The 2020 Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) are a comprehensive revision of the AHA’s guidelines for adult, pediatric, neonatal, resuscitation education science, and systems of care topics. They have been developed for resuscitation providers and AHA instructors to focus on the resuscitation science and guidelines recommendations that are most significant or controversial, or those that will result in changes in resuscitation training and practice, and to provide the rationale for the recommendations.
The Kenya Emergency Medical Care (EMC) Policy 2020-2030 is the first-ever policy in Kenya that seeks to establish a working Emergency Medical Care (EMC) System as a key component of the healthcare system in the country. The policy also speaks to the World Health Assembly resolution WHA 72.16 of 21 May 2019 which urged member states to create policies for sustainable funding, effective governance and universal access to safe, high-quality, needs-based emergency care for all as part of universal health coverage. In developing this policy, the Ministry of Health (MOH) aims to ensure access to the highest standards of emergency medical care in Kenya as envisioned in The Constitution of Kenya (2010) and the Health Act (2017) which guarantees every Kenyan the right to emergency medical treatment.
Patients who are assessed by a Health Care Worker and meet all the criteria below will be considered for home-based isolation and care:
- Laboratory confirmed COVID-19
- Asymptomatic patients or patients with mild symptoms of COVID-19
- Absence of comorbidities
- Access to a suitable space for home-based isolation and care
The findings of this well done randomized controlled trial indicate that in patients with COVID-19 pneumonia, that dexamethasone improves 28d mortality compared to placebo in patients requiring invasive mechanical ventilation (IMV) (NNT = 8.5) and those patients requiring oxygen therapy (NNT = 29). There was no benefit to patients not requiring oxygenation support and even a signal for harm. It is important to remember this is a preprint, preliminary report, which is better than a press release. At this time, in patients requiring any oxygen therapy, HFNC, NIV, IMV, or ECMO I would recommend dexamethasone until further evidence disproves this benefit.