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Prevalence of COVID-19 in Out-of-Hospital Cardiac Arrest: Implications for Bystander CPR

 Prevalence of COVID-19 in Out-of-Hospital Cardiac Arrest: Implications for Bystander CPR.

Circulation: 10.1161/CIRCULATIONAHA.120.048951 Sayre MR, Barnard LM, Counts CR, et. al.

Background:

  • The AHA has previously provided modified recommendations for CPR for out of hospital cardiac arrest (OHCA) in the face of the COVID – 19 Pandemic previously posted on the ACURE site.
  • No data has been available to assess the actual risk of CPR for OHCA until this publication.
  • The current study comprises OHCA with emergency medical services (EMS) involvement in Seattle and King County, WA from 1/1/2020 – 4/15/2020.
  • Study Goal: To estimate the incidence of COVID-19 infection among a cohort of OHCA.

Key Points:

  • EMS responded to 1.067 OHCAs from 1/12020 to 4/15/2020; EMS treated 478 (44.8%). COVID was lab test positive in 23 (2.2%) or considered high likelihood of COVID – 19 illness based on chart review in 13 (1.2%) episodes of OHCA.
  • Focusing on the active COVID – 19 period, 2/26/2020 – 4/15/2020, EMS responded to 537 (50.3%) episodes of OHCA; EMS treated 230 (48.1) of this group.
  • COVID – 19 was diagnosed by Test or likely clinical history in 3.7% of DOA and 6.5% of EMS treated cases.
  • Distribution of COVID – 19, OHCA cases by site included 5% in homes, 11% in nursing homes and none in public places. Bystander CPR was performed in 57% of OHCA episodes.
  • Risk of COVID – 19 infection to healthcare workers without PPE: 121 exposed – <5% had symptomatic infection from intensive care of a COVID – 19 patient.
  • Risk of COVID infection for bystander’s is likely low as time of resuscitation is usually limited and chest compressions alone is thought to have a low probability of aerosolization of the virus from an infected patient.
  • Local mortality was 15 per 100,000 for COVID (high for this area); COVID was present in <10% of OHCA. Considering a transmission risk of 10% for bystander, hands-only CPR without PPE, treating 100 OHCAs could lead to one COVID – 19 infection. With approximately a 1% mortality for COVID patients, a rescuer might die for every 10,000 patients treated. In contrast bystander CPR is likely to save 300 patients for every 10,000 treated.
  • The authors state that given these numbers, current CPR guidelines for bystander CPR without PPE is justified unless a patient with OHCA has a high probability of infection, in which case delaying CPR to allow donning PPE is justified.