MCH PEDS - MCMASTER CHILDREN'S HOSPITAL PROTOCOL ON RESUSCITATIVE MANAGEMENT OF A CHILD WITH SUSPECTED OR CONFIRMED COVID -19 IN THE PEDIATRIC ...
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Approved and Released: 2020-04-30 Authors: Alyssa Marfisi, Clinical Practice and Education, MUMC PED
Joint Health & Safety Committee Review: 2020-05 Dr. James Leung, MUMC PED
Dr. April Kam, MUMC PED
PED ERPs, COVID-19 Expert group, PEMSOC, MUMC PED
MRP - Christine Chaston, Clinical Manager, MUMC PED
MCH PEDS - McMaster Children’s Hospital
Protocol on resuscitative management of a child with suspected
or confirmed COVID -19 in the Pediatric Emergency Department
1|Page
Approved and Released: 2020-04-30 Authors: Alyssa Marfisi, Clinical Practice and Education, MUMC PED
Joint Health & Safety Committee Review: 2020-05 Dr. James Leung, MUMC PED
Dr. April Kam, MUMC PED
PED ERPs, COVID-19 Expert group, PEMSOC, MUMC PED
MRP - Christine Chaston, Clinical Manager, MUMC PED
Table of Contents
Topic Page(s)
Introduction and Guiding Principles 3-4
Location and Equipment Definitions 5
Aerosol Generating Medical Procedures (AGMPs) 6
Standard Acute 1 Negative Pressure Room Set Up: Personnel 7
Standard Acute 1 Negative Pressure Room Set Up: Equipment 8
Standard Advanced Procedure + Hepa Filter Room Set-up: Personnel 9
Standard Advanced Procedure + Hepa Filter Room Set Up: Equipment 10
Standard Work for Resuscitation Personnel 11
HHS Airborne Personal Protective Equipment (PPE) Donning/Doffing Instructions 12
HHS Airborne Personal Protective Equipment (PPE) Donning/Doffing Locations 13
MUMC PED Resuscitation Procedure for suspected or confirmed COVID-19 patient 14-15
MUMC PED Transfer of a suspected or confirmed COVID-19 patient 16
Debriefing Guidelines 17
COVID-19 Respiratory Literature 18
2|Page
Approved and Released: 2020-04-30 Authors: Alyssa Marfisi, Clinical Practice and Education, MUMC PED
Joint Health & Safety Committee Review: 2020-05 Dr. James Leung, MUMC PED
Dr. April Kam, MUMC PED
PED ERPs, COVID-19 Expert group, PEMSOC, MUMC PED
MRP - Christine Chaston, Clinical Manager, MUMC PED
Situation:
In response to the global COVID-19 pandemic declared by the World Health Organization, and rising cases in Canada, an HHS protocol on the
safe resuscitation of a child with suspected or confirmed COVID-19 in the Pediatric Emergency Department (PED) at McMaster Children’s
Hospital is required to deliver high quality care to children while protecting staff from harm. Due to the isolation requirements while performing
various AGMPs during resuscitation of a patient, standard PED resuscitative practices have been altered, including: conducting resuscitations
outside of our normal designated resuscitation rooms (isolation rooms); using different interprofessional team models of care; and heightened
infection prevention and control (IPAC) protocols. These changes create an urgent need for an HHS protocol to assist PED care providers in
resuscitating children under these challenging conditions. To align with HHS’s vision of ‘Best Care for All’, best practice changes that support the
safe and timely resuscitation of a COVID-19 patient must be available to all staff supporting the care of our patients. Simultaneously, all staff
need to be empowered with the knowledge and skills to safely resuscitate a COVID-19 patient while maintaining their own safety through use of
appropriate Personal Protective Equipment (PPE). Conservation of PPE is paramount during the COVID-19 pandemic, and practices highlighted in
this document align with HHS guidelines for conservation at time of publication.
Background:
The Corona Virus Infectious Disease of 2019 (COVID-19) is a novel viral infectious disease that first originated in China in December 2019.
Despite efforts to contain the virus, it has continually spread and was declared a global pandemic on March 12, 2020 by the World Health
Organization. In Ontario, the first presumptive case of COVID-19 was detected on January 25, 2020, and a provincial state of emergency declared
March 17, 2020. COVID-19 primarily results in respiratory symptoms including fever, cough, dyspnea, anosmia, and sometimes gastrointestinal
symptoms such as vomiting and diarrhea. While preliminary case series from China suggests that most children present with mild to moderate
symptoms, there is still a high likelihood of children presenting to the PED requiring resuscitation. While the original case definition was based
around travel, the emergence of community spread has rapidly increased the difficulty of clinically diagnosing COVID-19, given the significant
overlap of symptoms from other common respiratory infections. Therefore, for this pandemic, any patient who has fever or cough is placed in
Droplet/Contact precautions and treated as a suspect COVID-19 patient until a swab has been completed, showing negative status. Because of
the nature of Pediatric Emergency Medicine, staff generally do not have swab results prior to treatment and need to additionally employ an N95
when conducting AGMPs on all patients who are under Droplet/Contact precautions. Because many AGMPs, such as nebulization, assisted
ventilation and intubation, are related to resuscitation, a detailed outline of safety practices related to the Additional Precautions requirements
are necessary for safe resuscitation. It is important to note that Health Care Workers are susceptible to exposure of this virus if they are not
wearing appropriate PPE for the procedure they are completing on a child with suspected or confirmed COVID-19.
3|Page
Approved and Released: 2020-04-30 Authors: Alyssa Marfisi, Clinical Practice and Education, MUMC PED
Joint Health & Safety Committee Review: 2020-05 Dr. James Leung, MUMC PED
Dr. April Kam, MUMC PED
PED ERPs, COVID-19 Expert group, PEMSOC, MUMC PED
MRP - Christine Chaston, Clinical Manager, MUMC PED
Assessment:
A literature review was conducted to look at changes in pediatric resuscitative procedures during similar respiratory virus outbreaks, including
SARS and MERS-Coronavirus (CoV). Several interprofessional simulations were conducted in March 2020 with assistance from a number of our
PED Physicians, Registered Nurses, Registered Respiratory Therapists, Pharmacists and Certified Child Life Specialists. One of these simulations
was attended and observed by an expert panel of Pediatric Infection Prevention and Control practitioners, Pediatric Infectious Diseases
physicians, and Occupational Health and Safety. Knowledge from background literature, feedback and observations from simulations as well as
input from an expert interprofessional PED panel was incorporated to generate these guidelines. Of note, a primary finding from both the review
of relevant literature and hands-on experiential learning in a simulated environment specifically noted need for a formal protocol to provide
step-by-step recommendations related to gathering and use of appropriate equipment and provide instructions regarding PPE to ensure staff
safety.
Recommendation:
This protocol outlines the process for resuscitation of a child with suspected or confirmed COVID-19 in the PED at McMaster Children’s Hospital.
Principles Guiding Decision-Making of Resuscitating Suspected or Confirmed COVID-19 Patients:
1. ‘Best care for all’ provision of high quality care to children requiring resuscitation related to suspected or confirmed COVID-19.
2. Minimizing infectious risk to all Healthcare Providers.
3. Appropriate allocation of resources: PPE, AIIR (Airborne Infection Isolation Rooms) availability, mechanical ventilators, RT/RN supports
4. Standardization of resuscitation care delivery for a patient requiring Airborne or Droplet/Contact + Eye protection isolation precautions to
promote effective interprofessional collaboration with expected roles and communication methods
5. Avoiding delay in resuscitative care by having planned strategies and processes in place to support staff using appropriate isolation
precautions while delivering standard of care.
4|PageApproved and Released: 2020-04-30 Authors: Alyssa Marfisi, Clinical Practice and Education, MUMC PED
Joint Health & Safety Committee Review: 2020-05 Dr. James Leung, MUMC PED
Dr. April Kam, MUMC PED
PED ERPs, COVID-19 Expert group, PEMSOC, MUMC PED
MRP - Christine Chaston, Clinical Manager, MUMC PED
Location and Equipment Definitions:
I. Acute 1 AIIR
Ideal location for a Suspected or Confirmed COVID-19 patient who requires resuscitation that includes the use of AGMPs due to the
Negative Pressure system. Acute 1 has an ante-room for doffing PPE appropriately. Acute 1 also has a dedicated bathroom for
patient/caregiver use. Acute 1 has signage to indicate door to enter and Don PPE as well as door to Exit and Doff PPE. Standard
resuscitation equipment and resource set-up in room to facilitate resuscitation as practiced in Simulations.
II. Advanced Procedure room
Back-up location for a Suspected or Confirmed COVID-19 patient who requires resuscitation that includes the use of AGMPs. Advanced
procedure has minimal supplies in room in the case that AGMPs are used to prevent contamination of clean unused supplies. Large
room that can accommodate a portable HEPA filter unit. HEPA Filter Unit set up in room as base set-up for availability. Advanced
Procedure room has signage to indicate door to enter and Don PPE as well as door to Exit and Doff PPE. Standard resuscitation
equipment and resource set-up in room to facilitate resuscitation as practiced in Simulations.
III. Standard Resuscitation Equipment and Resource set-up
1. Laminated Resuscitation Medication list with dry erase 12. Monitoring capability:
marker a. CRM leads
2. Laminated intubation checklist b. BP cuff (sized appropriate)
3. Laminated communication tool for resource MD ex. relevant c. Spo2 monitor
patient history, critical labs 13. Suction canister and tubing
4. White board in room to write supply orders for runners 14. Yankauer and tip suction available
5. White board outside room to relay questions/labs/clarify 15. Trauma stretcher with weigh scale
doses 16. Alaris pump with straight line tubing and NS 1000ml bag
6. Calculator 17. IV tray set-up required supplies x 3 attempts
7. 2-way communication system from inside room to outside 18. Red tray drop-off method
8. Adult and Ped Non Rebreather O2 mask 19. N95 + eye protection PPE available for AGMP
9. Adult and Ped Bag Valve Mask with viral filter 20. Droplet/Contact PPE
10. Suction canister, tubing, Yankauer and tip suction available 21. Additional Precautions Signage
11. Laminated continuous medication infusions list 22. Contact Tracing sheet
5|PageApproved and Released: 2020-04-30 Authors: Alyssa Marfisi, Clinical Practice and Education, MUMC PED
Joint Health & Safety Committee Review: 2020-05 Dr. James Leung, MUMC PED
Dr. April Kam, MUMC PED
PED ERPs, COVID-19 Expert group, PEMSOC, MUMC PED
MRP - Christine Chaston, Clinical Manager, MUMC PED
Aerosol Generating Medical Procedure PPE requirement:
Risk Level of AGMP Continuous Risk of Transient AGMP Low risk AGMP
Aerosolization
AGMP Intubation or extubation, once ETT Nebulized therapy (lower
Respiratory support: High Flow in place and connected - no ongoing risk of aerosolization)
nasal cannula, CPAP, BiPAP, High risk
AGMP through closed
Frequency Oscillatory or Jet Cardiopulmonary Resuscitation incubator
Ventilation (HFOV, HFJV)
Open airway (ETT or tracheostomy)
suctioning
PPE (face protection) N95, eye protection (goggles/visor/face shield)
Hepa filter or HEPA filter OR Negative pressure HEPA filter/Negative pressure not necessary
negative pressure room if available
required
Gown type Fluid resistant disposable gown (blue) gown preferred Fluid resistant disposable gown(blue)
or Yellow Gown acceptable
6|PageApproved and Released: 2020-04-30 Authors: Alyssa Marfisi, Clinical Practice and Education, MUMC PED
Joint Health & Safety Committee Review: 2020-05 Dr. James Leung, MUMC PED
Dr. April Kam, MUMC PED
PED ERPs, COVID-19 Expert group, PEMSOC, MUMC PED
MRP - Christine Chaston, Clinical Manager, MUMC PED
Standard Acute 1 AIIR Set Up: Personnel
Airway
Airway
Operator
Operator
Patient/Caregiver
Team
Washroom
Leader
(Airway #2)
Patient
Bedside RN
Bedside
ANTE ROOM Bedside
RN
BedsideRN
RN
Runner #1
Runner #1
Runner #2:
PPE Donned
Exit Enter
RN Documenter Glidescope Airway Cart Broselow Cart
Runner #3
2nd 2nd Parent
MD RT Support*
OUTSIDE
*RSW, CLS or otherwise delegated in droplet/contact PPE
7|PageApproved and Released: 2020-04-30 Authors: Alyssa Marfisi, Clinical Practice and Education, MUMC PED
Joint Health & Safety Committee Review: 2020-05 Dr. James Leung, MUMC PED
Dr. April Kam, MUMC PED
PED ERPs, COVID-19 Expert group, PEMSOC, MUMC PED
MRP - Christine Chaston, Clinical Manager, MUMC PED
Standard Acute 1 Negative Pressure Room Set Up: Equipment
Pre-patient arrival equipment
Monitor NRB + BVM Intubation
considerations:
Checklist
Verify phone on speaker to
extension labelled on White
handset
Board
Disposable stethoscope
Oxygen tubing with nasal
cannula Patient
Patient positioning adjuncts
ex. shoulder roll
Documentation table set- Alaris +
up with flow chart,
1000ml NS
calculator, timer, kidney
basin for medications + IV tubing
+/- Pharmacy cart
Intubation box
Resus
Med List
Red Tray Drop-off Window
Phone on speaker
for Documentation
8|PageApproved and Released: 2020-04-30 Authors: Alyssa Marfisi, Clinical Practice and Education, MUMC PED
Joint Health & Safety Committee Review: 2020-05 Dr. James Leung, MUMC PED
Dr. April Kam, MUMC PED
PED ERPs, COVID-19 Expert group, PEMSOC, MUMC PED
MRP - Christine Chaston, Clinical Manager, MUMC PED
Desk
Standard Advanced Procedure + Portable HEPA Filter Unit Set-up: Personnel
Glidescope
2nd
MD
Airway
Operator 2nd
Parent RT
Support*
Team
Broselow
Leader
Patient (Airway #2)
RN
Documenter
Airway Cart
Bedside RN
Bedside RN
Runner #1
Runner #2:
Donned PPE
Exit Enter
Runner #3
9|PageApproved and Released: 2020-04-30 Authors: Alyssa Marfisi, Clinical Practice and Education, MUMC PED
Joint Health & Safety Committee Review: 2020-05 Dr. James Leung, MUMC PED
Dr. April Kam, MUMC PED
PED ERPs, COVID-19 Expert group, PEMSOC, MUMC PED
MRP - Christine Chaston, Clinical Manager, MUMC PED
Standard Advanced Procedure + Hepa Filter Room Set-up: Equipment
Monitor NRB + BVM Intubation
Checklist Pre-patient arrival equipment
considerations:
Hepa
Verify phone on speaker to
extension labelled on handset
Patient Disposable stethoscope
Oxygen tubing with nasal cannula
Alaris + Patient positioning adjuncts ex.
1000ml NS shoulder roll
Documentation table set-up with
+ IV tubing flow chart, calculator, timer ,
kidney basin for medications
+/- Pharmacy cart
Intubation Box
Red Tray Drop-off
Phone on speaker Resus White
Exit for Documentation Med List Board Enter
*RSW, CLS or otherwise delegated in droplet/contact PPE
10 | P a g eApproved and Released: 2020-04-30 Authors: Alyssa Marfisi, Clinical Practice and Education, MUMC PED
Joint Health & Safety Committee Review: 2020-05 Dr. James Leung, MUMC PED
Dr. April Kam, MUMC PED
PED ERPs, COVID-19 Expert group, PEMSOC, MUMC PED
MRP - Christine Chaston, Clinical Manager, MUMC PED
Standard Work for Resuscitation Personnel
2nd
Additional resources
Most proficient in managing airway RT at discretion of
Airway Primary attempt using glidescope Team Leader
Operator Support ventilation and definitive airway placement Obtain medical history
2nd
MD Utilize language line if necessary
Review labs
Team Review med dosing
2nd most proficient in managing airway Speak with consults
Leader Support ventilation and definitive airway placement
(Airway #2) Closed-loop communication to team outside room to prepare equipment and medication
Most proficient in establishing IV access
Bedside RN Draw required labs
Set up IVF and medication infusions
2nd most proficient in establishing IV access
Bedside RN Place patient on monitor
Runner #1 Obtain supplies using red drop-off table method
Observe and support bedside team in donning/doffing PPE
Runner #2: Donned in Droplet/Contact PPE
RN Next most proficient in skills to switch into room if required
Donned PPE
Review all orders written on white board and obtain equipment
Obtain standard equipment for outside room:
o Broselow Cart
Runner #3: o Airway Cart: obtain all items according to Intubation checklist
RN o Defibrillator: Zoll unit only
Obtain RSI kit from Accudose
Draw up medications according to Resus med list
Document patient care using Resuscitation flowchart
RN Documenter Double check medications as drawn up by Runner #3
11 | P a g eApproved and Released: 2020-04-30 Authors: Alyssa Marfisi, Clinical Practice and Education, MUMC PED
Joint Health & Safety Committee Review: 2020-05 Dr. James Leung, MUMC PED
Dr. April Kam, MUMC PED
PED ERPs, COVID-19 Expert group, PEMSOC, MUMC PED
MRP - Christine Chaston, Clinical Manager, MUMC PED
Airborne + Eye Protection Donning and Doffing Instructions
12 | P a g eApproved and Released: 2020-04-30 Authors: Alyssa Marfisi, Clinical Practice and Education, MUMC PED
Joint Health & Safety Committee Review: 2020-05 Dr. James Leung, MUMC PED
Dr. April Kam, MUMC PED
PED ERPs, COVID-19 Expert group, PEMSOC, MUMC PED
MRP - Christine Chaston, Clinical Manager, MUMC PED
Airborne + Eye Protection Donning and Doffing Locations
Acute 1 AIIR Room Advanced Procedure Room + Portable HEPA Filter Unit
Patient/bed enter through main door from the hallway Patient/bed enter through ‘exit’ door in back hallway
Staff don PPE in hallway using Airborne PPE cart Staff don PPE in main ED hallway using Airborne PPE cart
Staff use tape to place name on front/back of PPE to ensure Staff use tape to place name on front/back of PPE to ensure
closed-loop communication closed-loop communication
Staff enter room using main door Staff use ‘enter’ door to enter room
Doff all PPE (including N95 respirator) in anteroom Staff doff all PPE (including N95) next to exit door
*Observed/Instructed by another staff through window *Observed/Instructed by another staff through view window
Use sink to wash hands x 20s using phone on speaker
Exit to hallway, opening door with elbow Exit into the hall directly to Alcohol Based Hand Sanitizer
13 | P a g eApproved and Released: 2020-04-30 Authors: Alyssa Marfisi, Clinical Practice and Education, MUMC PED
Joint Health & Safety Committee Review: 2020-05 Dr. James Leung, MUMC PED
Dr. April Kam, MUMC PED
PED ERPs, COVID-19 Expert group, PEMSOC, MUMC PED
MRP - Christine Chaston, Clinical Manager, MUMC PED
Resuscitation Pathway for Suspected or Confirmed COVID-19 patient:
14 | P a g eApproved and Released: 2020-04-30 Authors: Alyssa Marfisi, Clinical Practice and Education, MUMC PED
Joint Health & Safety Committee Review: 2020-05 Dr. James Leung, MUMC PED
Dr. April Kam, MUMC PED
PED ERPs, COVID-19 Expert group, PEMSOC, MUMC PED
MRP - Christine Chaston, Clinical Manager, MUMC PED
Resuscitation Pathway for Suspected or Confirmed COVID-19 patient cont’d:
15 | P a g eApproved and Released: 2020-04-30 Authors: Alyssa Marfisi, Clinical Practice and Education, MUMC PED
Joint Health & Safety Committee Review: 2020-05 Dr. James Leung, MUMC PED
Dr. April Kam, MUMC PED
PED ERPs, COVID-19 Expert group, PEMSOC, MUMC PED
MRP - Christine Chaston, Clinical Manager, MUMC PED
Disposition from the PED WITHOUT active AGMP:
1. Ensure receiving unit aware of pending transfer and isolation precautions
2. Clean high-touch areas of patient stretcher
3. Ensure all transport staff are aware of isolation precautions
4. Ensure patient chart remains clean during transport
5. If possible, patient should wear surgical mask
6. If patient unable to wear surgical mask, transport staff to wear mask and eye protection
*Please follow universal masking procedures if active
7. Staff to perform hand hygiene when leaving room, prior to patient transfer
8. Ticket to Ride 2 (TTR2) to be completed if no RN accompaniment
Disposition from the PED WITH active AGMP or stably intubated:
1. Ensure receiving unit aware of pending transfer and isolation precautions
2. Clean high-touch areas of patient stretcher
3. Ensure all transport staff are aware of isolation precautions
4. Ensure patient chart remains clean during transport
5. If possible, patient should wear surgical mask
6. Staff to remain in PPE: N95, eye protection, blue fluid resistant disposable gown, gloves
*Please follow universal masking procedures
7. Use the Freight Elevator if travelling to PICU
8. Use main hallway if travelling to OR with staff member to clear hallway
Refer to IPAC transport policy:
http://policy.hhsc.ca/site_published/hhsc/document_render.aspx?documentRender.IdType=6&documentRender
.GenericField=&documentRender.Id=96593
16 | P a g eApproved and Released: 2020-04-30 Authors: Alyssa Marfisi, Clinical Practice and Education, MUMC PED
Joint Health & Safety Committee Review: 2020-05 Dr. James Leung, MUMC PED
Dr. April Kam, MUMC PED
PED ERPs, COVID-19 Expert group, PEMSOC, MUMC PED
MRP - Christine Chaston, Clinical Manager, MUMC PED
Debriefing Guidelines:
Post resuscitation debriefing (PRD) is a valuable educational tool in emergency medicine. It is recommended by international resuscitation
guidelines, has been shown to improve both patient outcomes and resuscitation team performance, and is frequently requested by medical
learners. The purpose of PRD is to facilitate reflective discussion of actions and thought processes, providing the opportunity for experiential
learning. Debriefing allows for both interpersonal feedback as well as the identification of larger systems-level issues in patient care. PRD has
been shown to improve patient outcomes on a number of measurable factors including the rate of return of spontaneous circulation, neurologic
outcomes, hand-off time for chest compressions during cardiopulmonary resuscitation, and delay in initiating chest compressions. Furthermore,
PRD has been shown to be beneficial for health care providers, reducing stress and helping providers feel more comfortable and competent in
their role during resuscitations.
McMaster Children’s Hospital ED has participated in the piloting of PRD with high uptake by staff. It would be beneficial for the team for
continued debriefing after resuscitations, unexpected clinical deteriorations, or other events deemed to require debriefing by the clinical team
(e.g. de-escalation of patient/staff).
The principles of debriefing after resuscitation include that the team will aim for it to be:
1. Efficient (can be anywhere from 5 to 30 minutes with an average of 15 minutes depending on specific case)
2. Timely (occurring as soon as possible after event when clinically safe to do so)
3. A safe space for all (open, respectful communication, with only staff present during event present)
4. Engaging - active participation by those present (inviting RT, consulting staff as relevant, and allowing that there may not be 100% attendance
due to various limitations)
5. Accountability - follow through of improvement opportunities/patient safety issues (through drop-off of debriefing form and/or improvement
opportunity forms) of specific quality improvement suggestions to the ED Manager/Educator for follow up through either or both of continuous
quality improvement opportunities and PED Best Practices committee
There are two frameworks available in the debriefing box located in the PED depending on comfort level of team leader/debriefing facilitator.
17 | P a g eApproved and Released: 2020-04-30 Authors: Alyssa Marfisi, Clinical Practice and Education, MUMC PED
Joint Health & Safety Committee Review: 2020-05 Dr. James Leung, MUMC PED
Dr. April Kam, MUMC PED
PED ERPs, COVID-19 Expert group, PEMSOC, MUMC PED
MRP - Christine Chaston, Clinical Manager, MUMC PED
COVID-19 Respiratory Literature:
World Health Organization. Mar. 2020. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is
suspected. file:///C:/Users/HSL%20STAFF/Downloads/WHO-2019-nCoV-clinical-2020.4-eng.pdf
Royal College of Paediatrics and Child Health. Mar. 2020. Covid-19 – guidance for paediatric services.
https://www.rcpch.ac.uk/sites/default/files/generated-pdf/document/COVID-19---guidance-for-paediatric-services.pdf
Canadian Paediatric Society. COVID-19 information and resources for paediatricians. https://www.cps.ca/en/tools-outils/covid-19-
information-and-resources-for-paediatricians
Centers for Disease Control and Prevention. Interim Infection Prevention and Control Recommendations for Patients with Suspected
or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings. https://www.cdc.gov/coronavirus/2019-ncov/infection-
control/control-recommendations.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-
ncov%2Fhcp%2Finfection-control.html
Alberta Health Services. Mar. 2020. Care of the Pediatric Critically Ill COVID-19 Patient Annex E.
https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-care-pedatric-critically-ill.pdf
American Heart Association. Interim guidance to reduce COVID-19 transmission during resuscitation care [press release]. Dallas,
Texas: American Heart Association. https://newsroom.heart.org/news/interim-guidance-to-reduce-covid-19-transmission-during-
resuscitation-care.
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