Risk of COVID-19 infection associated with bystander CPR

Editor's Note

Bystander cardiopulmonary resuscitation (CPR) is a lifesaving procedure whose benefits outweigh the risk of COVID-19 infection, finds this study.

University of Washington, Seattle, researchers’ analysis of data found that from January 1 to April 15, emergency medical services (EMS) responded to 1,067 out-of-hospital cardiac arrests of which 478 were treated with CPR. During the active period of COVID-19 (February 26 to April 15), EMS responded to 537 out-of-hospital cardiac arrests, of which 230 were treated with CPR.

As of April 15:

• There were 15 deaths/100,000 population from COVID-19.
• COVID-19 was diagnosed in less than 10% of out-of-hospital cardiac arrests.
• Assuming the risk of transmission to bystanders performing CPR without PPE is 10%, treating 100 patients could result in 1 bystander infection.
• Given a 1% mortality for COVID-19, approximately 1 bystander might died in 10,000 CPR events.
• In comparison, bystander CPR saves more than 300 additional lives/10,000 patients with out-of-hospital cardiac arrest.

The current findings support bystanders maintaining the most efficient approach that prioritizes rapid identification of cardiac arrest and proceed to chest compressions and use of a defibrillator, the authors say. Delaying CPR to put on PPE should only be considered with the prevalence of COVID-19 is substantially increased.