Pediatric Resuscitation Practices During the Coronavirus Disease 2019 Pandemic

Pediatr Crit Care Med. 2020 Sep;21(9):e651-e660. doi: 10.1097/PCC.0000000000002512.


Objectives: While most pediatric coronavirus disease 2019 cases are not life threatening, some children have severe disease requiring emergent resuscitative interventions. Resuscitation events present risks to healthcare provider safety and the potential for compromised patient care. Current resuscitation practices and policies for children with suspected/confirmed coronavirus disease 2019 are unknown.

Design: Multi-institutional survey regarding inpatient resuscitation practices during the coronavirus disease 2019 pandemic.

Setting: Internet-based survey.

Subjects: U.S. PICU representatives (one per institution) involved in resuscitation system planning and oversight.

Interventions: None.

Measurements and main results: Of 130 institutions surveyed, 78 (60%) responded. Forty-eight centers (62%) had admitted coronavirus disease 2019 patients; 26 (33%) reported code team activation for patients with suspected/confirmed coronavirus disease 2019. Sixty-seven respondents (86%) implemented changes to inpatient emergency response systems. The most common changes were as follows: limited number of personnel entering patient rooms (75; 96%), limited resident involvement (71; 91%), and new or refined team roles (74; 95%). New or adapted technology is being used for coronavirus disease 2019 resuscitations in 58 centers (74%). Most institutions (57; 73%) are using enhanced personal protective equipment for all coronavirus disease 2019 resuscitation events; 18 (23%) have personal protective equipment policies dependent on the performance of aerosol generating procedures. Due to coronavirus disease 2019, most respondents are intubating earlier during cardiopulmonary resuscitation (56; 72%), utilizing video laryngoscopy (67; 86%), pausing chest compressions during laryngoscopy (56; 72%), and leaving patients connected to the ventilator during cardiopulmonary resuscitation (56; 72%). Responses were varied regarding airway personnel, prone cardiopulmonary resuscitation, ventilation strategy during cardiopulmonary resuscitation without an airway in place, and extracorporeal cardiopulmonary resuscitation. Most institutions (46; 59%) do not have policies regarding limitations of resuscitation efforts in coronavirus disease 2019 patients.

Conclusions: Most U.S. pediatric institutions rapidly adapted their resuscitation systems and practices in response to the coronavirus disease 2019 pandemic. Changes were commonly related to team members and roles, personal protective equipment, and airway and breathing management, reflecting attempts to balance quality resuscitation with healthcare provider safety.

MeSH terms

  • Airway Management / methods
  • Betacoronavirus
  • COVID-19
  • Cardiopulmonary Resuscitation / methods*
  • Child
  • Coronavirus Infections / epidemiology*
  • Coronavirus Infections / therapy
  • Heart Arrest / therapy*
  • Hospitals*
  • Humans
  • Intensive Care Units, Pediatric
  • Pandemics*
  • Pneumonia, Viral / epidemiology*
  • Pneumonia, Viral / therapy
  • Practice Guidelines as Topic
  • SARS-CoV-2
  • Surveys and Questionnaires
  • United States