Time matters for resuscitation and COVID-19: double bind and duty of care

Correspondence to Dr Rodric Vian Francis, Department of Infectious Diseases, Nottingham University Hospitals, City Campus, Nottingham NG5 1PB, UK; rodric.francis@nhs.net INTRODUCTION During the coronavirus disease 2019 (COVID-19) pandemic, there has been divergent guidance on the aspects of personal protective equipment (PPE) to be worn during cardiopulmonary resuscitation (CPR). Public Health England (PHE) guidance advises that first responders can wear fluid-resistant surgical face masks. 1 The Resuscitation Council UK (RCUK) guidance is that aerosol-generating procedure (AGP) level of PPE should be worn, which includes FFP3 (filtering face piece) respirators and long-sleeved gowns. 2 3 Local Resuscitation Committees have had to grapple with divergent guidance and balance the duty of care to patients and to staff. In-hospital cardiac arrests have an 18.4% survival to hospital discharge rate. 10 Chances of survival are reduced by significant co-morbidities, irreversible causes of cardiac arrest and a delay in the initiation of chest compressions. 11 Delays longer than 1 min can reduce survival to discharge by half. 10 12 The additional time taken to don PPE prior to chest compressions could therefore decrease a patient’s chance of survival. Rates of COVID-19 and deaths among healthcare workers understandably raise staff anxieties. 14 15 While the majority of individuals seem to have mild disease, the healthcare workforce includes many with co-morbidities and co-factors which could worsen outlook. 16 With patients with COVID-19, potentially infectious virus-laden aerosol or droplets could land on exposed skin, the eyes, the nose, mouth and clothing.