Risks of pandemic H1N1 2009 influenza (swine influenza) during cardiopulmonary resuscitation (CPR)

Survival-linX Solutions has received several enquiries about the risks of pandemic H1N1 2009 influenza (swine influenza) during cardiopulmonary resuscitation (CPR ).  We have recently updated all our life support trainers with the most recent recommendations provided by the Resuscitation Council (UK) for management of patients with suspected pandemic H1N1 2009 influenza requiring cardiopulmonary resuscitation. 

The Resuscitation Council(UK) have provided a  statement which provides specific guidance for healthcare workers (HCWs) on CPR in healthcare settings for patients with suspected or confirmed pandemic H1N1 2009 influenza.- please visit http://www.resus.org.uk/pages/cprH1N1.htm. Further advice is available from The Department of Health.

Overview of recommendations for suspected Pandemic H1N1 2009 Influenza during CPR (applicable to the prehospital healthcare setting) – NB this advise does not replace local/regional policy/procedure (if provided).

The minimum PPE requirements to assess a patient start chest compressions and establish monitoring of the cardiac arrest rhythm, are a surgical facemask, plastic apron, and gloves.
 
Recognize cardiac arrest by looking for absence of signs of life, and absence of normal breathing. Feel for a carotid pulse if trained. Do not listen and feel for breathing by placing your ear and cheek close to the patient’s mouth. If there are doubts about the diagnosis of cardiac arrest, the default position is to start chest compressions until help arrives.
 
Start compression-only CPR. Avoid mouth-to-mouth ventilation and the use of a pocket mask during CPR.
 
If, as is highly likely, the patient is already receiving oxygen therapy using a face mask, leave the mask on the patient’s face during chest compressions.
 
Defibrillate shockable rhythms rapidly - early restoration of a circulation may prevent the need for airway and ventilatory support.
 
 
If full PPE is not worn then the HCW should be assessed by the local Occupational Health Department to determine whether post-exposure prophylaxis (PEP) is required.
 
Airway interventions should be carried out by experienced individuals: techniques include bag-mask ventilation, use of supraglottic airway devices and tracheal intubation. Individuals should use the airway skills for which they have received training. For many HCWs this will mean a two-person bag-mask technique with the use of an oropharyngeal airway.
 
Dispose of, or clean, the equipment used during CPR, following manufacturer’s instructions and according to local guidelines. Any work surfaces on which airway and resuscitation equipment has been placed will also need to be cleaned according to local guidance. 
 

Remove PPE safely to avoid self contamination and dispose of clinical waste bags with care; follow this with hand hygiene.