Dear Doctor: A few years ago, you had a column about why it’s important to know CPR. My boyfriend took the Red Cross class, and he actually ended up helping someone once. But what about now, during the pandemic? Is it safe to give or get CPR?
Dear Reader: Considering that a main avenue of transmission of the coronavirus that causes COVID-19 is believed to be respiratory droplets from an infected person, your question about CPR is a timely one.
For anyone unfamiliar with CPR, which is short for cardiopulmonary resuscitation, it’s an emergency procedure performed when someone’s heart has stopped beating. This can occur for many reasons, including heart attack or cardiac arrest due to near-drowning, an extreme allergic reaction, asthma attack, smoke inhalation or poisoning. When initiated at the start of a medical emergency, CPR can double, or even triple, someone’s odds of survival.
The process is made up of three distinct components. First, call 911 and report the emergency. The other two elements of CPR are chest compressions, which are performed on the sternum in a specific rhythm, and mouth-to-mouth rescue breathing. The challenge during the pandemic is the proximity that is required to perform CPR. The rescuer is literally on top of, and just inches away from, the person they are helping. Even without the element of rescue breathing, an exchange of breath during the CPR process is likely. Regarding rescue breathing, only someone who is formally trained in CPR should attempt it. And during the pandemic, the Red Cross advises against performing rescue breathing when COVID-19 is either suspected or confirmed.
This leaves chest compressions, which still put people into far closer proximity than the 6-foot distance guidelines we’re all trying to adhere to. To keep both parties as safe as possible from the airborne respiratory droplets or aerosols, the Red Cross has outlined specific procedures. The person performing CPR should wear as much personal protective equipment as possible. This includes respiratory protection, eye protection, disposable gloves and a disposable gown or covering of some sort. Although N95 masks are optimal, they remain in very short supply. A properly fitted mask made of multiple layers of fabric is an acceptable substitute. The person receiving CPR should be outfitted with a mask as well. If only one mask is available, the Red Cross recommends using it on the victim.
Part of performing CPR is assessing whether or not the victim has begun to breathe on their own. At this time, the Red Cross is asking rescuers to do a visual assessment rather than listening or feeling for breath. Taking this precaution can decrease the risk of transmission of the virus. People trained in CPR have been taught that using rescue breathing when cardiac arrest follows a breathing problem, such as choking, a drug overdose or near-drowning, often leads to a better outcome. However, due to the risk of viral transmission, it is now recommended that compression-only CPR be administered until paramedics arrive in response to your 911 call.
Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health.
