Ethical guidelines on cardiopulmonary resuscitation in the context of the COVID-19 pandemic in Colombia

Eduardo A. Rueda, Edilma Suárez, Fritz E. Gempeler, Lilian Torregrosa, Andrea Caballero, Diana Bernal, Nora Badoui, .

Keywords: Coronavirus infections, cardiopulmonary resuscitation, codes of ethics, practice guideline

Abstract

The pandemic caused by COVID19 is associated with an increase in the number of cases of cardiorespiratory arrest, which has resulted in ethical concerns regarding the
enforceability of cardiopulmonary resuscitation, as well as the conditions to carry it out. The risk of aerosol transmission and the clinical uncertainties about the efficacy, the potential sequelae, and the circumstances that could justify limiting this procedure during the pandemic have multiplied the ethical doubts on how to proceed in these cases.
Based on ethical and legal grounds, this paper offers a practical guide on how to proceed in the clinical setting in cases of cardiopulmonary arrest during the pandemic. The criteria of justice, benefit, no harm, respect for autonomy, precaution, integrity, and transparency are asserted in an organized and practical framework for decision-making regarding cardiopulmonary resuscitation.

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  • Eduardo A. Rueda nternational Bioethics Committee - UNESCO, Red Latinoamericana y del Caribe de Educación en Bioética; Facultad de Derecho y Ciencias Políticas, Universidad Nacional de Colombia, Bogotá, D.C., Colombia https://orcid.org/0000-0002-3512-6872
  • Edilma Suárez Facultad de Enfermería, Pontificia Universidad Javeriana, Bogotá, D.C., Colombia https://orcid.org/0000-0002-8663-5909
  • Fritz E. Gempeler Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, D.C., Colombia; Servicio de Ética, Hospital Universitario de San Ignacio, Bogotá, D.C., Colombia https://orcid.org/0000-0002-6036-9155
  • Lilian Torregrosa Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, D.C., Colombia; Servicio de Ética, Hospital Universitario de San Ignacio, Bogotá, D.C., Colombia; Asociación Colombiana de Cirugía, Bogotá, D.C., Colombia; Departamento de Cirugía, Hospital Universitario San Ignacio, Bogotá, D.C., Colombia https://orcid.org/0000-0002-5392-7083
  • Andrea Caballero Clínica Campo Abierto, EPS Sanitas, Bogotá, D.C., Colombia https://orcid.org/0000-0001-9745-5551
  • Diana Bernal Facultad de Jurisprudencia, Universidad del Rosario, Bogotá, D.C., Colombia; Consejo Nacional de Bioética de Colombia, Bogotá, D.C., Colombia https://orcid.org/0000-0001-9345-2193
  • Nora Badoui Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, D.C., Colombia; Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia https://orcid.org/0000-0002-9066-0867

References

Edelson DP, Sasson C, Chan PS, Atkins DL, Aziz K, Becker LB, et al. Interim guidance for basic and advanced life support in adults, children, and neonates with suspected or confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get With the Guidelines - Resuscitation Adult and Pediatric Task Forces of the American Heart Association. Circulation. 2020;141:e933-43. https://doi.org/10.1161/CIRCULATIONAHA.120.047463

Cabrera-Vargas LF, Pedraza Ciro M, Torregrosa Almonacid L, Figueredo E. Cirugía durante la pandemia del SARS-Cov-2/COVID-19: el efecto de la generación de aerosoles de partículas en escenarios quirúrgicos. Revista Colombiana de Cirugía. 2020;35:190-9.

Morgenstern J. Aerosols, droplets, and airborne spread: Everything you could possibly want to know. First10EM blog. 2020;1–25. Fecha de consulta: 3 de junio de 2020. Disponible en: https://first10em.com/aerosols-droplets-and-airborne-spread/

Torregrosa-Almonacid L, Prieto-Ortiz RG, Cabrera-Vargas LF, Ordóñez-Mosquera JM, Sánchez-Cortés EF, Rodríguez-Vargas CM, et al. Recomendaciones generales para los servicios de cirugía en Colombia durante la pandemia COVID-19 (SARS-CoV-2). Revista Colombiana de Cirugía. 2020;35:264-80.

DeFilippis EM, Ranard LS, Berg DD. Cardiopulmonary resuscitation during the COVID-19 pandemic: A view from trainees on the front line. Circulation. 2020;141:1833-5. https://doi.org/10.1161/CIRCULATIONAHA.120.047260

Craig S, Cubitt M, Jaison A, Troupakis S, Hood N, Fong C, et al. Management of adult cardiac arrest in the COVID-19 era. Interim guidelines from the Australasian College for Emergency Medicine. Med J Aust. 2020. Fecha de consulta: 20 de mayo de 2020. Disponible en: https://www.mja.com.au/journal/2020/management-adult-cardiac-arrest-covid-19-erainterim-guidelines-australasian-college

Fritz Z, Perkins GD. Cardiopulmonary resuscitation after hospital admission with COVID-19. BMJ. 2020;369:m1387. https://doi.org/0.1136/bmj.m1387

Cha AE. Hospitals consider universal do-not-resuscitate orders for coronavirus patients. Washington Post. 2020, Mar 25. Fecha de consulta: 20 de mayo de 2020. Disponible en: https://www.washingtonpost.com/health/2020/03/25/coronavirus-patients-do-not-resucitate/

Kramer DB, Lo B, Dickert NW. CPR in the COVID-19 era — An ethical framework. N Engl J Med. 2020. https://doi.org/10.1056/NEJMp2010758

Mahase E, Kmietowicz Z. COVID-19: Doctors are told not to perform CPR on patients in cardiac arrest. BMJ. 2020;368:m1282. https://doi.org/10.1136/bmj.m1282

Rueda-Barrera EA, Caballero-Duque A, Bernal-Camargo DR, Torregrosa-Almonacid L, Suárez-Castro EM, Gempeler-Rueda FE, et al. Pautas éticas para la asignación de recursos sanitarios escasos en el marco de la pandemia por COVID-19 en Colombia. Revista Colombiana de Cirugía. 2020;35:281-9.

American Heart Association. Statistical update. Dallas: AHA; 2013.

Mallikethi-Reddy S, Briasoulis A, Akintoye E, Jagadeesh K, Brook RD, Rubenfire M, et al. Incidence and survival after in-hospital cardiopulmonary resuscitation in nonelderly adults: US experience, 2007 to 2012. Circ Cardiovasc Qual Outcomes. 2017;10:e003194. https://doi.org/10.1161/CIRCOUTCOMES.116.003194

Schluep M, Gravesteijn BY, Stolker RJ, Endeman H, Hoeks SE. One-year survival after inhospital cardiac arrest: A systematic review and meta-analysis. Resuscitation. 2018;132:90-100. https://doi.org/10.1016/j.resuscitation.2018.09.001

Gempeler-Rueda FE, de Brigard-Pérez AM. Órdenes de no reanimación y anestesia. Revista Colombiana de Anestesiología. 2016;44:146-50.

Shao F, Xu S, Ma X, Xu Z, Lyu J, Ng M, et al. In-hospital cardiac arrest outcomes among patients with COVID-19 pneumonia in Wuhan, China. Resuscitation. 2020;151:18-23. https://doi.org/10.1016/j.resuscitation.2020.04.005

Gempeler FE. Reanimación cardiopulmonar. Más allá de la técnica. Revista Colombiana de Anestesiología. 2015;43:142–6.

van de Voorde P, Monsieurs K, Renier W, Ghuysen A, Lemoyne S, van Asbroek PJ, et al. Ethical principles and guidance with regard to ethical decisions in pre-hospital and emergency medicine in Belgium during the COVID-19 pandemic. A joint statement of the Belgian Society of Emergency and Disaster Medicine and the Belgian Resuscitation Coun. 2020. 20 de mayo de 2020. Disponible en: https://www.brc-rea.be/wp-content/uploads/2020/03/Ethical-decision-making-in-emergencies_COVID19_22032020_final.pdf

Curtis JR, Kross EK, Stapleton RD. The importance of addressing advance care planning and decisions about do-not-resuscitate orders during novel coronavirus 2019 (COVID-19). JAMA. 2020. https://doi.org/10.1001/jama.2020.4894

Saavedra-Trujillo CH. Consenso colombiano de atención, diagnóstico y manejo de la infección por SARS-COV-2/COVID 19 en establecimientos de atención de la salud. Recomendaciones basadas en consenso de expertos e informadas en la evidencia. Infectio. 2020;24S1. https://doi.org/10.22354/in.v24i3.851

Ministerio del Trabajo. Decreto Legislativo 488 de 2020. Presidencia de la República. Bogotá,D.C.: Mintrabajo; 2020. Fecha de consulta: 6 de junio de 2020. Disponible en: https://dapre.presidencia.gov.co/normativa/normativa/DECRETO%20488%20DEL%2027%20DE%20MARZO%20DE%202020.pdf

Ministerio del Trabajo. Decreto Legislativo 500 de 2020. Presidencia de la República. Bogotá, D.C.; Mintrabajo; 2020. Fecha de consulta: 6 de junio de 2020. Disponible en: https://dapre.presidencia.gov.co/normativa/normativa/DECRETO%20500%20DEL%2031%20DE%20MARZO%202020.pdf

How to Cite
1.
Rueda EA, Suárez E, Gempeler FE, Torregrosa L, Caballero A, Bernal D, et al. Ethical guidelines on cardiopulmonary resuscitation in the context of the COVID-19 pandemic in Colombia. biomedica [Internet]. 2020 Oct. 30 [cited 2024 May 11];40(Supl. 2):180-7. Available from: https://revistabiomedica.org/index.php/biomedica/article/view/5762

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Published
2020-10-30

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