COVID-19 in cardiac arrest and infection risk to rescuers: A systematic review

Keith Couper, Sian Taylor-Phillips, Amy Grove, Karoline Freeman, Osemeke Osokogu, Rachel Court, Amin Mehrabian, Peter T Morley, Jerry P Nolan, Jasmeet Soar, Gavin D Perkins

Research output: Contribution to journalArticle (Academic Journal)peer-review

131 Citations (Scopus)


BACKGROUND: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSION: 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.

Original languageEnglish
Pages (from-to)59-66
Number of pages8
Publication statusPublished - Jun 2020

Structured keywords

  • Covid19


  • Aerosols/adverse effects
  • Betacoronavirus
  • COVID-19
  • Cardiopulmonary Resuscitation/instrumentation
  • Communicable Disease Control/organization & administration
  • Coronavirus Infections/epidemiology
  • Emergency Medical Services/organization & administration
  • Female
  • Heart Arrest/epidemiology
  • Humans
  • Infectious Disease Transmission, Patient-to-Professional/prevention & control
  • Male
  • Occupational Health
  • Pandemics/prevention & control
  • Personal Protective Equipment/statistics & numerical data
  • Pneumonia, Viral/epidemiology
  • Risk Assessment
  • SARS-CoV-2
  • World Health Organization


Dive into the research topics of 'COVID-19 in cardiac arrest and infection risk to rescuers: A systematic review'. Together they form a unique fingerprint.

Cite this