Abstract
Background
There may be a risk of COVID-19 transmission to rescuers delivering treatment for
cardiac arrest. The aim of this review was to identify the potential risk of transmission
associated with key interventions (chest compressions, defibrillation, cardiopulmonary
resuscitation) to inform international treatment recommendations.
Methods
We undertook a systematic review comprising three questions: (1) aerosol generation
associated with key interventions; (2) risk of airborne infection transmission associated
with key interventions; and (3) the effect of different personal protective equipment
strategies. We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials,
and the World Health Organization COVID-19 database on 24th March 2020. Eligibility
criteria were developed individually for each question. We assessed risk of bias for
individual studies, and used the GRADE process to assess evidence certainty by outcome.
Results
We included eleven studies: two cohort studies, one case control study, five case
reports, and three manikin randomised controlled trials. We did not find any direct
evidence that chest compressions or defibrillation either are or are not associated
with aerosol generation or transmission of infection. Data from manikin studies indicates
that donning of personal protective equipment delays treatment delivery. Studies provided
only indirect evidence, with no study describing patients with COVID-19. Evidence
certainty was low or very low for all outcomes.
Conclusion
It is uncertain whether chest compressions or defibrillation cause aerosol generation
or transmission of COVID-19 to rescuers. There is very limited evidence and a rapid
need for further studies.
Review registration: PROSPERO CRD42020175594.
Keywords
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Article info
Publication history
Published online: April 20, 2020
Accepted:
April 16,
2020
Received in revised form:
April 15,
2020
Received:
April 6,
2020
Identification
Copyright
© 2020 Published by Elsevier B.V.
