The balance of benefits and risks has changed, and practice must change with it In normal times, the medical obligation to “first do no harm” applies to the actions of individual doctors on individual patients. During pandemics, the ethical imperatives shift: we must consider the safety of not only the individual patient but also the clinician and the population. Guidelines on attempting cardiopulmonary resuscitation (CPR) in the acute hospital setting for patients with covid-19 have produced conflict and moral discomfort because of differences of opinion about the balance of benefits and risks to both patients and staff.1 In normal circumstances, the annual incidence of in-hospital cardiac arrests in adults is 1-10 per 1000 admissions.23 Those with non-cardiac causes of cardiac arrest have worse outcomes.3 In 80% of cardiac arrests the patient has a non-shockable rhythm (pulseless electrical activity or asystole), for which survival to hospital discharge is around 15-20%.2 By contrast, the likelihood of survival from an initially shockable rhythm is 2-3 times higher (about 50%).2 However, these figures can be misleading because CPR will not be attempted in patients who are unlikely to survive resuscitation or the period of ventilation on an intensive care unit that often follows. The decision …

中文翻译：

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使用covid-19入院后进行心肺复苏

利益与风险之间的平衡已经改变，实践也必须随之改变。在正常情况下，“首先没有伤害”的医疗义务适用于个别医生对个别患者的行为。在大流行期间，道德要求发生了变化：我们不仅必须考虑患者的安全，而且还必须考虑临床医生和人群的安全。由于对患者和员工双方的利益和风险之间的平衡存在意见分歧，在急性医院环境中对covid-19患者尝试心肺复苏（CPR）的准则产生了冲突和道德上的不适。1在正常情况下，每年成人的院内心脏骤停的发病率是每1000例入院1-10例。23非心脏原因引起的心脏骤停的人预后较差。3在80％的心脏骤停中，患者有不可电击的节律（无脉冲电活动或心搏停止），其出院生存率约为15-20％。2相比之下，最初令人震惊的节律可以使患者存活高出2到3倍（约50％）。2但是，这些数字可能会产生误导，因为在复苏后或在重症监护病房通气后难以幸存的患者中，将不会进行心肺复苏术。决定…… 这些数字可能会产生误导，因为在复苏后或在重症监护病房通气后通常无法生存的患者中，将不会进行心肺复苏术。决定…… 这些数字可能会产生误导，因为在复苏后或在重症监护病房通气后通常无法生存的患者中，将不会进行心肺复苏术。决定……