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Even at the peak of COVID-19 prevalence in Seattle, the risk of getting it while performing CPR on strangers in out-of-hospital cardiac arrest (OHCA) was too low to justify withholding resuscitation, according to a study.

"As of April 15, our community had 15 deaths per 100,000 population from COVID-19, higher than 42 other states at that time. COVID-19 was diagnosed in less than 10% of OHCA," reported a team led by Michael Sayre, MD, of the University of Washington in Seattle, in a paper published online in .

It would take treatment of 100 OHCA patients to result in one rescuer infection (assuming transmission to be 10%), the investigators said, and 10,000 bystander CPR events for one rescuer to die (assuming 1% mortality in COVID-19).

In contrast, bystander CPR saves over 300 lives for every 10,000 OHCA patients, the authors cited from the literature.

"We believe the current findings support telecommunicators and bystanders maintaining the most efficient approach that prioritizes rapid identification of cardiac arrest and immediately proceeds to chest compressions and use of a defibrillator. Delaying bystander CPR to implement PPE should only be considered when the prevalence of COVID-19 is substantially increased," the group concluded.

Interim guidelines released in April by the American Heart Association and other societies recommended that bystanders should weigh their risk of infection and perform hands-only or standard CPR with face masks (or cloth coverings) on themselves and the victim.

"Our results have implications when considering the balance of risks and benefits of changes in OHCA resuscitation guidelines for bystander CPR," Sayre and colleagues added. "The balance depends on risk of COVID-19 transmission from infected patients and the disease's prevalence among all OHCAs."

may have been threatened by the pandemic, as one European group noted, citing a case of a Chinese man who died outside an Australian restaurant after bystanders fearing infection refused to perform CPR.

Deaths attributed to cardiac arrest from late March to early April compared to the same period last year, according to a report from the New York City Fire Department, although is thought to have contributed to much of the excess.

Groups from and have also reported upticks in OHCA during their respective pandemic periods.

Data for the present study came from a population-based OHCA registry covering Seattle and King County, Washington, a region of 2.2 million persons. Included were people who had been attended by EMS from January 1 to April 15 of this year.

Study authors linked the Washington's COVID-19 surveillance system to EMS electronic records in order to identify patients with lab-confirmed COVID-19. Patients without PCR results had possible COVID-like illness determined by the authors.

From February 26 to April 15, EMS responded to 537 OHCAs, 48.1% of which were treated by EMS. Confirmed or possible COVID-19 was observed in 3.7% of those dead on EMS arrival and 6.5% of those treated by EMS. There were no COVID-19 cases among OHCAs in public places.

Limitations of the study include incomplete testing of potential COVID-19 patients, the investigators acknowledged.

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