key: cord-0882893-0aynfe9e authors: Mudalige, N. Lakmal; Sze, Shirley; Oyefeso, Oluwatobiloba; Koeckerling, David; Barker, Joseph; Pan, Daniel title: To PPE or not to PPE? Making sense of conflicting international recommendations for PPE during chest compressions in patients with COVID-19 date: 2020-09-22 journal: Resuscitation DOI: 10.1016/j.resuscitation.2020.09.019 sha: 1cb5499eb6e463fcd44e6912cfe7459dc6ee0cae doc_id: 882893 cord_uid: 0aynfe9e nan This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. We therefore reviewed the COVID-19 resuscitation guidelines of the ten countries with the highest incidence of COVID-19 as of 29 th June 2020, focusing on PPE recommendations for chest compressions. In addition, we searched MEDLINE between 1 December 2019 and 29 th June 2020, using the terms "guidelines, recommendations, COVID-19, resuscitation, and chest compressions" and approached experts in infectious diseases and resuscitation to systematically identify any guidelines independent of the resuscitation councils. There is in fact, little evidence for or against transmission of SARS-CoV-2 during chest compressions. Whilst there is biological plausibility for viral aerosolisation from passive ventilation during chest compressions, generation of robust clinical evidence is difficult due to the sudden and emergent nature of CPR. [1] The recently commissioned systematic review by Couper and colleagues, from ILCOR, recommends full PPE prior to commencing chest compressions, whilst acknowledging the low level of evidence upon which to generate these recommendations are made. [4] This is in contrast to the older evidence cited by PHE to refute the requirement for full PPE during CPR. It is worth noting this review is based on respiratory viruses other than SARS-CoV-2 and the USA cite the same meta-analysis whilst concluding the opposite and recommending full PPE. [1] In conclusion, guidelines for chest compressions in patients with COVID-19 amongst different countries are highly variable. Importantly, there is currently no clear consensus as to whether PPE should be worn during chest compressions. Further research is needed to establish how infectivity during CPR can be measured accurately. The development of an evidence-based CPR guideline for patients with COVID-19 is an urgent research priority. Dr. Pan has nothing to disclose. Dr. Mudalige has nothing to disclose. Dr. Sze has nothing to disclose. Dr. Oyefeso has nothing to disclose. Dr. Koeckerling has nothing to disclose. Dr. Pan has nothing to disclose. Aerosol Generating Procedures and Risk of Transmission of Acute Respiratory Infections to Healthcare Workers : A Systematic Review COVID-19 infection risk to rescuers from patients in cardiac arrest Rational use of personal protective equipment ( PPE ) for coronavirus disease ( COVID-19 ) COVID-19 in cardiac arrest and infection risk to rescuers: a systematic review