CPR in the Covid-19 Era — An Ethical Framework

Bottom Line:

With an increasing number of COVID-19 cases, the typical assumptions regarding the provision of cardiopulmonary resuscitation (CPR) are challenged. This article summarizes the underlying issues and proposes an ethical framework with recommendations for crisis standards of patient care.

Reference:

Kramer, D.B., Lo, B. & Dickert, N.W. CPR in the Covid-19 Era—An Ethical Framework. New England Journal of Medicine (2020). DOI: 10.1056/NEJMp2010758

Date Published:

6 May 2020

Synopsis:

The role of CPR is very important for resuscitation, and normally requires transfer to an ICU with mechanical ventilation in order to be successful. However, the COVID-19 crisis has severely limited the number of available ICU beds and ventilators, which means that CPR may not be very useful. In addition, patients requiring resuscitation are considered COVID-19 positive until proven otherwise, which means that healthcare workers must wear personal protective equipment before engagement. Therefore, increased time for donning PPE as well as shortage in staff both contribute to reduced likelihood of a successful resuscitation. To address these issues, the crisis standards of care should be followed that outline core ethical principles such as autonomy, transparency, and harm reduction. These principles can further be transformed into three recommendations for crisis care for CPR. First, realize the resource constraints when discussing goals of care and CPR preferences throughout the admission and hospitalization process. The doctors should emphasize to patients that resource constraints will limit some aspects of ordinary care. Second, CPR should be forgoed in certain situations, which depends on the medical condition and age of patients. Third, ensure the safety of every healthcare worker through personal protective equipment before performing resuscitation, as the risk of transmission outweighs the small chance of benefiting a particular patient. 

Summary by: Winston Li