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‘Sono-cardiopulmonary resuscitation’ in COVID-19: a proposed algorithm
  1. Brunda R L1,
  2. Vishakh C Keri2,
  3. Tej Prakash Sinha1,
  4. Sanjeev Bhoi1,
  5. Prakash Ranjan Mishra1
  1. 1 Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
  2. 2 Infectious Diseases (Medicine and Microbiology), All India Institute of Medical Sciences, New Delhi, India
  1. Correspondence to Tej Prakash Sinha, Emergency Medicine, New Delhi 110049, India; drsinha123{at}

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As cardiac arrest occurs in around 20% of the patients with severe COVID-19, a large number of them will require immediate resuscitative efforts.1 Cardiopulmonary resuscitation (CPR) in COVID-19 pandemic has become a source of speculation and debate worldwide. Healthcare professionals (HCPs) resuscitating this subset of patients are subject to fears and enormous mental stress pertaining to risk of transmission, breach in personal protective equipment (PPE), unsure effectiveness of PPE and nevertheless bleak positive outcomes in patients despite best resuscitative measures.2 CPR, which is conventionally deemed to be life-saving for patients, appears as an aerosol-generating procedure risking lives of HCPs caring for patients with COVID-19. Protected code blue algorithm has been formulated to address both performer and patient safety.3


Danilo Buonsenso and colleagues have described COVID-19 era as demanding less stethoscope and more ultrasound usage in clinical practice.4 PPE is now an essential measure for HCP protection, and goggles used as a part of PPE are associated with fogging and poor visibility. This coupled with the inability to confirm endotracheal tube position with stethoscope due to poor accessibility in PPE, increases the risk of oesophageal intubation, re-intubation attempts, aerosol generation and thus HCP exposure. Bedside ultrasound could act as visual stethoscope in the described scenario. Sono-CPR in COVID-19 can help intervene quickly in treatable cases and reduce the time spent by HCP in futile resuscitative efforts. Reduced time spent equates to reduced duration of aerosol exposure and thus reduced risk …

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