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CPR and COVID-19 – When is it safe to save a life?


Imagine you’re walking your dog down the street when you see someone ahead of you collapse. Prior to the outbreak of the COVID-19 pandemic, you’d rush to their side, check to see if they are breathing, feel for a heartbeat. Unable to detect either, you’d begin cardiopulmonary resuscitation (CPR) with chest compressions and mouth-to-mouth breaths, potentially saving the stranger’s life.

But today, with the risk of COVID-19 transmission, you might wonder if it’s still safe to help — and you’re not alone. Each year an estimated 350,000 sudden cardiac arrest (SCA) events occur in the United States outside the hospital setting. While Penn-led research shows that survival outcomes for in-hospital cardiac arrest (IHCA) has remains stable throughout the pandemic, survival outcomes for instances of out-of-hospital cardiac arrest (OHCA) have decreased during the same period by around 18 percent.

But people should not be afraid to perform CPR if needed, says Benjamin Abella, MD, MPhil, a professor of Emergency Medicine in the Perelman School of Medicine. “Because of the pandemic, people have been hesitant to step up and help a stranger for fear of contracting COVID-19. But hands-only CPR is a safe and effective way to help someone in cardiac arrest with a very low risk of transmitting the virus. You can even perform it while wearing a mask,” says Abella.

Hands-only CPR, which involves chest compressions with no mouth-to-mouth, is proven to be as effective as conventional CPR (with mouth-to-mouth). The American Heart Association says that for teens and adults experiencing cardiac arrest, the lungs and blood contain enough oxygen to keep vital organs healthy for the first few minutes, as long as someone provides high quality chest compressions with minimal interruption. The most important thing someone near the victim can do for a person in sudden cardiac arrest is to pump blood to the brain and to the heart muscle, delivering the oxygen that still remains in the lungs and blood.

“For patients experiencing cardiac arrest, time is the most valuable resource. The faster someone can help by calling 911 and administering CPR, the likelier it is they will survive,” explains Abella.

Further, a study in Circulation confirmed a very low risk of transmission when infected people receive CPR by someone wearing PPE, like a mask. In the study, the researchers argue that the benefit of saving someone’s life with hands-only CPR far outweighs the low risk of COVID-19 transmission.

In addition to this CPR hesitation trend during the pandemic, social distancing protocols in place during the pandemic have made CPR certification courses — typically taught in group settings — difficult to conduct. As a result, a large number of people haven’t been certified to perform CPR in the first place, or those who were previously certified haven’t been able to renew their certification.

While there are options for online and video training, for immediate guidance, Abella suggests dispatch assisted CPR, where bystanders can call 911 and the dispatcher will walk them through CPR over the phone. Whether you’ve never performed CPR before, or if your certification has lapsed and you’re out of practice, a professional is available to help.

“There are two major determinants of surviving cardiac arrest: if it is witnessed, and if CPR is performed,” says Abella. “People should feel safe and empowered to help a stranger who is experiencing cardiac arrest, even during the COVID-19 pandemic. You could save someone’s life.”

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