To the Editor,
The pediatric 2019 novel coronavirus disease (COVID-19) cases report mostly asymptomatic or mild infections, with a better prognosis than in adults.1,2 Any pediatric victim who dies from COVID-19 has a significant media impact. These pediatric COVID-19 cardiac arrests occur mostly in intra-hospital settings. To date, we have not found any publication on the prehospital management of COVID-19 pediatric out-of-hospital cardiac arrest (OHCA) by Basic Life Support (BLS) teams (personal systematic review).
In Paris, France, the Fire Brigade Prehospital Rescue System treats approximately 50 pediatric OHCA per year. From March 20, 2020 to April 7, 2020, two children benefited from prehospital cardiopulmonary resuscitation by a BLS team with an unknown etiology.
During the pandemic, in the case of pediatric OHCA whose etiology is definitely not a COVID-19 infection, children should be considered in all cases as potential carriers of COVID-19, and therefore as contaminants as a symptomatic adult, particularly from nasopharyngeal and stool excretion.1
We are focusing on raising awareness among prehospital teams working on pediatric OHCAs about the need to systematically protect themselves regardless of the cause of pediatric OHCA, and routinely wear personal protective equipment (gloves, filtering face piece [FFP2] respirators, goggles, and long-sleeved gown), especially since there are still uncertainties about the spread of airborne viral particles during resuscitation procedures such as chest compressions, defibrillation, insufflation maneuvers, tracheal intubation, and oral and pharyngeal aspirations.3,4
The International Liaison Committee will reach a consensus on the science of the balance between therapeutic benefit and risk of contamination for each of these procedures, also for pediatric cases.
Conflicts of interest/funding
none
References
- 1. Hagman SFH. COVID-19 in children: more than meets the eye. Travel Med Infect Dis. 2020; epub ahead of print. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. Dong Y, Mo X, Hu Y, et al. Epidemiological characteristics of 2,143 pediatric patients with 2019 coronavirus disease in China. Pediatrics. 2020; epub pre-publication ahead of print. [Google Scholar]
- 3. Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One. 2012;7:e35797. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4. Mahase E, Kmietowicz Z. Covid-19: doctors are told not to perform CPR on patients in cardiac arrest. BMJ. 2020;368:m1282. [DOI] [PubMed] [Google Scholar]