Modification to Public Hands-Only CPR during the COVID-19 pandemic

Guidance for the public to reduce the risk of virus transmission

Note: These recommendations are intended for public/bystanders. If you are a healthcare professional, please refer to the fundamental CPR knowledge you learned from your certification course with the additional directions from your institutions during COVID-19.

Sudden cardiac arrest occurs when a person’s heart unexpectedly stops beating. Every year, 35,000 people have an out-of-hospital cardiac arrest in Canada. Cardiopulmonary resuscitation (CPR) and the use of automated external defibrillators (AED) significantly improve the chance of survival.

In this unusual time of the COVID-19 pandemic, there is concern about the risk of a public responder contracting COVID-19 from a person when providing CPR or using an AED.

The vast majority of cardiac arrests (over 80%) will be in the home setting and responders are likely to be friends or family.

The recommendations below are based on expert opinion. They will reduce the risk of the public responder getting the virus from the person when providing CPR and using an AED during cardiac arrest. They are modifications of usual Hands-Only CPR to be used only during the COVID-19 pandemic. They apply to both adults and children.

If you encounter a person who may be in cardiac arrest during the COVID-19 pandemic and you feel comfortable helping the person while reducing the risk of COVID transmission you should apply the following modified CPR steps:

  • Check for signs of cardiac arrest: recognize cardiac arrest by no response when you shake and shout AND the person is not breathing or is making strange gasping sounds. Do not listen or feel for breathing by placing your ear and cheek close to the person’s mouth, simply observe the person’s breathing.
  • Call 9-1-1 and tell them you have found someone unconscious and not breathing normally. Tell them if COVID-19 is suspected.
  • Prevent contamination: lay a cloth, towel, or clothing over the person’s mouth and nose to prevent any potential spread of the virus through contaminated air or saliva.
  • Provide Hands-Only CPR: Push hard and fast in the centre of the chest with one hand on top of the other. Think of the beat of Stayin' Alive or about 100-120 beats per minute. Don't stop until the ambulance arrives. Do not give rescue breaths. The 9-1-1 dispatcher will coach you if necessary.
  • Use an automated external defibrillator (AED) if available. AEDs are safe and simple to use.  Turn it on and follow the voice prompts.

Hygiene and cleaning after attempted resuscitation

After paramedics or first responders take over the resuscitation, wash or throw away the cloth, towel, or clothing used to cover the person's face. Then you should wash your hands thoroughly with soap and water; alcohol-based hand gel is an alternative.

Special circumstances

The above procedures apply to the majority of cases of sudden unexpected cardiac arrest. In some circumstances, you may choose to provide additional treatments if you are trained to do so. You should only do so if infectious transmission of COVID-19 is not a concern to you (e.g. the person is known to you).

These situations include:

  • A witnessed overdose caused by opioids (use Naloxone and rescue breathing, then chest compressions if no response)
  • A witnessed drowning (rescue breathing and chest compressions)
  • Cardiac arrest in a child (rescue breathing and chest compressions)

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