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.
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.
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.
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.
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- Coronavirus disease (COVID-19) pandemic.2020 (https://www.who.int/emergencies/diseases/novel-coronavirus-2019 [accessed 04.04.20])
- Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China.JAMA. 2020; 323: 1061-1069
- Modes of transmission of virus causing COVID-19: implications for IPC precaution recommendations.World Health Organization, Geneva2020 (https://www.who.int/news-room/commentaries/detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations [accessed 31.03.20])
- Infection prevention and control of epidemic- and pandemic-prone acute respiratory infections in health care: WHO guidelines.World Health Organization, Geneva2020 (https://apps.who.int/iris/bitstream/handle/10665/112656/9789241507134_eng.pdf?sequence=1 [accessed 31.03.20])
- Guidance: COVID-19: infection prevention and control. GOV.UK.2020 (https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control [accessed 31.03.20])
- Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review.PLoS ONE. 2012; 7: e35797
- European Resuscitation Council Guidelines for Resuscitation 2015: Section 2. Adult basic life support and automated external defibrillation.Resuscitation. 2015; 95: 81-99
- Delayed time to defibrillation after in-hospital cardiac arrest.N Engl J Med. 2008; 358: 9-17
- Using simulation for training and to change protocol during the outbreak of severe acute respiratory syndrome.Critical Care. 2006; 10: R3
- Predicting survival from out-of-hospital cardiac arrest: a graphic model.Ann Emerg Med. 1993; 22: 1652-1658
- Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.BMJ. 2009; 339: b2535
- Aerosol-generating procedures and risk of transmission of acute respiratory infections: a systematic review.Canadian Agency for Drugs and Technologies in Health, Ottowa2011 (https://www.cadth.ca/sites/default/files/pdf/M0023__Aerosol_Generating_Procedures_e.pdf [accessed 20.03.20])
- Global research on coronavirus disease (COVID-19).2020 (https://www.who.int/emergencies/diseases/novel-coronavirus-2019/global-research-on-novel-coronavirus-2019-ncov [accessed 27.03.20])
- Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19).Intensive Care Med. 2020; (Mar 28 [Epub ahead of print])https://doi.org/10.1007/s00134-020-6022-5
- The Cochrane Collaboration's tool for assessing risk of bias in randomised trials.BMJ. 2011; 343: d5928
- Tool to assess risk of bias in case-control studies.2017 (https://www.evidencepartners.com/wp-content/uploads/2017/09/Tool-to-Assess-Risk-of-Bias-in-Case-Control-Studies.pdf [accessed 26.03.20])
- Tool to assess risk of bias in cohort studies.2017 (https://www.evidencepartners.com/wp-content/uploads/2017/09/Tool-to-Assess-Risk-of-Bias-in-Cohort-Studies.pdf [accessed 26.03.20])
- Methodological quality and synthesis of case series and case reports.BMJ Evid-Based Med. 2018; 23: 60-63
- GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables.J Clin Epidemiol. 2011; 64: 383-394
- Transmission of Panton-Valentine leukocidin-producing Staphylococcus aureus to a physician during resuscitation of a child.Clin Infect Dis. 2005; 41: e29-e30
- Possible SARS coronavirus transmission during cardiopulmonary resuscitation.Emerg Infect Dis. 2004; 10: 287-293
- Nosocomial transmission of severe fever with thrombocytopenia syndrome in Korea.Clin Infect Dis. 2015; 60: 1681-1683
- Transmission of tuberculosis during cardiopulmonary resuscitation. Focus on breathing system filters.Notf Rettungsmed. 2016; 19: 48-51
- Risk factors for SARS infection among hospital healthcare workers in Beijing: a case control study.Trop Med Int Health. 2009; 14: 52-59
- SARS among critical care nurses, Toronto.Emerg Infect Dis. 2004; 10: 251-255
- Healthcare worker infected with Middle East Respiratory Syndrome during cardiopulmonary resuscitation in Korea, 2015.Epidemiol Health. 2017; 39: e2017052
- Risk factors for SARS transmission from patients requiring intubation: a multicentre investigation in Toronto, Canada.PLoS One. 2010; 5: e10717
- Respiratory protection during simulated emergency pediatric life support: a randomized, controlled, crossover study.Prehospital Disaster Med. 2013; 28: 33-38
- Comparing the protective performances of 3 types of N95 filtering facepiece respirators during chest compressions: a randomized simulation study.Medicine (Baltimore). 2017; 96: e8308
- The “delay effect” of donning a gown during cardiopulmonary resuscitation in a simulation model.CJEM. 2008; 10: 333-338
- Risk factors of healthcare workers with corona virus disease 2019: a retrospective cohort study in a designated hospital of Wuhan in China.Clin Infect Dis. 2020; (Mar 17 [Epub ahead of print])https://doi.org/10.1093/cid/ciaa287
- Does compression-only cardiopulmonary resuscitation generate adequate passive ventilation during cardiac arrest?.Resuscitation. 2007; 75: 53-59
- Evaluation of droplet dispersion during non-invasive ventilation, oxygen therapy, nebuliser treatment and chest physiotherapy in clinical practice: implications for management of pandemic influenza and other airborne infections.Health Technol Assess. 2010; 14: 131-172
- Why did outbreaks of severe acute respiratory syndrome occur in some hospital wards but not in others?.Clin Infect Dis. 2007; 44: 1017-1025
Published online: April 20, 2020
Accepted: April 16, 2020
Received in revised form: April 15, 2020
Received: April 6, 2020
© 2020 Published by Elsevier B.V.