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Pediatric Resuscitation Practices During the Coronavirus Disease 2019 Pandemic
Ryan W Morgan1, Martha Kienzle1, Anita I Sen2
1Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Insights
Pediatric institutions rapidly modified resuscitation practices during the COVID-19 pandemic, focusing on safety and adapting procedures like intubation and personal protective equipment use. Many institutions lacked formal policies on resuscitation limitations for severe COVID-19 cases.
Area of Science:
- Pediatric critical care medicine
- Infectious disease epidemiology
- Healthcare system response
Background:
- Severe cases of pediatric coronavirus disease 2019 (COVID-19) can necessitate emergency resuscitation.
- Resuscitation events pose risks to healthcare providers and patient care quality.
- Current practices for pediatric COVID-19 resuscitation were largely unknown.
Purpose of the Study:
- To survey current inpatient resuscitation practices during the COVID-19 pandemic.
- To understand adaptations in pediatric intensive care units (PICUs).
- To identify changes in emergency response systems and protocols.
Main Methods:
- A multi-institutional survey was conducted.
- The survey targeted U.S. PICU representatives involved in resuscitation oversight.
- An internet-based questionnaire was utilized.
Main Results:
- 60% of surveyed institutions responded, with 62% having admitted COVID-19 patients.
- 86% implemented changes to emergency response systems, including limiting personnel and refining roles.
- 74% adopted new technologies, and 73% enhanced personal protective equipment (PPE) use; 59% lacked policies on resuscitation limitations.
Conclusions:
- U.S. pediatric institutions quickly adapted resuscitation systems and practices for COVID-19.
- Key changes involved team composition, PPE, and airway management to balance patient care and provider safety.
- Further development of policies regarding resuscitation limitations is needed.
Objectives:
While most pediatric coronavirus disease 2019 cases are not life threatening, some children have severe disease requiring emergent resuscitative interventions. Resuscitation events present risks to healthcare provider safety and the potential for compromised patient care. Current resuscitation practices and policies for children with suspected/confirmed coronavirus disease 2019 are unknown.
Design:
Multi-institutional survey regarding inpatient resuscitation practices during the coronavirus disease 2019 pandemic.
Setting:
Internet-based survey.
Subjects:
U.S. PICU representatives (one per institution) involved in resuscitation system planning and oversight.
Interventions:
None.
Measurements And Main Results:
Of 130 institutions surveyed, 78 (60%) responded. Forty-eight centers (62%) had admitted coronavirus disease 2019 patients; 26 (33%) reported code team activation for patients with suspected/confirmed coronavirus disease 2019. Sixty-seven respondents (86%) implemented changes to inpatient emergency response systems. The most common changes were as follows: limited number of personnel entering patient rooms (75; 96%), limited resident involvement (71; 91%), and new or refined team roles (74; 95%). New or adapted technology is being used for coronavirus disease 2019 resuscitations in 58 centers (74%). Most institutions (57; 73%) are using enhanced personal protective equipment for all coronavirus disease 2019 resuscitation events; 18 (23%) have personal protective equipment policies dependent on the performance of aerosol generating procedures. Due to coronavirus disease 2019, most respondents are intubating earlier during cardiopulmonary resuscitation (56; 72%), utilizing video laryngoscopy (67; 86%), pausing chest compressions during laryngoscopy (56; 72%), and leaving patients connected to the ventilator during cardiopulmonary resuscitation (56; 72%). Responses were varied regarding airway personnel, prone cardiopulmonary resuscitation, ventilation strategy during cardiopulmonary resuscitation without an airway in place, and extracorporeal cardiopulmonary resuscitation. Most institutions (46; 59%) do not have policies regarding limitations of resuscitation efforts in coronavirus disease 2019 patients.
Conclusions:
Most U.S. pediatric institutions rapidly adapted their resuscitation systems and practices in response to the coronavirus disease 2019 pandemic. Changes were commonly related to team members and roles, personal protective equipment, and airway and breathing management, reflecting attempts to balance quality resuscitation with healthcare provider safety.
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