Introduction
Roughly 12 percent to 19 percent of COVID-positive patients demand hospital access, and around three to six percent become critically unhealthy. Hypoxemic respiratory collapse secondary to acute respiratory distress, myocardial infarction, ventricular arrhythmia, and shock are some of the most common amongst critically unwell patients and lead them to cardiac arrest, just as do a few of the suggested therapies, such as Hydroxychloroquine or Azithromycin, that has the potential to prolong the heart functions. With infections rising exponentially throughout the world, the rate of patients with cardiac conditions, as well as COVID-19, is assumably going to increase.
Healthcare professionals are at the highest risk of contracting COVID-19. The risk is compounded by shortages of PPE or personal protective equipment. Resuscitations harbor an added threat to healthcare professionals for good reasons. The administration of basic life support implicates achieving innumerable aerosol-generating strategies, including chest contractions, positive-pressure ventilation, as well as installation of an advanced airway. During those processes, viral particles may stay hovered in the air with a half-life of one hour and be inhaled by those nearby. Resuscitation measures demand countless providers to work close to one another and the patient. These are high-stress crisis events in which the primary needs of the patient demanding resuscitation can result in reversals in infection-control conventions.
What Are the General Principles for Resuscitation in Pediatric Patients With Suspected and Confirmed COVID-19?
There are several principles to be taken into consideration for resuscitation in pediatric patients who are confirmed with or suspected of COVID-19, and a few of them are mentioned below.
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Healthcare professionals must save themselves, as well as their colleagues, from unwarranted disclosure. Those healthcare professionals who are exposed or who contract COVID-19 may decrease the strained workforce that is open for answering and add additional strain in case they become critically sick.
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The procedure of intubation holds an elevated risk of aerosolization in case the patient is intubated with the help of a cuffed endotracheal tube along with a connection to a ventilator that has a HEPA or high-efficiency particulate air filter in the same path as that of exhaled gas or an inline suction catheter. However, the result of a closed circuit carries a much lower risk of aerosolization than any other kind of positive-pressure ventilation.
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Basic life support (BLS) is a high-intensity team effort that requires and diverts the rescuer’s attention from any other patient. The risk to the health care clinician’s team is duly increased, and resources may be profoundly much more limited, especially in areas that are encountering a high burden of disorders. The outcomes of cardiac arrest in patients suffering from COVID-19 are yet unknown. The mortality for critically unwell patients with COVID-19 is also on the rise with increasing age and comorbidities, such as cardiovascular disease. Thus, it is fitting to assess the patient’s age, comorbidities, as well as the severity of illness in accurately determining the appropriate resuscitation and to balance the likelihood of any possible success against the potential risk for the rescuers along with the patient from whom these resources are being diverted.
Resuscitating pediatric patients with suspected or confirmed COVID-19 can be challenging. But, by taking appropriate precautions and following standard procedures, healthcare providers can help to ensure that these patients receive the best possible care.
What Are the Situation Considerations for Resuscitation in Pediatric Patients With Suspected and Confirmed COVID-19?
Several considerations and situations need to be taken into consideration to accurately resuscitate pediatric patients who are suspected of or have been confirmed with COVID-19. Mentioned below are a few such considerations.
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Bystander basic life support has consistently improved the likelihood of survival from cardiac arrest, which decreases every minute that BLS or basic life support is delayed.
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Rescuers in the vicinity are unlikely to have any access to acceptable personal protective equipment. Therefore this can put them at an increased risk of exposure to COVID-19 during BLS as healthcare providers who are with adequate safety pieces of equipment.
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Rescuers who are old and may also have the presence of any comorbid conditions such as heart disorders or diabetes mellitus are at an increased risk of becoming critically unwell in case they are infected with COVID-19 or severe acute respiratory syndrome.
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Rescuers may additionally perform chest compressions as well as consider mouth-to-mouth ventilation, in case they are willing to or can since the incidence of respiratory arrest in pediatric patients is higher.
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During mouth-to-mouth life support, it is recommended to place a cloth or barrier between the rescuer and the pediatric patient’s nose since this may reduce the risk of transmission of COVID-19 or any other airborne disease, though this may only lead to a little aid in the same.
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In case the return of spontaneous blood circulation has not been successfully achieved even after appropriate resuscitation aid in the field, one must consider not transferring the patient to the hospital since there is a low likelihood of survival for the pediatric patient. This is done keeping in mind the balance against the added potential risk of exposure to healthcare providers at the hospital.
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Since defibrillation is not normally expected to be a very highly aerosolizing technique, the rescuers must use an automated external defibrillator, in case it is available, to assess as well as treat patients with any kind of cardiac arrest.
It is important to note that these are just some of the situational considerations that should be taken into account when resuscitating pediatric patients with suspected or confirmed COVID-19. The specific considerations will vary depending on the individual patient's circumstances.
Conclusion
Healthcare professionals must protect themselves, as well as their colleagues, from any sort of unnecessary exposure to COVID-19. Exposed healthcare providers who contract COVID-19 may decrease the number of professionals available at the hospital who are available to respond to pediatric patients. Therefore, it is exceptionally crucial for healthcare professionals and individuals to first save themselves for the betterment of society from COVID-19 and then make a wise decision as to which BLS procedure to use for attending the pediatric patient.
