UMHC Protected Cardiac Arrest SOP

TRIGGER • Patient found in cardiac arrest (no pulse identified)

No one enters the patient’s room without first safely donning full PPE
Door to room remains closed unless team members are entering/exiting
• Person who identified patient in cardiac arrest (already in room in PPE)
1. Press “Code Blue” button
2. Start chest compressions (if know how)
• 2nd person to arrive
1. Obtain code cart and place outside room
2. Don PPE (Bunny suit, N95 mask with face mask with shield over it, gloves,
booties)
TEAM & RESPONSIBILITIES

3. Open code cart & bring medication tray (drawer 1) & intubation box (on top of
cart) into the room
4. Assist with CPR as able (compressions, administer meds, etc.)
• Later people to arrive
1. Assess if you are needed in the room
** goal to have:
• 1 RN
• 2 providers (1 code leader; 1 able to manage airway)
• 1 RT
• 2 people capable of chest compressions
If needed in room: Don PPE and enter
2. Assess if you are needed outside the room (as a runner) – goal of 2 runners
If needed as a runner: stay outside room without donning PPE
Do not enter the room if you are not needed
Chest Compressions – no deviations from standard
Ventilation
• All oxygen delivery systems need HEPA filter
DEVIATIONS FROM STANDARD CPR

• Do not use bag-mask ventilation at any point (can bag with LMA/ETT – see below)
• Do not intubate during CPR; insert LMA (ideally, intubating LMA) for bag ventilation
• Intubation following ROSC as outlined in “Protected Intubation SOP”
• For patients already intubated on a ventilator prior to CPR, in order of preference, can:
1. Set vent to PSV (PEEP patient was on/PS 15/100% FiO2) and provide manual
breaths on the ventilator (this avoids opening the circuit)
2. Manually bag ventilate with HEPA filter in place (must clamp ETT and place
vent on standby prior to vent disconnect until bag connected and for
replacement on vent at time of ROSC)
Medications – no deviations from standard
Family Presence – for their safety, family members cannot remain in the room during CPR
Decision regarding futility – given the potential risk to healthcare workers, a decision not
to perform CPR despite a patient being “full code” may be reasonable
• Exit room
ACTIVITIES
POST-CPR

• Doff PPE
• Change into new scrubs
• Debrief with full team reviewed Feb. 2021