Guidance on Cardio-Pulmonary Resuscitation (CPR) for lay rescuers in the context of COVID-19

Immediate cardio-pulmonary resuscitation (CPR) and use of an automated external defibrillator (AED) are vital to the survival of people who have a cardiac arrest. In the community CPR is often provided by a member of the public (lay rescuer) while waiting for the ambulance service to arrive. Ireland has a very high number of trained lay rescuers who save many lives every year by giving help to people who have a cardiac arrest.

This note gives lay rescuers information about what COVID-19 means for them when faced with a situation where someone needs CPR.

The disease COVID-19 is caused by a virus. The virus is shed from the respiratory tract of people who are infected and it causes infection in other people when it reaches their respiratory tract. The virus can be present in fluid and droplets from the mouth and nose before a person shows any symptoms of COVID-19. If someone has a cardiac arrest in a public place and you are first on the scene you probably will not know whether or not they have symptoms of COVID-19.

For many people who were willing to carry out CPR a few months ago it is now more difficult to know what to do because of COVID-19. The decision is very personal and may depend on how well you know the person who has the cardiac arrest, how vulnerable you are to severe disease or death from COVID-19 and your responsibility to provide and care for other people who depend on you including your spouse, children or parents.

This information leaflet does not tell you to carry out CPR and it does not tell you not to carry out CPR. It will give you some information to help you decide the right thing for you to do if you have to make this very difficult choice.

What is the risk if you decide to carry out CPR?
At the time of writing this leaflet, we know of no case in the world where a person has become infected with COVID-19 while acting as a lay rescuer to a cardiac arrest.

Even though thousands of people in Ireland have tested positive for COVID-19 since February, the chance that any individual person who has a cardiac arrest has COVID-19 at the time they have the cardiac arrest is low but there is no way to be sure.

If you provide first aid of any kind including CPR to a person with COVID-19 you are at risk of getting infection from them if the virus from the person gets into your nose, eyes or mouth. Direct contact with the airway (fluids from the nose or mouth) is the highest risk part of attending to anyone with a cardiac arrest.  Performing chest compression and using the AED on someone who has COVID-19 infection is a much lower risk activity than managing the airway but there is still a risk.  The most important measures that improve survival of most people with cardiac arrest are chest compression and use of the AED.

If you decide you are able to act as a lay rescuer

  1. Keep your hands away from your face and thoroughly clean your hands (soap and water or alcohol hand rubs) as soon as you finish attending to the person.
  2. If you have access to a mask and gloves used them (you will still need to wash your hands when you take off the gloves)
  3. Avoid any contact of your hands with the airway (for example putting your hands into the mouth) is expected to reduce the risk to a large degree even if the person has COVID-19
  4. If you feel able to give chest compressions and use the AED but want to avoid contact with the airway covering the mouth and nose with a cloth or a tissue may help to reduce the scatter of droplets from their airway.

Note. Although CPR is regarded as an Aerosol Generating Procedure (AGP) this is related to airway management as part of CPR. Use of an Automated External Defibrillator (AED) and performance of chest compression in the absence of airway management are not considered as AGPs associated with an increased risk of transmission of infection. https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control/covid-19-personal-protective-equipment-ppe#ppe-guidance-by-healthcare-context

Version: 1.0

Last updated: 12 May 2020