Confusion around what to do during COVID-19 when someone’s in a cardiac arrest could cause delay in life-saving action. With 80% of out of hospital sudden cardiac arrests occurring in the home and with a person’s chance of surviving a cardiac arrest reducing by 10% for every minute without CPR and defibrillation, the clear message is to learn CPR and have the confidence to use it.
Whenever CPR is carried out, particularly on an unknown victim, there is of course some risk of cross infection, associated particularly with giving rescue breaths. Normally, this risk is very small and is set against the inevitability that a person in cardiac arrest will die if no assistance is given.
The first things to do are shout for help and dial 999.
Watch what to do in an emergency:
- First responders should consult the latest advice on the NHS website ( https://www.gov.uk/government/publications/novel-coronavirus-2019-ncov-interim-guidance-for-first-responders/interim-guidance-for-first-responders-and-others-in-close-contact-with-symptomatic-people-with-potential-2019-ncov).
- Those laypeople and first responders with a duty of care (workplace first-aiders, sports coaches etc.) that may include CPR should be guided by their employer’s advice.
- This guidance may change based on increasing experience in the care of patients with COVID-19.
- Resuscitation Council UK Guidelines 2015 state “If you are untrained or unable to do rescue breaths, give chest compression-only CPR (i.e. continuous compressions at a rate of at least 100–120 min-1)”
Because of the heightened awareness of the possibility that the victim may have COVID-19, Resuscitation Council UK offers this advice:
- Recognise cardiac arrest by looking for the absence of signs of life and the absence of normal breathing. Do not listen or feel for breathing by placing your ear and cheek close to the patient’s mouth. If you are in any doubt about confirming cardiac arrest, the default position is to start chest compressions until help arrives.
- Make sure an ambulance is on its way. If COVID 19 is suspected, tell them when you call 999.
- If there is a perceived risk of infection, rescuers should place a cloth/towel over the victims mouth and nose and attempt compression only CPR and early defibrillation until the ambulance (or advanced care team) arrives. Put hands together in the middle of the chest and push hard and fast.
- Early use of a defibrillator significantly increases the person’s chances of survival and does not increase risk of infection.
- If the rescuer has access to any form of personal protective equipment (PPE) this should be worn.
- After performing compression-only CPR, all rescuers should wash their hands thoroughly with soap and water; alcohol-based hand gel is a convenient alternative. They should also seek advice from the NHS 111 coronavirus advice service or medical adviser.
- We are aware that paediatric cardiac arrest is unlikely to be caused by a cardiac problem and is more likely to be a respiratory one, making ventilations crucial to the child’s chances of survival. However, for those not trained in paediatric resuscitation, the most important thing is to act quickly to ensure the child gets the treatment they need in the critical situation.
- For out-of-hospital cardiac arrest, the importance of calling an ambulance and taking immediate action cannot be stressed highly enough. If a child is not breathing normally and no actions are taken, their heart will stop and full cardiac arrest will occur.
- Therefore, if there is any doubt about what to do, this statement should be used.
It is likely that the child/infant having an out-of-hospital cardiac arrest will be known to you. We accept that doing rescue breaths will increase the risk of transmitting the COVID-19 virus, either to the rescuer or the child/infant. However, this risk is small compared to the risk of taking no action as this will result in certain cardiac arrest and the death of the child.
To conclude, failure to provide effective CPR in the event of cardiac arrest will undoubtedly lead to death of a casualty. Effective CPR is absolutely necessary to be in with a chance of preserving life.
In adults, it is recommended that you do not perform mouth-to-mouth ventilation given the current COVID-19 pandemic – perform chest compressions only. Compression only CPR may be as effective as combined ventilation and compression in the first few minutes after non-asphyxial arrest (cardiac arrest not due to lack of oxygen).
If you suspect asphyxial arrest (due to a lack of oxygen) for example, drowning, allergic reaction, choking etc then mouth to mouth ventilation alongside chest compression is absolutely necessary if the casualty is to stand any chance of survival.
Cardiac arrest in children is more likely to be caused by a respiratory problem (asphyxial arrest), therefore chest compressions alone are unlikely to be effective.
If a decision is made to perform mouth-to-mouth ventilation in asphyxial arrest, use a resuscitation face shield and appropriate Personal Protection Equipment (PPE) where available.