PG19 Resuscitation in covid patients- an in-situ simulation that resulted in immediate change of practice

Introduction Early in the coronavirus epidemic prior to lockdown, the resus council released its guidance on resuscitation in patients who were considered high risk for covid. We tested the guidance with a multiprofessional in situ sim on AMU. Design Teams from AMU, theatres and anaesthetics and the trust lead for resuscitation attended AMU for a prebrief. Our simulation team admitted SimMan into a side room on the AMU as a possible covid patient but as per guidance at that time was not being nursed with level 3 PPE. The anaesthetic team were to be on ITU where they would normally be based if covering the crash bleep. The nurse in charge of the patient was the first responder who noticed a change in their patient and called a junior doctor. By the time the junior doctor arrived the patient was in cardiac arrest and a crash call put out. The time taken to respond, to establish a secure airway and to initiate first shock were noted. There was then a multiprofessional debrief involving all of the teams. The simulation was repeated a week later to see if findings were consistent. Results Time taken to establish a secure airway was on average 15 minutes with time to first shock being administered of 7 minutes. The requirement for full PPE added a significant delay and complication to the process. The anaesthetists found difficulty in ensuring cross contamination did not occur when using airway adjuncts. Discussion We felt the delay in establishing an airway and instigating the first shock was unacceptable. This was despite the team being primed and ready to respond to the crash when it happened. We therefore changed local guidance ahead of national guidance being altered that the first attender could deliver a shock even if not in PPE. The need for early discussion around DNACPR was established and because of this simulation awareness of this issue was spread before national guidance was circulated. Changes were made to the crash trolley including transparent bags for the anaesthetists to keep used equipment clean and to hand. The juniors involved summarised their learning (appendix) and circulated this to the junior staff. It is not often that we are able to demonstrate such a clear change in practice as being directly applicable to a simulation. This undoubtedly had a clear benefit for our patients.