If someone is not breathing, performing CPR (cardio-pulmonary resuscitation) can give that person a chance of survival. CPR is chest compressions, often combined with artificial ventilation (or rescue breaths), which helps circulate oxygenated blood around a casualty who is not breathing normally – and it’s vital to help save a life. If CPR is not performed effectively when needed, chances of survival drop significantly with every minute that passes.
CPR involves close contact with the casualty. It’s certainly not possible to follow the 2 metre social distancing rule that is advised to limit the spread of COVID-19 while performing CPR! This raises the question – how can we protect ourselves at this time of COVID-19, while still ensuring we help others who need urgent lifesaving treatment?
The UK Resuscitation Council have produced some helpful advice for performing CPR in a first aid / community setting during the time of 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 115.
- 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 personal protective equipment (PPE) (e.g. FFP3 face mask, disposable gloves, eye protection), these 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 COVID-19 Hotlines.
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. “
For those who are trained, using a pocket mask with a one way valve may also reduce the risk of infection while giving artificial respirations. A bag valve mask (BVM) offers greater protection also.
In Vietnam, it is worth noting at the time of writing this that the number of confirmed is relatively low compared to other countries, especially the UK. It is still important that CPR is provided in community settings for casualties who are not breathing – it may save a life!
UK Resuscitation Council – taken on 08/04/2020: https://www.resus.org.uk/media/statements/resuscitation-council-uk-statements-on-covid-19-coronavirus-cpr-and-resuscitation/covid-community/