[Message sent on behalf of Deputy Medical Director and Deputy Nurse Director – Acute Services 5th June 2020]
During the current pandemic there has been significant national and local debate around the risks associated with cardiopulmonary resuscitation, the balance of risks and the appropriate PPE for these circumstances and, as with all resuscitation attempts, a rapid assessment of safety should be undertaken whilst ensuring the minimum of delays to commencing CPR.
Further to the recent NERVTAG review and consensus on cardiopulmonary resuscitation by chest compressions and whether this is an aerosol generating procedure (AGP), guidance has now been published by Public Health England on 27 April 2020. This national expert group does not consider that the evidence supports chest compressions or defibrillation as being procedures that are associated with a significantly increased risk of transmission of acute respiratory infections and is not considered to be an AGP. The link to this update can be accessed here
This advice aligns with Health Protection Scotland and Public Health England and previous advice given within NHS Greater Glasgow and Clyde. The advice remains that chest compressions and defibrillation (as part of resuscitation) are not considered AGPs; first responders (any setting) can commence chest compressions and defibrillation without the need for AGP PPE while awaiting the arrival of other clinicians to undertake airway manoeuvres.
In practice this means that only chest compressions can be commenced and defibrillation undertaken (if indicated) by any first responders wearing plastic apron, gloves, fluid resistant surgical mask and eye protection. DO NOT provide any airway manoeuvres unless everyone in the room has full AGP PPE donned (surgical gown, gloves, eye protection and FFP3 mask).
We ask all colleagues within health and care to also ensure that anticipatory care plans, along with treatment escalation planning and DNACPR decision making has been undertaken as sensitively and consistently as possible for individual patients. We also ask that this involves discussions with families and carers, where applicable as well as with our patients.
We acknowledge the ongoing debate in this area and the anxiety that this can produce and we are hugely grateful for the invaluable work that you are doing and hope that this clarity is useful and supportive in that work.