AHA PUI/COVID+ Resuscitation and Arrest

All PUI/COVID+ patients requiring emergent resuscitation or in arrest will be taken to Resus C.
A total of 8 people will be designated and assigned specific roles during the resuscitation.
Please see the graphic below for visual description of the lay out.
Please see below for PPE checklist and video for PPE donning and doffing instructions.

• MD#1 will be the intubator in full PPE
• MD#2 will be the team lead in full PPE
• There will be 2 bedside RNs in full PPE
• There will be 1 charting RN in full PPE
• There will be 2 RTs. Roles assigned at beginning of the shift
  • RT#1 goes to airway in full PPE
  • RT#2 retrieves C-MAC then becomes backup/secondary RT PRN
• “Communication RN” in full PPE will be inside the room next to the door to relay items requested by team to the outside.
• “Hand-off RN” in full PPE will stay outside the room and will pass on items or medications requested to people outside Resus C and pharmacy. They will deliver items or medications to “communication RN.”
• Pharmacy will have their table with supplies in the hallway and will stay outside of Resus C. They will utilize the “hand-off RN” to hand off medications to “communication RN” inside the room. The hallway Pyxis was changed and updated to now stock medications found inside of Resus rooms. Pharmacy is now utilizing brief sign off for blood if RN/MD unavailable. They will sign for blood and hand off to “hand-off RN.”
• There will be a PPE cart parked and readily available next to the room for donning and doffing. There will be extra IV supplies, medication administration equipment, and LifeFlows located in this cart as needed.
• There is a separate IV cart that will stay in Resus C and will be used primarily for IV fluids, angiocaths, etc.
• The “COVID airway cart” with the necessary airway equipment will stay in Resus C as well. The only difference in the “COVID airway cart” is that it includes extra viral/HEPA filters and ETT clamps as compared to generic airways carts that have the same equipment.
• An “intubation box” will also be kept in this room for use.
• Please mind the signs that are hung on doors to Resus C reminding people of donning and doffing procedures, role assignment cards for people in the room. There is also a large STOP sign reminding people that Resus C is a “dirty room” and anyone who enters should be in full PPE.
• Please see updated AHA PALS algorithm for additions to intubation procedures for PUI/COVID+.

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Disclaimer: These clinical pathways are intended to be a guide specifically for residents, fellows, CRNPs, and physicians (“practitioners”) at Children’s of Alabama (“COA”). These clinical pathways may be adapted for each patient depending on clinical scenarios based on the practitioner’s judgment, consideration of unique circumstances, needs of the patient and their respective family, and availability of resources of where the patient is located. These clinical pathways are not to be construed as medical advice or treatment. COA does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one of more of them apply to a particular patient or medical condition. COA is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.