AHA Issues New Guidelines for Performing CPR During Pandemic

The American Heart Association (AHA) has updated its cardiopulmonary resuscitation (CPR) guidelines to protect healthcare providers during the COVID-19 pandemic.

The interim guidance was released on January 24, 2022, and advises healthcare providers to wear a respirator, like an N95 mask, along with other personal protective equipment (PPE) like a gown, gloves, and eye protection, when performing CPR on people with a suspected or confirmed case of COVID-19.

The AHA stressed the importance of wearing the appropriate PPE before performing procedures that can produce aerosols like chest compression, defibrillation, bag-mask ventilation, and intubation.

“In the event initial responders are not already wearing appropriate PPE, they should immediately put on PPE and then begin CPR,” the AHA said in a press release. “As the science surrounding COVID-19 and variants evolves, healthcare professionals should continue to follow the most up-to-date recommendations from the [World Health Organization], [Centers for Disease Control and Prevention], and their regional health authorities and local institutions.”

The AHA also noted that heart attack survival rates have dramatically decreased during the pandemic, noting that “the reasons for this decline are both unclear and complex.”

Survival of a heart attack “is dependent on early initiation of CPR, including chest compressions as soon as it is safely possible,” the AHA said, adding, “patients with confirmed or suspected COVID-19 should receive the best resuscitative efforts possible.”

“CPR saves lives and it is important in the midst of a pandemic to ensure that those performing CPR are aware of what PPE will keep them safe during this procedure,” Amesh A. Adalja, MD, a senior scholar at the Johns Hopkins Center for Health Security, told Verywell.

The new guidance raises some questions, including what this means for people who need to perform CPR outside of a medical setting. Here’s what you need to know.

How to Do CPR

The recommended form of CPR when an adult or teen suddenly collapses is called hands-only CPR. (This doesn’t involve breathing for someone with rescue breaths.) These are the recommended steps involved in hands-only CPR, per the American Red Cross:

• Call 911. Or ask a bystander to call for help.
• Kneel beside the person. You want your knees to be near the side of their body and spread shoulder-width apart.
• Place your hands on their chest. The heel of one of your hands should be on the center of their chest and your other hand should be on top. Interlace your fingers and make sure your fingers are hovering off their chest.
• Put your shoulders directly over your hands. Your elbows should also be locked to keep your hands straight.
• Give constant chest compressions. Push hard and fast, pushing in the person’s chest at least two inches with each compression and allowing their chest to rise back up between. You want to aim to do 100 to 120 compressions a minute.
• Keep doing this until help arrives. An emergency medical service technician can take over at that point.

This New Guidance Makes Sense

Experts say the new guidance just makes sense.

“If you’re doing chest compressions, you have the potential to aerosolize respiratory secretions,” Thomas Russo, MD, professor and chief of infectious disease at the University at Buffalo, told Verywell. “You’re going to be in close contact with that person and it’s critical to protect yourself.”

But Lewis Nelson, MD, chair of emergency medicine at Rutgers New Jersey Medical School, told Verywell that gowns are probably unnecessary. “While masks clearly provide benefit against an airborne virus, gowns are primarily sanitary,” he said. “There are no credible data that suggest that one can transmit COVID-19 through touching of clothes, curtains, door handles, or surfaces.”

He also added that while “eye protection makes sense, transmission by this route remains unproven and likely exceptionally rare.”

How the New Guidance Applies to Everyone Else

Technically, the new guidance is just aimed at healthcare workers. However, experts say that you should keep it in mind if you ever need to perform CPR on someone outside of a medical setting.

“Most bystanders will not have the recommended PPE, but at the very minimum a well-fitting mask, preferably of the N95 or similar type, should be worn,” Nelson said. “A surgical or other mask is better than nothing, but should optimally be swapped out once possible.” He points out that performing CPR in an outdoor or well-ventilated setting would also “minimize potential exposure risk.”

Jennifer Wong, MD, a cardiologist and medical director of Non-Invasive Cardiology at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in California, told Verywell that it’s “reasonable” to advise people to wear some level of protection while performing CPR.

“Certainly with COVID being so transmissible, it makes sense to recommend masks at least,” she said. “In general, it’s probably a good idea to be masking in most situations if you can.”