CPR and resuscitation in first aid and community settings
This statement is for anyone who is performing CPR/defibrillation in an out-of-hospital setting.
Whenever CPR is carried out, particularly on an unknown victim, there is some risk of cross infection, associated particularly with giving rescue breaths. Normally, this risk is very small and is set against the inevitability that a person in cardiac arrest will die if no assistance is given. The first things to do are shout for help and dial 999.
“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 per minute”.
Resuscitation Council UK Guidelines 2015
Because of the heightened awareness of the possibility that the victim may have COVID-19, Resuscitation Council UK offers this advice:
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.
General recommendations for BLS in adults by lay rescuers for suspected or confirmed COVID-19. This guideline was provided on 24 April 2020 and will be subject to evolving knowledge and experience of COVID-19. As countries are at different stages of the pandemic, there may be some international variation in practice.
Check for responsiveness - in an unresponsive child, assess breathing visually (chest rise) and optionally by placing a ‘hand on the belly’. Do not approach the victim’s mouth or nose at this stage. Cardiac arrest is defined by ‘being unresponsive and not breathing normally’.
Untrained lay rescuers will likely have called the emergency medical services [EMS] dispatcher (112/national emergency number) at the start; trained providers should do so before starting chest compressions. In cases where there are two or more rescuers, a second rescuer should call the EMS immediately.
Once cardiac arrest is identified, rescuers should provide at least compression-only CPR. In such a case, place a surgical mask over the child’s mouth and nose before commencing chest compressions. The routine use of a cloth as an alternative is not advised because of the potential risk of airway obstruction and/or restriction of passive air movement (due to compressions); there is also no evidence that a cloth prevents airborne transmission. However, when a surgical mask is not available and this cloth encourages rescuers to provide support where otherwise they would not, they should use it (lightly draped over mouth and nose).
Unless a primary cardiac origin is likely (‘sudden witnessed collapse’), those rescuers who are willing and able should also open the airway and provide rescue breaths, as per 2015 guidelines, knowing that this is likely to increase the risk of infection (if the child has COVID-19), but can signi cantly improve the outcome (see ‘Protection of bystanders and healthcare professionals’).
When an automated external de brillator [AED] is readily available, trained providers should use it as soon as feasible. An AED should primarily be advised as part of dispatcher-assisted CPR in those cases where the likelihood of a primary shockable rhythm is suficiently high: in cases of sudden witnessed collapse; for children with a specific ‘cardiac’ history; or for children older than 1 year of age without any identifiable non-cardiac cause of arrest, always provided there are at least two bystanders and an AED nearby.
The Health & Safety Executive in the UK states the following;
If you hold a first aid certificate that expires on or after 16 March 2020 and cannot access requalification training because of coronavirus you may qualify for a 3-month extension. This applies to:
To qualify for the extension, you must be able to explain why you haven’t been able to requalify and demonstrate what steps you have taken to access the training, if asked to do so.