NHS staff given conflicting advice over resuscitation of coronavirus patients

‘It is very confusing for people. The advice is not clear. This is a major ethical dilemma’

NHS nurses and doctors have been issued with conflicting advice on resuscitation for Covid-19 patients (Getty)

Doctors, nurses and paramedics have been given conflicting advice about when to start resuscitation for coronavirus patients, amid fears the procedure could put them at risk of infection.

While Public Health England has said it does not believe CPR creates a risk, the UK’s Resuscitation Council – which is responsible for setting standards for resuscitation in the NHS – has said it believes there is a risk and staff should wear full equipment.

The Independent has seen several examples of different messages being sent out to hospital staff and ambulance workers, and some NHS trusts were forced to change their guidance within a matter of days after PHE changed its stance.

One set of guidance could mean a delay in starting CPR for patients while staff put on protective equipment, while the other means staff could be at risk of being infected with coronavirus.

Ken Spearpoint, a former consultant nurse and resuscitation officer at Imperial College Healthcare Trust, said the situation had led to confusion and created an “ethical dilemma” for some staff who were being forced to choose between the Resus UK’s position and their trust’s guidance.

He said: “It is very confusing for people. The advice is not clear. This is a major ethical dilemma for people who throughout their professional lives have focused on rescuing people from avoidable death.

“My view is we should be following the Resus UK guidance. I am troubled that the decision Public Health England took, it is out of kilter with the Resuscitation Council. I don’t understand and can’t find the evidence for why Public Health England have taken a different position.”

Normally patients get CPR immediately and they are given an electric shock to restart their heart if the heart has a compatible rhythm. CPR is normally withheld where patients have an advance decision in place or what is known as a ‘do not resuscitate’ order.

One doctor told The Independent the conflicting advice had caused concern among medics and meant if Covid-19 patients suffered a cardiac arrest they were “essentially left to die” if their heart did not have a shockable rhythm, which they said went against the advice from the Resuscitation Council.

Initial guidance from PHE, dated 13 March, agreed with the stance of the Resuscitation Council, published on 25 March, and advised staff to wear personal protective equipment, or PPE before starting chest compressions.

This is because there is a concern CPR could generate fine droplets released into the air from the patient that carry a risk of infection. Aerosol generating procedures require full protective masks and equipment.

The UK has seen a severe shortage of protective equipment as demand increased during the coronavirus outbreak. The government has been forced to use its pandemic stockpile and bring in the military to ensure hospitals have sufficient supplies.

Initial advice issued to doctors and nurses at the University Hospital’s Birmingham Trust, where a patient suffered a cardiac arrest, was: “Do not commence chest compressions or any form of ventilation.”

But after PHE issued new guidance on 28 March stating it did not consider CPR to be an aerosol generating procedure, UHB changed its advice saying chest compressions should be carried out.

In a message to staff at the end of March, the trust, which has now issued three versions, said there was “rapidly changing guidance” and it had altered its official advice in line with the new position of Public Health England.

It added: “The speed of change is sometimes challenging.”

Concerns were raised by staff at the East of England Ambulance service after they were sent guidance that conflicted with the Resuscitation Council on 1 April. Staff responded to an email warning the advice was different but were told by an operations manager: “To reiterate, these are the current trust guidelines as per the NHS England documentation outlined in the email.

“In this ever changing, and challenging period you will of course receive updates to any changes in trust guidance as they are published.”

The Resuscitation Council, which delivers training to 135,000 healthcare professionals a year, said its guidance was first published on 4 March and was “based on the best available scientific evidence and clinical expertise from a wide range of resuscitation experts”.

In a statement it added: “We moved quickly to assess how resuscitation practices should be modified to take account of the complexities and threats posed by the Covid-19 virus. We have, at all times, sought to ensure that clinician safety is balanced with maximising the prospect of viable resuscitation attempts.

“At no time did our guidance advise that CPR should not be provided to patients infected with the Covid-19 virus. Rather it provides practical advice as to how to do so safely.”

A spokesman for Public Health England said its own guidance had been reviewed by the government’s New and Emerging Respiratory Virus Threats Advisory Group, or Nervtag adding: “It is their expert consensus that chest compressions and defibrillation are not aerosol generating procedures.”