Basic life support response during COVID-19

Royal Life Saving has been closely monitoring the COVID-19 Pandemic through official sources, including the Australian Government Department of Health, and State/Territory Government Departments of Health, as well as seeking guidance from organisations such as the Australian Resuscitation Council (ARC).

We have recently received a number of enquiries seeking advice on the delivery of cardiopulmonary resuscitation (CPR) by rescuers/lay persons in an authentic emergency situation (ie, in a non-training environment) in the current COVID-19 Pandemic.

The advice below is based on information and guidelines set out by the International Liaison Committee on Resuscitation (ILCOR). ILCOR’s statement, COVID-19 Practical Guidance for Implementation, suggests that, in the current COVID-19 Pandemic:

• Chest compressions and cardiopulmonary resuscitation have the potential to generate aerosols (weak recommendation, very low certainty evidence).
• Lay rescuers should consider compression-only resuscitation and public access defibrillation (good practice statement).
• Lay rescuers who are willing, trained and able to do so, may wish to deliver rescue breaths to children in addition to chest compressions (good practice statement).
• Royal Life Saving interprets this to include infants aged 0 to 1 year as well as children aged 1 to 8 years.
• Healthcare professionals should use personal protective equipment for aerosol generating procedures during resuscitation (weak recommendation, very low certainty evidence).
• It may be reasonable for healthcare providers to consider defibrillation before donning personal protective equipment in situations where the provider assesses the benefits may exceed the risks (good practice statement).

In its Statement on COVID-19 in relation to CPR and resuscitation in first aid and community settings, the Resuscitation Council (UK) notes that, with regard to the use of rescue breaths in the resuscitation of children and infants, most rescuers that are required to provide CPR to a child or infant are immediate family members or people who routinely care for the child. In addition, most incidents of children or infants requiring CPR typically relate to respiratory issues rather than cardiac arrest, which increases the importance of delivering rescue breaths. In these circumstances, the issues that come with transmitting or contracting COVID-19 are small compared with the risk of taking no action, as this is likely to result in cardiac arrest and the death of the child.

Royal Life Saving advises that the Basic Life Support (Primary Survey) sequence below should be followed in an emergency situation:

D – Check for Danger

R – Check for Response

S – Send for help

A – Open Airway

B – Check for normal Breathing (Look for breathing. Do not open the airway or place your face next to the victims’ mouth/nose in current COVID-19 Pandemic.)

C – Start CPR

D – Attach Defibrillator

For more information about the Basic Life Support sequence, visit the Australian Resuscitation Council website.

A NOTE ON DROWNING

It is important to recognise that, in the case of drowning, if optimal CPR (which includes rescue breaths) is not given, the chance of the victim dying is very high and this should be weighed against the extremely low likelihood of the victim having COVID-19 and any risk of cross-infection.