key: cord-0982727-4u470zuc
authors: Kandori, Kenji; Narumiya, Hiromichi; Iizuka, Ryoji
title: Reply to: Coronavirus disease 2019 and ethical considerations for extracorporeal cardiopulmonary resuscitation
date: 2020-07-22
journal: Resuscitation
DOI: 10.1016/j.resuscitation.2020.07.012
sha: 8efe821693a5389d05fb18d17755dd424481082f
doc_id: 982727
cord_uid: 4u470zuc

nan

Patients." 1) . They have, however, expressed some concerns that we would like to address.

They argue that extracorporeal cardiopulmonary resuscitation (E-CPR) should be performed irrespective of COVID-19 status, resuscitation provider safety, emotional or physical stress, and resource availability 2 ; however, we emphasize these risks.

We believe that resuscitation provider safety, emotional or physical stress, and resource availability, are very important factors, and could be key determinants in deciding whether to perform E-CPR. It is clear that the highest priority should be the prevention of infection in healthcare workers, and we believe that E-CPR should be discouraged if there is any risk of infection by performing E-CPR. They point out that actual confirmed COVID-19 cases may well represent a small fraction of the number of originally suspected cases; however, the source that they have cited 3 also mentions that healthcare professionals underestimating the risk of transmission may spread the virus J o u r n a l P r e -p r o o f 4 to the rest of their team, and within the larger community, putting further strain on the healthcare system. Patient safety during E-CPR is an important issue. Stress during cardiopulmonary resuscitation (CPR) has been shown to be associated with worse CPR performance 4, 5 . Stress reduces focus and, therefore, in stressful situations, the ability to dismiss irrelevant information is reduced, leading to an increase in distractibility.

Additionally, stress impairs rational decision-making, and is associated with a loss of team perspective and poor team performance. Stress-induced poor performance can further increase the mental stress of the rescuer, which could lead to a vicious cycle. 

Extracorporeal cardiopulmonary resuscitation should not be performed on confirmed or suspected COVID-19 patients

Coronavirus disease 2019 and ethical considerations for extracorporeal cardiopulmonary resuscitation

European Resuscitation Council COVID-19 Guidelines. Section 7. Ethics and end-of-life decisions

Perceived stress and team performance during a simulated resuscitation

Impact of a stress coping strategy on perceived stress levels and performance during a simulated cardiopulmonary resuscitation: a randomized controlled trial

The authors declare no conflict of interest.J o u r n a l P r e -p r o o f