It’s a very sad fact that the COVID-19 pandemic has prevented providers of Basic Life Support training, such as CPR Counts, from holding their courses. Could this, and the virus itself, have had an impact on survival rates from Out-Of Hospital Cardiac Arrest (OHCA)?

In the quest to find an answer I’m extremely grateful for the assistance I’ve received from

Rachel Warren – Policy Officer at the Resuscitation Council UK

Firstly, how important is such training?

This has been investigated by the Resuscitation Council UK:

16 October 2019 – Only 31% of people in the UK who haven’t had professional training on a CPR course are likely to help someone who has collapsed and stopped breathing. Research by Resuscitation Council UK and St John Ambulance to mark the sixth annual Restart a Heart Day shows that the general public are afraid to give cardiopulmonary resuscitation (CPR) without training, putting lives in danger.

The survey of 2326 people by YouGov, which asked respondents to consider what would make them more or less likely to intervene in a cardiac arrest, clearly shows the positive effect of CPR training. An impressive 71% of people who have had some first aid professional training would be prepared to stop and help someone if they had a cardiac arrest in any situation.


So, fewer courses is a very likely factor in reducing OHCA survival.

Then there’s fear of cross infection with the COVID-19 virus:

“Confusion around what to do during COVID-19 when someone’s in a cardiac arrest could cause delay in life-saving action, warn charities. New research has revealed that a third of UK adults don’t know if, during the COVID-19 pandemic, CPR should only be carried out by professionals wearing PPE.”


This short video shows COVID-safe CPR for OHCA in a nutshell:

Is there evidence that the pandemic has led to an increase in incidence and a decrease in survival rates from OHCA?

These articles tell a story:

Out-of-hospital cardiac arrest during the COVID-19 pandemic in Paris, France: a population-based, observational study

“A transient two-times increase in OHCA incidence, coupled with a reduction in survival, was observed during the specified time period of the pandemic when compared with the equivalent time period in previous years with no pandemic. Although this result might be partly related to COVID-19 infections, indirect effects associated with lockdown and adjustment of health-care services to the pandemic are probable. Therefore, these factors should be taken into account when considering mortality data and public health strategies.”

Out-of-Hospital Cardiac Arrest during the Covid-19 Outbreak in Italy

“The median arrival time of the emergency medical service was 3 minutes longer in 2020 than in 2019, and the proportion of patients who received cardiopulmonary resuscitation from bystanders was 15.6 percentage points lower. Among patients in whom resuscitation was attempted by the emergency medical service, the incidence of out-of-hospital death was 14.9 percentage points higher in 2020 than in 2019.”

Characteristics Associated With Out-of-Hospital Cardiac Arrests and Resuscitations During the Novel Coronavirus Disease 2019 Pandemic in New York City

“In this population-based cross-sectional study of 5325 patients with out-of-hospital cardiac arrests, the number undergoing resuscitation was 3-fold higher during the 2020 COVID-19 period compared with during the comparison period in 2019. Patients with out-of-hospital cardiac arrest during 2020 were older, less likely to be white, and more likely to have specific comorbidities and substantial reductions in return and sustained return of spontaneous circulation.

Identifying patients at risk for out-of-hospital cardiac arrest and death during the COVID-19 pandemic should lead to interventions in the outpatient setting to help reduce out-of-hospital deaths.”

Out-of-Hospital Cardiac Arrest in London during the COVID-19 pandemic!

“We compared OHCA presentations in London during March and April 2019 and 2020.

There was an 81% increase in OHCAs during the first peak of the COVID-19 pandemic.

This increase was closely related to SARS-CoV-2 infection rates in London.

We report an increase in the rate of bystander CPR in London during the pandemic.

Outcomes following OHCA were significantly poorer during the COVID-19 pandemic

We observed an 81% increase in OHCAs during the pandemic, and a strong correlation between the daily number of COVID-19 cases and OHCA incidents . We report an increase in OHCA occurring in a private location and an increased bystander CPR during the pandemic, as well as fewer resuscitation attempts and longer EMS response times . Survival at 30 days post-arrest was poorer during the pandemic and amongst patients where COVID-19 was considered likely.”

Overall, these studies show a direct correlation between COVID-19 and rates of OHCA but also a significant reduction in survival that is not altogether explained by the virus alone. There is a natural reluctance to attempt CPR in the current climate but the above video gives clear instructions on how to do this safely.
In my next posting I shall look at the retention of knowledge following training in Basic Life Support. In other words how well do you remember what you learned on your course?
Malcolm Robinson