 March 2020 Version 1

 PHILIPPINE HEART ASSOCIATION
Council of Cardiopulmonary Resuscitation
Out-of-Hospital Cardiac Arrest and In-Hospital Cardiac Arrest
Resuscitation for Suspected or Confirmed Cases of COVID-19
Victim unconscious/not moving
Put on full PPE: on visual assessment
• N95 mask
• Goggles
• Face shield Ensure scene safety • AVOID giving rescue
• Gown breaths.
• Double gloves • AVOID bag-mask
• Hair cap ventilation.
• Booties Check for response • If already on MV, do
continuous chest
Alert EMT/code team of compressions while on MV
possible COVID-19 (SIMV or AC mode, FiO2
If unresponsive, call for help 1.0, BUR 10-12)
infection.
• If not on MV, do hands-
only CPR, consider early
DO NOT listen and feel Check for pulse and intubation then hook to
for breathing anymore. breathing MV.
*MV = mechanical ventilator

If with no pulse and no breathing or only gasping, start CPR

Hook to a defibrillator or cardiac monitor

Yes No
Is the rhythm
shockable?

Give 1 shock Resume CPR for 2 minutes, or until ALS

Resume CPR immediately for 2 minutes providers take over or victim starts to move

Defibrillate shockable rhythms

During CPR immediately (early ROSC may
• Ensure high-quality CPR: rate, depth, recoil preclude the need for airway
• Plan actions before interrupting CPR and ventilatory support).
• Give oxygen
• Consider advanced airway and capnography
• Continuous chest compressions when advanced airway in place
• Vascular access Most experienced person to
• Give epinephrine 1 mg/IV every 3-5 minutes intubate.
• Correct reversible causes

After resuscitation:
• Remove PPE as per donning and doffing instructions.
• Throw away all disposable equipment.
• Disinfect/sterilize other equipment.
• All waste should be double-bagged and taken to the COVID-19 bin by a porter.

Updated 29 March 2020 Version 1

 PHILIPPINE HEART ASSOCIATION
Council of Cardiopulmonary Resuscitation
Adult Cardiac Arrest Algorithm for Suspected or Confirmed Cases of COVID-19
Put on full PPE: N95 mask, goggles, face shield, gown, double gloves, hair cap, booties
NO PPE, NO CPR

AIRWAY AND VENTILATION

If not on mechanical ventilator (MV): CHEST COMPRESSIONS
AVOID giving rescue breaths. Perform continuous chest
AVOID bag-mask ventilation. compressions, regardless if with
Place clear aerosol box over patient’s advanced airway or not.
head if available. If patient arrests while in the prone
Consider early advanced airway 1 position, turn the patient to supine
(endotracheal tube preferred over Start CPR position then proceed with
laryngeal mask airway) then hook to MV. Give oxygen conventional CPR. Prone CPR is
In case of difficult or failed advanced Attach monitor/defibrillator reasonable only if with experience
airway placement, apply surgical and training.
mask on the patient’s nose and mouth Hook to automatic chest
and proceed with hands-only CPR. compression device if available.
If on MV:
Yes No
DO NOT disconnect from MV. Rhythm
Set MV to SIMV or AC mode, FiO2 1.0, shockable?
BUR 10-12.

2 VF/pVT 9 Asystole/PEA

DEFIBRILLATION/CARDIOVERSION
3 Shock Prefer single-use defibrillator pads
over paddles.

4
CPR 2 min
IV/IO access

No
Rhythm
shockable?

Yes

5 Shock

CPR 2 min
6 10 IV/IO access
CPR 2 min
Epinephrine every 3-
Epinephrine every 3-
5 min
5 min
Consider advanced
Consider advanced
airway if not yet in
airway if not yet in
place, capnography
place, capnography

No Yes
Rhythm Rhythm
shockable? shockable?

Yes No

7 Shock 11 CPR 2 min

Treat reversible
causes

8
CPR 2 min
Amiodarone No Yes
Treat reversible Rhythm
causes shockable?

12 If no sign of return of Go to 5 or 7
spontaneous circulation
(ROSC), go to 10 or 11
If ROSC, go to Post-
Cardiac Arrest Care

AFTER RESUSCITATION
• Remove PPE as per donning and doffing instructions.
• Throw away all disposable equipment.
• Disinfect/sterilize other equipment.
• All waste should be double-bagged and taken to the COVID-19 bin by a porter.

Updated 29 March 2020 Version 1

 PHILIPPINE HEART ASSOCIATION
Council of Cardiopulmonary Resuscitation
Tachycardia Algorithm for Suspected or Confirmed Cases of COVID-19

Put on full PPE: N95 mask, goggles, face shield, gown, double gloves, hair cap, booties

Assess appropriateness for clinical condition

Heart rate typically ≥150/min if tachyarrhythmia

Identify and treat underlying cause

Maintain patent airway; assist
breathing as necessary
Oxygen (if hypoxemic)
Cardiac monitor to identify rhythm;
monitor blood pressure and oximetry

Persistent tachyarrhythmia causing:

Hypotension? Synchronized cardioversion
Yes
Acutely altered mental status? Consider sedation
Signs of shock? If regular narrow complex,
Ischemic chest discomfort? consider adenosine
Acute heart failure?

No

Yes Yes Yes

Wide QRS Torsades de pointes/ Sustained?
Defibrillate
(≥0.12 sec)? polymorphic VT? (>30 sec)

No No No

IV access and 12-lead ECG if

IV access and 12-lead ECG if
available DISCONTINUE hydroxychloroquine/
available
Consider adenosine only if regular chloroquine and azithromycin.
Vagal maneuvers
and monomorphic DISCONTINUE other QT-prolonging
Adenosine (if regular)
Consider antiarrhythmic infusion
Β-blocker or calcium channel blocker medications.
Consider expert consultation CORRECT electrolyte abnormalities (goal:
Consider expert consultation
K+ >4.0 mmol/L and Mg+2 > 2.0 mmol/L)
Magnesium sulfate IV 1 to 2 g in D5W 50
to 100 mL over 15 minutes (range: 5 to 60
minutes); may follow with a continuous IV
*Sample magnesium sulfate infusion: infusion* of 0.5 to 1 g/hr.
Preparation: 2,500 mg MgSO4/vial x 2 vials in D5W to make 250 mL solution Consider temporary pacing (atrial or
Concentration of solution: 5,000 mg MgSO4/250 mL solution ventricular at a rate of 100 bpm)
Desired dose: 500 mg MgSO4/hr

desired dose ( mg MgSO4Τhr)

Infusion rate ሺmLΤhrሻ =
concentration of solution ( mg MgSO4ΤmL solution)

500 mg MgSO4Τhr
Infusion rate ሺmLΤhrሻ =
5,000 mg MgSO4Τ250 mL solution)

Infusion rate ሺmLΤhrሻ = 25 mL/hr

Updated 29 March 2020 Version 1