 This is like just completely backwards to how I was taught my entire life and how most people were taught This is what so many people had problems with welcome back to the channel everybody for those of you who are new around here My name is Michael a.k.a. Dr. Chalina and I'm a board certified Diagnostic and interventional radiologist in New Jersey things are a little different on today's video one I'm talking about the American Heart Association, which I never have in the past number two I'm also recording on this fancy new microphone to try to give some better audio to this video So today we're going to be talking about the latest update to the American Heart Association CPR guidelines in COVID patients more specifically that is the new paper They came out with entitled the 2021 interim guidance to healthcare providers for basic and advanced Cardiac life support in adults children and neonates was suspected or confirmed COVID-19 now This has gotten a lot of uproar on Twitter and a few reddit posts here and there but for some reason nobody's really talking about it in the mainstream media and Who better than myself to take on this burden and talk about it? It is very interesting that they would post something like this given the current environment where healthcare workers are feeling very Underappreciated to say the least so let's go ahead and get into this paper and the new guidelines and we'll talk about it Let's go So for this video we are going to break it down in a couple different categories here So for one we're gonna talk about what is the American Heart Association or the AHA? Why should we listen to them? What exactly are the new guidelines that the AHA put out? Should you follow these new guidelines and finally my thoughts on the new guidelines? So let's go ahead and get into it with what is the American Heart Association? So I know what the American Heart Association is But I don't actually know how to describe it So for those reasons I had to doodle it and this is what doodle came up with the American Heart Association is a Non-profit organization in the United States that funds cardiovascular medical research Educates consumers on healthy living and fosters appropriate cardiac care in an effort to reduce Disability and deaths caused by cardiovascular disease and stroke That's why I had to look that up because I couldn't come up with that off the top of my head So the AHA is very important in the medical world because they do put out these guidelines for basic life support and advanced cardiac life Support and they provide these algorithms with us and everybody in the hospital throughout the United States Uses these algorithms when someone is in cardiac arrest now I'm not too involved in the American Heart Association or know too much about them as probably most physicians and healthcare workers don't But what I know the AHA most for is the basic life support classes and the advanced cardiac life support classes that we as Providers have to be certified in in order to be credentialed in the hospital The BLS and ACLS certifications are required every two years I believe and they are very important because they keep you up to date with how to manage critically ill patients in Cardiac arrest so that's the AHA now. Why should we listen to them? Well, like I mentioned prior they do a lot of research and come up with the preferred guidelines for treatment for cardiac arrest And they have come up with a very useful algorithmic approach to treating cardiac arrest and like I mentioned prior Almost every hospital in the United States uses these guidelines and algorithm And it's essentially the standard of care and if you've never heard of this I'll actually pull up one of the images right here of the actual algorithm It is what we use on a daily basis in the hospital I fortunately do not have to use it very often But most critical care medicine specialties and specialties taken care of critical patients will have to use this Likely on a daily basis these algorithms are very simple to understand. They're very simple to perform And it's our best response to treating patients and cardiac arrest. Alright, so now let's get into the meat of this topic What is this new policy that the AHA put out and why are healthcare providers so up in arms about it? So let's go ahead and pull this up here. This is from the AHAjournals.org website I'll leave a link in my description and you can check it out yourselves This is the actual summary of the adjustments to CPR algorithms in patients with suspected or confirmed COVID-19 So first and foremost, we say reduce provider risk So before anybody codes in the hospital, we need to reduce provider risk And how do we do that? Well, healthcare providers can significantly reduce their risk of infection by receiving a vaccine And or a booster if applicable against these SARS-CoV-2 virus So we already know this that's not new a lot of hospitals and healthcare systems are requiring providers to be vaccinated before coming to work I'm not even gonna touch that subject because it can get pretty dicey. So moving on So reduce provider exposure and provide timely care. Okay, obviously that's what we want, right? When someone goes into cardiac arrest time is heart We have to get in there start CPR and initiate the ACLS protocol immediately However, you do not risk your own life to help others. So what do they say here? So first and foremost, we need to rapidly provide chest compressions without delay or interruption Basically, that means when somebody codes or someone's heart stops We have to provide chest compressions first and foremost amongst anything else The next line is what makes people a little concerned about these guidelines Do not delay chest compressions for provider PPE or to place face covering on the patient That's kind of a loaded sentence there. So do not delay chest compressions for provider PPE So like we mentioned, chest compressions are the first thing we need to initiate However, they want you to start chest compressions before donning PPE for yourself Think about that for a second They want you to just run in there start chest compressions before you actually protect yourself This goes against every single thing we were taught about any sort of advanced cardiac life support BLS protocol, all that stuff This goes against all of that because the very first thing you do in all of our teachings That I've been taught forever is check to see if the scene is safe And part of that is allowing yourself to be protected before you go into the scene The scene here is the actual patient's room who is coding And before you go in if the patient has COVID, you must don PPE They're basically retracting all that stuff because now we're vaccinated And now we're invincible, which we know not to be true That we should risk our lives and go in there and start chest compressions Before donning PPE Now, this is what so many people had problems with And myself included, it just seems a little ridiculous for them to tell us to risk our lives Especially in the time where healthcare workers, nurses, physicians are stressed out, overworked And we already feel underappreciated as it is Now you're gonna tell us to just run in there and risk our lives To help someone who is coding without protecting ourselves The next part of this same sentence here, the same bullet point is Do not place a face covering on a patient before starting chest compressions Now I don't know if any of you all have been in too many codes But the first thing we do when we are in a code is not to put a mask on a patient At that point we should be dressed in PPE and everything should be done We should be safe But now they're saying don't interrupt chest impressions by putting a mask on a patient But the only mask we'd be putting on a patient would be a bag valve mask before intubation Nobody goes in there and puts on a mask on the patient That just doesn't happen How are they supposed to get oxygen? It's really odd But anyways, the next line here is Relieve initial resuscitation personnel with providers wearing PPE or AGPs as soon as possible So they're basically saying the first person should just run into the fire And then once it's time to switch chest impressions The next person should have time to have PPE on and they can start chest impressions And that person can be relieved to go put on PPE This is like just completely backwards to how I was taught my entire life And how most people were taught Then they'd want to say don appropriate PPE for AGPs In 95 masks with eye protection, positive pressure airway respirators, gloves and gowns Prior to confirmed AGPs including bad mask, blah blah blah You see here these new guidelines are a little concerning to say the least Then we go down here to the specific additional resuscitation strategies Pediatric and adult cardiac arrest Defibrillate as soon as possible when indicated Do not delay defibrillation for application of masks or other PPE Again, this is basically just saying that we should not protect ourselves And put ourselves in harm's way To help others Now a lot of us take these jobs because we want to help people But we don't want to risk our own lives at the expense of helping people We want to help other people safely and in a safe manner When you see stuff like this It basically puts providers in harm's way And that's where they get angry And I completely see where the anger is coming from After this new paper was released All right, so now let's talk about Should you follow these recommendations? Well, I'm not going to tell you you should follow these recommendations Or that you should follow any recommendations Because that is ultimately your choice Now, I personally would not risk my own life To go into a room to help someone I spoke on this topic briefly during one of my live streams And someone put in the comments It's basically like saying for a fireman To run into a burning house Without putting on his protective gear Because someone is in there That's just not the case He shouldn't have to risk his life To go into the fire without protective gear And that's no different than what we're doing here We shouldn't have to risk our own lives Before going into a patient's room with COVID Because they're coding We should don our PPE as fast as possible And, you know, it takes like 10 seconds And that's the other thing too But I guess we'll get into that in a second Much like the paramedics who are on the front line If they were called to, say, a game fight The first thing they do is assess the scene To make sure it's safe for them To go help someone who is injured They do not run out in the middle of gunfire Because that's what they're supposed to do They wait, make sure the scene's safe Wait till the police get there And then they do assess the situation to help people Asking them to just run out on the fire Is a little crazy, to be honest with you So what are my thoughts on this matter? Well, for starters The most people who are running codes in the hospital Are already wearing at least some sort of PPE So people who worked in the ICU setting Are wearing N95 masks Almost all of them are wearing goggles Protective goggles and protective head covering already That's just what they wear on their 12 plus hour shift For them, I think they're already prepared To run into a patient's room if they need to I don't think this paper matters too much for them But for everybody else including myself Who works in interventional radiology Every now and then we'll have a patient code And every now and then we'll be doing procedures On COVID positive patients And we have COVID positive patients Who are getting CT scans all the time Who could code while they're down there And I, the radiologist who would respond To these codes in the MRI or CT scanner Would not be wearing a N95 mask Or any PPE at that time The only time I ever put on an N95 mask In the hospital is if I'm doing a procedure On a COVID positive patient Otherwise I just have a normal surgical mask on So for myself, I do take this kind of personally I don't think I would run into the room And start CPR on someone with COVID Without putting at least an N95 mask or goggles on After all, it takes about 10 seconds And I don't think that 10 seconds Is going to make that bit of a difference Especially when talking about putting my life at risk And actually for this video I tried to find data on the survival rate For patients who code in the hospital The only thing I could really find Was something that was a little outdated But differentiate the average survival to discharge rate For adults who suffer in hospital cardiac arrest Is around 17 to 20 percent So one in five patients essentially Make it out of the hospital after a code So even if everything goes perfectly smoothly And the patient gets return of spontaneous circulation The patient still may not be discharged out of the hospital alive So those survival rates are not in the favor of the patient And we also have to keep in mind That the patients who are coding Are severely sick to begin with And a lot of times are in multi-system organ failure Especially from COVID or other comorbidities So risking our own lives as providers When we know that there's 20 or even less percent chance Of that patient actually maintaining out of the hospital alive Puts us in a very difficult position That is basically it for this video I just wanted to shed some light on the AHA guidelines Because I don't think they have gotten the publicity That they deserve And for some reason the media has not covered it at all Here you are, here are the new guidelines Let me know in the comments what you think I think now you know what I think about these guidelines And I want to know how you will respond to these guidelines Or if you disagree with me Or just your thoughts in general So let me know in the comments below As always, stay safe out there Make sure you gently tap on the subscribe button For this channel If I'll manage spamming tiktok And I guess I'll see you all on the next video Bye