Guidelines
Cardiac Arrest

Cardiac Arrest

Interior Health Code Blue Algorithm in the setting of suspected or confirmed COVID-19

Note: local protocols may differ at sites depending on prevalence of disease

"In IH, the use of a plastic drape will not be dissuaded nor endorsed at this time. The BCCDC recommendation is to only cover the patient airway – listed as BVM and filter OR clear plastic OR surgical face mask"

BCCDC Guidelines, March 31 2020

Initial Approach:

  • Review MOST and COVID status/risk assessment and communicate to team

  • COVID positive, suspected, or cannot be determined: treat as AGMP with airborne precautions

  • COVID negative or unlikely : use surgical mask, eye protection, gloves as per standard

  • Maximum of 4-5 people (e.g. code team leader, airway operator, 2 RNs, and one RT)

  • Initial responders can attach patient to monitor, start IV and check glucose

  • Apply surgical/procedure mask to patient and start compressions only CPR

  • Do not assist respirations

  • Apply either:

    • 6-10 L/min non-rebreather (NRB) mask
    • OR bag valve mask with high efficiency hydrophobic filter (DO NOT ASSIST RESPIRATIONS WITH BVM) and remove patient surgical mask if present
  • Follow ACLS protocols- early defibrillation may prevent need for intubation

  • Avoid AGMPs where possible

  • Consider early intubation per COVID airway management guideline (pause compressions during intubation)

  • Prolonged resuscitation not recommended

  • If arrest was unwitnessed, consider possible futility and early termination

  • Apply either:

    • 6-10 L/min non-rebreather (NRB) mask
    • OR bag valve mask with high efficiency hydrophobic filter (DO NOT ASSIST RESPIRATIONS WITH BVM)
  • Follow ACLS guidelines

  • Avoid AGMPs where possible

  • Consider transfer to a negative pressure room for intubation if stable for transfer vs. emergent intubation in current room

  • Communicate with receiving unit regarding disposition and timing if appropriate

  • Avoid CXR/ECG until in receiving unit

  • Team to doff PPE with a spotter and then don new PPE prior to transfer as PPE assumed heavily contaminated

  • Ensure all contaminated equipment is either cleaned or disposed of

  • Ensure a clear path to receiving unit

  • Negative pressure room preferred or private room if possible

  • If code occurs in a multiple occupancy room, ensure curtains are pulled around remaining patients

  • If code occurs in open area, document all staff and patient names to submit to infection control