Basic Life Support & Advanced Life Support Communique during the COVID-19 Pandemic
Basic Life Support &
Advanced Life Support Communique during the COVID-19 Pandemic
AHCSA | BLS & ALS Communique during the COVID-19 Pandemic 1
Basic Life Support and Advanced Life Support; Communique during the COVID-19 Pandemic
Introduction The current COVID-19 pandemic has caused a high level of concern to health care workers and the wider
community, with ongoing uncertainty and variation in practice around the world concerning the optimal
clinical approach to resuscitative procedures in known or suspected COVID-19 patients.
In the context of Primary Health Care (PHC) clinics, be they metropolitan, rural or remote based, there is
another dimension outside of hospital settings that adds further or amended considerations.
The danger to the first responders and Health Care team is the risk of potential transmission of the virus
during resuscitative procedures, hence the critical importance of the use of Personal Protective Equipment
(PPE) and an awareness of the potential of generating aerosols in using supportive treatments.
The Key aim is to provide basic resuscitation as per recommended guidelines, with adaptions to mitigate
risks.
Key Points The Australian Resuscitation Council, 2020, has issued a communique from ANZCOR (Australian and New
Zealand Committee on Resuscitation) in regard to CPR in present pandemic situation; https://resus.org.au/
Their key message is that underlying principles for CPR remain the same:
Any Attempt at Resuscitation is better than No Attempt.
What has changed with this COVID-19 pandemic is the risk to rescuers.
Healthcare workers should be provided with appropriate PPE to perform their roles.
Note, many sudden cardiac arrests occur in the presence of family members, and many will be
unrelated to COVID-19. For lay rescuers who are unable or unwilling to do rescue breathing,
compression only CPR is acceptable.
After any attempts at resuscitation, please adhere to current advice about hand washing, cleaning
and decontamination
Key Considerations for both Basic Life Support (BLS) & Advanced Life Support (ALS) The question posed in many approaches is to ascertain if resuscitation is appropriate.
The considerations for such action will vary greatly from situation to situation and is a decision made by the health care team with full knowledge of each situation.
Aerosol generation: Chest compressions, assisted ventilation, and advanced airway manoeuvres
are all considered potentially aerosol-generating procedures, and should only be performed by
responders in airborne PPE (P2/N95 mask, gown, gloves, eye protection, hair covering)
Defibrillation is not considered an aerosol-generating procedure and can be performed by
responders wearing droplet precautions (surgical mask, gloves, gown, eye protection) as long as the
patient’s mouth and nose are covered and no chest compressions
As cardiac arrest is a time-sensitive condition, where delays to treatment reduce the likelihood of a
good patient outcome, an alternative approach is to perform defibrillation prior to donning
personal protective equipment if the arrest is witnessed and a defibrillator is immediately available,
and the patients mouth, and nose are covered
Thorough preparation in being prepared in responding to cardiac arrest situations, should include
access to full PPE gear in responder packs and on Emergency trolleys, including hand wash.
Consider permitting time for donning before you get to an out of clinic response. The opportunity
to don appropriate PPE prior to arrival at the scene will minimise delays to response.
AHCSA | BLS & ALS Communique during the COVID-19 Pandemic 2
Basic Life Support Defined: The preservation of life by the initial establishment of, and/or maintenance of, airway, breathing,
circulation and related emergency care, including use of an AED (ARC, 2020).
DANGER: the key danger is to the first responder and the need to protect themselves from potential cross
contamination in performing BLS. The main risk in transmission is in aerosol generating procedures which is
likely to be limited in the initial response.
Use of PPE as available. First responders should be wearing at least a surgical mask, eye protection
and gloves.
Consider placing a mask (or cloth) over the face of the person being attended to
RESPONSE: check for Response from a distance
SEND FOR HELP: Minimise the number of responders/persons in the room/close vicinity. Any available
bystanders should support maintaining necessary infection control measures where possible.
BREATHS: no rescue breaths with the exception for children, the Advanced Paediatric Life Support (APLS)
recommendation is that due to the most common scenario that hypoxia precipitates a cardiac arrest,
effective ventilation is a priority.
In contrast to the advice in adults in the out-of-hospital setting, APLS recommends that in the current
COVID-19 pandemic, health care professionals and lay rescuers who are willing, trained and able to do so,
should continue to deliver rescue breaths to children in addition to chest compressions. If rescuers are
untrained or unwilling to perform rescue breaths, chest compression only CPR is preferable to no CPR
(APLS, 2020)
COMPRESSIONS: only, exception for children to include breaths as above
DEFIBRILLATION: attach and follow instructions (see table) or insert flowchart reference
POST RESUS CARE: including adhering to all cleaning and disinfecting recommendations
BASIC LIFE SUPPORT
DANGER Protection of responder is priority
Don PPE
RESPONSE Look for response
SEND for Help
Send for Help
Limit the number of persons
Provide infection control support measures
AIRWAY Check and observe
BREATHING No rescue breaths (except for children)
COMPRESSIONS START CPR 30 compressions
Continue until responsive or other decision as directed
DEFIBRILLATION Attach Defibrillatorand follow instructions
POST RESUS CARE
Equipment requirements: If using pocket masks ensure availability of disposable filters
AHCSA | BLS & ALS Communique during the COVID-19 Pandemic 3
Advanced Life Support Defined: The provision of effective airway management, ventilation of the lungs and production of a
circulation by means of techniques additional to those of BASIC LIFE SUPPORT. These techniques may
include, but not be limited to, advanced airway management, vascular access/drug therapy and
defibrillation (ARC, 2020).
DANGER: As described in BLS regarding use of PPE, considerations must made in regards to aerosol
generating treatments.
Health care workers are encouraged to become familiar with and adhere to local guidleines which describe
the PPE that should be worn for aerosol generating procedures as per expert recommendations . The ideal
appropriate PPE for all resuscitaions that involve chest compressions , is a P2/N95 mask, gown, goggles,
gloves and hair covering
CPR: Compressions only with exception of children, as per APLS recommendations
ATTACH MONITOR DEFIBRILLATOR:Proceed as per recommnded Guidleines (ARC guidleines)
AIRWAY: The risk associated with aerosol-generating procedures (AGPs) should, where practical be
minimised and the following recommendations considered:
Preferentially allocating the most experienced clinician to manage the airway Do not attempt to clear the airway using any methods other than head tilt or chin lift Suctioning of the airway should not occur through an open suction device (i.e. Yankauer sucker)
until in an appropriate room with airborne PPE. A supraglottic airway (i.e. LMA) is preferred to a face mask, as it is thought to reduce the risk of
aerosols Pause compressions before inserting a supraglottic airway or attempting to intubate Recognising that a cuffed Endotracheal tube (ETT) is preferable to a supraglottic airway (LMA),
which is preferable to Bag Valve Mask Ventilation (BVM)
VENTILATION:
If using BVM, a two person technique with an oropharyngeal airway, is recommended as an option to increase the seal and minimise aerosol production
Addition of appropriate viral filters on all airway devices inclusive of Bag Valve Mask, Supraglottic airway or ETT where available and as close to the patient as possible. Take care to ensure that all connections are secure and consider the use of reinforcing tape.
ADVANCED LIFE SUPPORT COVID-19 considerations for COVID-19 suspected or confirmed case
CPR Compressions only (exception for children)
MONITOR/DEFIBRILLATOR Attach and follow algorithim
AIRWAY Minimising aerosol generation as practical and contextual
VENTILATION Minimising aerosol generation as practical and contextual
Continue CPR Follow ALS algorithim
POST RESUS
Equipment requirements: HME filters as a minimum
AHCSA | BLS & ALS Communique during the COVID-19 Pandemic 4
References Advanced Paediatric Life Support, 2020. APLS Statement on Paediatric Ewesuscitaion during the COVID-19
Pandemic. Accessed https://apls.org.au/
Australian College of Emergency Medicine. Adult Cardiac Arrest Managemen. Accessed.
https://acem.org.au/Content-Sources/Advancing-Emergency-Medicine/COVID-19/Resources/Clinical-
Guidelines/Adult-Cardiac-Arrest-Management
Australian Resuscitation Council, April 2020. Resuscitation during the COVID-19 Pandemic, accessed
https://resus.org.au/World Health Organisation. 2020 Modes of transmission of virus causing COVID-
19:implications for IPC precaution recommendations.
Couper K, Taylor-Phillips S, Grove A, Freeman K, Osokogu O, Court R, Mehrabian A, Morley P, Nolan JP, Soar
J, Berg K, Olasveengen T, Wychoff M, Greif, R, Singletary N, Castren M, de Caen A, Wang T, Escalante R,
Merchant R, Hazinski M, Kloeck D, Heriot G, Neumar R, Perkins GD on behalf of the International Liaison
Committee on Resuscitation.
COVID-19 infection risk to rescuers from patients in cardiac arrest.
Consensus on Science with Treatment Recommendations [Internet] Brussels, Belgium: International Liaison
Committee on Resuscitation (ILCOR), 2020 March 30. Available from: http://ilcor.org
WHO reference number: WHO/2019-nCoV/Sci_Brief/Transmission_modes/2020.2 Accessed
https://www.who.int/news-room/commentaries/detail/modes-of-transmission-of-virus-causing-covid-19-
implications-for-ipc-precaution-recommendations
BASIC LIFE SUPPORT COVID-19 considerations for COVID-19 suspected or confirmed cases
Dangers? Protection of responder is priority
Responsive? Look for response
Open Airway Check and observe
Normal Breathing? No rescue breaths (except for children)
Attach Defibrillator (AED) Follow instructions
Send for help Limit the number of persons
Provide infection control
Continue CPR until responsiveness or normal breathing occurs and provide post-resus care
Start CPR 30 compressions and continue until responsive
or other decision as directed
CPR for 2 minutes
ADVANCED LIFE SUPPORT COVID-19 considerations for COVID-19 suspected or confirmed cases
Non-Shockable Shockable
Shock
CPR for 2 minutes
Attach
Defibrillator / Monitor and follow algorithm
Start CPR Compressions only (exception for children)
Appropriate PPE
VENTILATION: Use interventions that minimise
aerosol generation. If using BVM,
a 2 person technique with
oropharyngeal airway, is
recommended with the addition
of viral filters
Post Resuscitation Care
Return of Spontaneous circulation?
Assess Rhythm
AIRWAY: Use interventions
that minimise aerosol generation.
A supraglottic airway (i.e. LMA) is
preferred to a face mask; a cuffed
Endotracheal Tube (ETT) is
preferable to a supraglottic airway
(LMA), which is preferable to BVM