Dear Editor
We compliment Scapigliati and colleagues1 for the aerosol-limiting solution with a supraglottic airway (SAD) during advanced life support for cardiac arrest, but we have concerns.
Cardiopulmonary Resuscitation (CPR) in COVID-19 pandemic posed unprecedented challenges for healthcare providers (HCP): safety before patients’ needs.2, 3 CPR and chest compressions is an aerosol-generating procedures (AGP),4, 5 and pose HCP at risk of airborne SARS-CoV2 infection. Currently chest compressions and defibrillation is recomended,2, 3 Rescuers should wear PPE before starting CPR3 independently on the ventilation interface.
Fast tracheal intubation, using videolaryngoscope and bougie, in one attempt is recommended.4 In case of failure use of second generation SADs has been claimed to lower aerosol spread,4, 6 providing leak-free seal be ensured.7 Solutions with facial or all-body plastic covers have been suggested to reduce aerosolization during airway management, including modifications of SADs,7 but these might be dangerous.
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(1)
Positioning the barrier would delay chest compressions and CPR;
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(2)
A completely occlusive barrier would limit any SAD's position tests (i.e. drain-tube leak test) and gastric access8;
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(3)
Wrapping the patient in a plastic cover would limit further airway maneuver, including fiberoptic-aided intubation through intubatable SAD,5 and would represent a dangerously inflammable pouch full of oxygen in case of defibrillation;
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(4)
Wrapping plastic removal is a dangerous maneuver, because of potential airway dislocation (including risk of bucking and coughing), and because of risk of “secondary aerosolization” of its contents upon removal.9
In lack of evidence, and facing the risk that use of similar devices may generate a false sense of security among HCPs, we strongly recommend to stay with well elaborated guidelines and to use certified airborne-level PPE during CPR and airway management.2, 3, 4, 5, 6
Funding (no external funding for this article)
Conflicts of interest/Competing interests MS has received paid consultancy from Teleflex Medical, Verathon Medical and DEAS Italia, is a patent co-owner (no royalties) of DEAS Italia and has received lecture grants and travel reimbursements from MSD Italia. IDG has received lecture grants and travel reimbursements from MSD Italia. SF declares no competing interest. RG is ERC Director if Training and Education, ILCOR Task Force Chair on Education, Implementation, Teams.
Ethics approval
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Consent to participate
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Consent for publication
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Authors’ contributions
MS idea and writing of manuscript draft; IDG critical appraisal, writing final manuscript; SF literature check and critical appraisal, writing final manuscript; RG final review, writing final manuscript.
References
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- 3.American Heart Association. (Accessed 10 May 2020, at https://cpr.heart.org/-/media/cpr-files/resources/covid-19-resources-for-cpr-training/english/algorithmbls_adult_cacovid_200406.pdf?la=en&hash=553095CDEBE3D215FDE9E45FFC168BD3A0D18C34).
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