New Guidance Regarding Pediatric Resuscitation for Children with COVID-19

Pediatric cardiac arrest is a rare event outside of hospital settings. In the hospital, where children with serious morbidities need specialized care, it is more common. Prompt resuscitation can prove life-saving, transforming a condition that would almost inevitably be fatal into a minor trauma. But as the COVID pandemic ravages the world, pediatric resuscitation practices are changing.

Children with COVID may need to be hospitalized. Though absolute child hospitalization rates remain low, the youngest patients can suffer catastrophic health effects from COVID. About one-third of hospitalized pediatric COVID patients require ICU care, and nearly one-quarter of children with the disease who are 2 years old and younger end up hospitalized. This means a once-rare event—pediatric cardiac arrest—may become increasingly commonplace, particularly in regions where schools and other public accommodations are opening. The American Heart Association (AHA) has issued new guidance for pediatric resuscitation. Here’s what you need to know. 

Treating COVID Patients

Children with COVID are often asymptomatic and may show up at the hospital seeking treatment for other injuries. Even with a negative test result, it is still possible for a child to be a carrier. One recent study even found that asymptomatic children may carry higher viral loads, suggesting they present a heightened risk to first responders and other medical personnel. 

Resuscitation generates a high volume of aerosolized particles, making it a risky intervention that can easily spread the novel coronavirus. Even if you are low-risk for developing serious COVID complications, the other patients you see will probably not be. Exposing yourself to this lethal infection means exposing others. To reduce the risk, treat all patients as potentially COVID-positive.

Resuscitation Guidelines

The AHA makes the following recommendations for slowing the spread of COVID when you must resuscitate pediatric patients:

• Wear personal protective equipment, including face masks and eye protection, before entering the room. 
• Minimize the number of personnel present for resuscitation. 
• Prioritize intubation and use mechanical CPR where possible. 
• Use a cuffed endotracheal tube that is connected to a ventilator with a HEPA filter to minimize aerosolization when intubating the patient. 
• Use a bag-mask device before intubation. 
• Intubating a child can be difficult. Choose the most skilled provider to perform intubations. This may require a pause or delay in training. Some agencies will need to select a dedicated member of the team to perform all intubations. 
• Try video laryngoscopy if possible. 
• Give epinephrine every 3-5 minutes for rhythm-shockable patients. 

Perhaps most difficult of all, medical providers should weigh the chances of successful resuscitation against the risk to others. In most situations, hospitals take extraordinary measures to save children—even when these measures are almost certain to fail. In the wake of COVID, it is important to weigh the likelihood of success, particularly in children with terminal illnesses and those who have repeatedly coded. 

One of the best ways to prevent resuscitation-related disease transmission is to minimize the need for resuscitation in the first place. Hospitalized patients should be closely monitored to reduce the risk of cardiac arrest. 

Additionally, practice common sense infection prevention. Aggressively and regularly wash hands between patients. Sterilize all equipment and never store equipment in public locations or unsealed containers where it may become contaminated. 

Suction can help you save the lives of COVID patients, particularly those needing emergency and ICU care. As emergency departments fill, hospitals must take extraordinary measures to meet their Emergency Medical Treatment and Active Labor Act obligations and save as many lives as possible. 

The right portable suction machine can help you treat patients wherever you find them, often without undertaking the risk of moving them to another location. For help finding the right portable suction machine for surviving the COVID crisis, download our free guide, The Ultimate Guide to Purchasing a Portable Emergency Suction Device.