Cardiopulmonary resuscitation and risk of transmission of acute respiratory infections to rescuers: A systematic review snapshot

Abstract

The novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified in Wuhan City, China, in December 2019. Currently, the zoonotic origin of SARS-CoV-2 is unknown. However, one of the hallmarks in severe cases of coronavirus disease 2019 (COVID-19) is hypoxemic respiratory failure. Management of severe cases involves procedures such as non-invasive ventilation and endotracheal intubation that have the potential to generate respiratory aerosols. During the current coronavirus (COVID-19) pandemic, we need to mitigate any risks related to resuscitation as best we can, even if this is disruptive or at some point proven to be overly cautious. Unless we are presented with new evidence, any maneuver performed during cardiopulmonary resuscitation (CPR) should be considered an aerosol generating procedure. Limited data from the SARS epidemic suggests baseline risk of infection among health care workers may be 10%. Performing endotracheal intubation is associated with a 3-5 times higher risk. If causative, this represents an enormous potential for harm (an absolute risk increase of up 40%). Thus, performing endotracheal intubation during CPR should be treated as a very high-risk procedure and managed with the highest precautions, including donning appropriate full enhanced personal protective equipment before entering the scene, to guard against contact with both airborne and droplet particles. The aim of this systematic review snapshot was to identify and summarize in the form of a clinical synopsis the literature surrounding the potential risk of infection transmission associated with key interventions performed in the context of cardiac arrest.