Protected Code Blue - Prehospital

Protocols and Procedures during CPR


  • Wear full PPE (including N95, Face mask, gown, gloves)
  • Intraosseous access over IV access
  • Early airway with SGA + viral filter
  • Perform airway procedure prior to loading patient in ambulance if possible
  • Early defibrillation (if indicated)
  • Notify receiving facility of COVID cardiac arrest
  • Minimize number of personnel


  • Perform rescue breaths
  • Mask ventilate prior to placing SGA
  • Attempt endotracheal intubation in prehospital setting


  • Consider field termination (follow local protocols)


*Some of these recommendations are based on our opinion/experience, please consult with local protocols

Savary, D., Morin, F., Fadel, M., Metton, P., Richard, J. F., & Descatha, A. (2020). Considering the challenge of the Covid-19 pandemic, is there a need to adapt the guidelines for basic life support resuscitation? Resuscitation.

Smereka, J., Szarpak, L., Filipiak, K. J., Jaguszewski, M., & Ladny, J. R. (2020). Which intravascular access should we use in patients with suspected/confirmed COVID-19? Resuscitation, 151, 8–9.

Couper, K., Taylor-Phillips, S., Grove, A., Freeman, K., Osokogu, O., Court, R., Mehrabian, A., Morley, P. T., Nolan, J. P., Soar, J., & Perkins, G. D. (2020). COVID-19 in cardiac arrest and infection risk to rescuers: A systematic review. Resuscitation, 151, 59–66.

Last Updated 1 year ago


1. Wash and glove hands and assemble mannequin shield
2. Place SGA through CPR mannequin shield
3. Thread distal end of SGA tip through small 1-cm cut in elastic tape
4. Thread distal SGA tip through plastic of CPR shield
5. Connect HMEF to distal tip/connector of SGA
6. Bunch elastic around tip and pull up plastic of CPR shield around the HMEF 
7. Apply tubular gauze around HMEF and contents 
8. Store SGA+filter assembled with lubricant in sealed plastic bag 


Yang, W.-S., Hou, S.-W., Lee, B.-C., Chiang, W.-C., Chien, Y.-C., Chen, S.-Y., & Ma, M. H.-M. (2020). Taipei Azalea - Supraglottic airways (SGA) preassembled with high-efficiency particulate air (HEPA) filters to simplify prehospital airway management for patients with out-of-hospital cardiac arrests (OHCA) during Coronavirus Disease 2019 (COVID-19) pandemic. Resuscitation, 151, 3–5.

Last Updated 1 year ago
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