CPR guidance changed over Omicron concerns despite soaring deaths from cardiac arrests

The American Heart Association (AHA) has told medics to mask up before giving CPR to people with Covid-19 despite a "dramatic" drop in heart attack survival rates.

In a bulletin published in the medical journal Circulation on Monday, researchers from the AHA tightened their stance on personal protective equipment (PPE) during heart resuscitation while implicitly acknowledging that this might lead to more patient deaths.

Whereas previous guidance from October had said that "chest compressions should not be delayed" for the donning of PPE, the new guidance says "all healthcare providers" should wear an N95 respirator and protective garments when dealing with confirmed or suspected Covid patients.

Instead of saying that "some components" of CPR are believed to generate airborne particles that can spread the disease, the new guidance says "all components" of the procedure are dangerous, citing US public health authorities.

That is despite a sharp fall in survival rates for patients with heart attacks during the pandemic, which the researchers believe may be driven in part by the need to wear PPE before giving CPR and the extra fatigue exerted on medics when wearing it.

"Due to new, more highly contagious variants of the SARS-CoV-2 virus, the guidance emphasizes the need for PPE, including respirators, gowns, gloves and eye protection," the AHA said in a press release accompanying the research.

"In the event that initial responders are not already wearing appropriate PPE, they should immediately put on PPE and then begin CPR."

AHA volunteer chair Dianne Atkins said that protecting medical providers is "critical" to the health of the people they care for.

Multiple studies have found that cardiac survival rates were much lower than usual in 2020, but according to the AHA bulletin the causes are "both unclear and complex". The effect is true even for those who die outside of hospitals and in places where Covid infection rates were low.

The researchers said there may be multiple reasons, including the severity of Covid-related heart attacks, overloaded hospitals and ambulance services, and "concerns that resuscitation from cardiac arrest due to Covid-19 may be futile".

They added: "The provision of prompt chest compressions and defibrillation may also have been delayed due to the additional time required in donning PPE or securing the airway, and the PPE may have accelerated rescuer fatigue, resulting in decreased CPR quality."