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The 2015 ILCOR Consensus on Science with Treatment Recommendations re‐emphasized the findings of the 2010 reviews [77]. It confirmed the importance of high‐quality CPR commencing as soon as cardiac arrest has been recognized. It referenced multiple studies that found no differences in neurologic outcomes or mortality between compression‐only and conventional high‐quality CPR but recommended that first‐responders should perform ventilations if trained and willing. It similarly re‐emphasized the importance of components such as compression rate between 100 and 120/min, noting lower survival when rates were faster. It emphasized a depth of 5 cm or 2 inches, the need for adequate chest recoil, and the need for a high as possible chest compression fraction [78].

As with many other facets of resuscitation, the COVID‐19 pandemic has significantly altered some of these recommendations, as the risk of coronavirus infection has increased the risk of some interventions (Figure 12.5). In Seattle, COVID‐19 was diagnosed in fewer than 10% of patients with OHCA and investigators estimated that, with an approximate 1% mortality rate for COVID‐19, approximately 1 rescuer in 10,000 bystander CPR events might die from the disease, compared with over 300 lives/10,000 events saved by the CPR [79].

Although older lay rescuers are more vulnerable to infection with SARS‐CoV‐2 and are unlikely to have access to adequate personal protective equipment (PPE), new guidelines state that if the cardiac arrest occurs at home, as the majority do, lay rescuers are likely to have already been exposed to COVID‐19 [80]. It is recommended that compression‐only CPR be delivered by lay rescuers, with a facemask or cloth covering the mouth and nose of the rescuer and the patient. Rescue breaths are still recommended for pediatric cardiac arrests, if the lay rescuers are household members who have been exposed to the patient at home. Lay rescuers should follow instructions given by the 9‐1‐1 telecommunicator [81].

The June 2020 consensus statement from the Emergency Cardiovascular Care Committee and Get With The Guidelines‐Resuscitation Adult and Pediatric Task Forces of the AHA stated that, “Before entering the scene, all rescuers should don PPE to guard against contact with both airborne and droplet particles,” and that personnel in the room or on the scene should be limited to those “essential for patient care” [80]. Hand hygiene should be performed before and after all patient contact, putting on and after removing PPE (including gloves), and contact with potentially infectious material [82].

The diagnosis of cardiac arrest still relies on the combination of unresponsiveness and an absence of normal breathing. Instead of opening the airway, and looking, listening, and feeling for breathing with the rescuer’s face close to the patient’s mouth and nose, it is recommended that rescuers place a hand on patient’s chest to feel for chest rise and fall while assessing for normal breathing [83]. The AHA statement continues to suggest that health care personnel check for a pulse while assessing respiratory effort.

ILCOR concluded that chest compressions and cardiopulmonary resuscitation have the potential to generate aerosols [84]. However, the risk of aerosol generation with defibrillation is very low. Therefore, ILCOR recommended that first‐responders move rapidly to defibrillation, using AEDs when possible. AHA guidelines state that efforts should be made to cover the face of the cardiac arrest victim with a cloth or face mask, with similar protection for the rescuer [80, 85]. Professional rescuers may consider defibrillation before donning PPE if they perceive that the benefit is greater than the risk [86].