COVID-19: BMA Scotland position on PPE usage during CPR

BMA Scotland position on PPE usage when performing chest compressions during CPR in adults and associated clinical decision making.
Location: Scotland
Audience: All doctors
Updated: Tuesday 12 May 2020

Members may be aware that there have been differences of opinion in guidance issued on PPE levels of protection required during adult resuscitation scenarios, and in particular whether or not chest compressions are an AGP (aerosol generating procedure).

The RCUK (Resuscitation Council UK) has highlighted concerns that chest compressions are designated as non-AGPs in some guidance (for example that issued by Public Health England and in the view of NERVTAG), and that this position may underestimate the risk to individuals performing chest compressions, particular as first or early responders to cardiac arrest.

The RCUK have produced their own COVID-19 related resuscitation guidance which recognises the risk associated with chest compressions during the pandemic, and states that Level 3 PPE (personal protective equipment) should be donned before chest compressions are undertaken by healthcare professionals. This guidance is based upon WHO and ILCOR (International Liaison Committee on Resuscitation) guidance and the emerging evidence available.

Some guidance maintains that chest compressions alone are not an AGP but recognise that individual employers or healthcare locations may at their discretion recommend PPE usage in line with the RCUK position.

Having considered the rightful concerns of members faced by these situations, and having made strong representation to Scottish Government we believe that the RCUK guidance is the ‘gold standard’ and should be used to avoid confusion as the safest measure to protect clinicians.

Other professional organisations have also issued statements backing the RCUK position, and there is therefore an emerging majority view from those representing practicing clinicians.

However, BMA Scotland recognises that some doctors may be faced with a very difficult decision on whether or not to undertake a potentially life restoring intervention, if full level 3 PPE is not available – namely respirator, disposable gown, disposable gloves and disposable eye protection.

Those decisions may be very much context dependent and cannot always be comprehensively covered by guidelines. The fact that different guidelines do not wholly agree illustrates there is not complete clinical consensus, and that guidance on PPE has frequently changed and will probably go on doing so, reinforces the need for doctors to make situation specific decisions in some instances.

Our advice – therefore and in line with that of RCUK is to put on appropriate PPE before commencing chest compressions if it is available, while staff in level 2 PPE use a defib to provide 3 initial shocks. If the appropriate PPE is not available, doctors must balance the real risk to their own health with the likelihood or otherwise of chest compressions – or other potential options for CPR - being effective for the patient in front of them.

Ultimately such decisions are about individual professional judgement and the BMA will robustly support the rights of its members to exercise that judgement should they find themselves in this difficult position.

 

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