key: cord-1044448-7brjf135
authors: Perman, Sarah M.
title: Overcoming Fears to Save Lives: COVID-19 and the Threat to Bystander CPR in Out-of-Hospital Cardiac Arrest
date: 2020-07-10
journal: Circulation
DOI: 10.1161/circulationaha.120.048909
sha: a9d7e533279b7c9407569fcf69afc97a47ce8a81
doc_id: 1044448
cord_uid: 7brjf135

nan

will undoubtedly see a devastating effect. Data from Washington showed that in the midst of the pandemic, ≈10% of individuals with cardiac arrest responded to by emergency medical services were COVID-19 positive. Assuming a transmission rate of 10% without personal protective equipment, after treating 100 patients, 1 rescuer may become infected. 4 Rates of OHCA have been increasing during COVID-19, but those arrests may not be caused primarily by the virus, and limiting bystander resuscitative measures to protect the rescuer will undoubtedly result in death caused by cardiac arrest, not necessarily COVID-19.

The American Heart Association has issued an interim guideline on basic life support during COVID-19. 5 Recommendations previously endorsed bCPR by the public for individuals with cardiac arrest, and in 2010 rescue breaths were removed from the basic life support algorithm in favor of a hands-only approach. That being said, even hands-only CPR can result in aerosolization of respiratory droplets and potential fomite transmission of severe acute respiratory syndrome coronavirus 2. Although evidence is sparse, current COVID-19 recommendations include taking caution while still performing bCPR. When CPR is performed on an unresponsive person, all efforts should be made to cover the face of the individual with cardiac arrest with a cloth to minimize the dispersion of respiratory droplets, and the rescuer also should have a face covering if possible for increased protection. Rescue breaths should not be provided, and the rescuer should administer guidelineconcordant chest compressions and placement of an automated external defibrillator as soon as possible. Additional rescuers should remain at a distance, away from the victim's airway and face, until they are needed to assume CPR when the initial rescuer fatigues. These suggested precautions and the early data on the risk of transmission must be relayed to the public immediately, and educational programs for bCPR should be amended to include this information as a means of keeping the rescuer safe while continuing to encourage bystander provision of basic life support to save lives.

Given the real and potential threat of viral inoculation perceived by the public, rates of bCPR will decline, undoubtedly resulting in more loss of life. There are many reasons why the public fears providing bCPR to an unresponsive person; the threat of contracting a deadly viral disease will undoubtedly enter the list of reasons not to render aid. Previous goals to improve rates of bCPR in the community are now in jeopardy as our new normal threatens to reduce current US bCPR rates. Declining rates of bCPR are a reality; addressing this issue before it results in more deaths or neurological disabilities is paramount. CPR saves lives. It saved lives before this pandemic, and it will save lives after this pandemic. Our task is to clearly understand the risk to operators, to train the public in best practices to maintain one's personal safety, and to allay fears once we are safe to do so (Figure) . Waiting for rates of bCPR to drop is too late. We must be prepared to educate and empower rescuers in our new normal. 

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Dr Perman is supported by K23 HL138164 from the National Heart, Lung, and Blood Institute. The views expressed in this manuscript represent those of the author and do not necessarily represent the official views of the National Heart, Lung and Blood Institute.