European Resuscitation Council COVID-19 guidelines executive summary
Open accessAbstract
Coronavirus disease 2019 (COVID-19) has had a substantial impact on the incidence of cardiac arrest and survival. The challenge is to find the correct balance between the risk to the rescuer when undertaking cardiopulmonary resuscitation (CPR) on a person with possible COVID-19 and the risk to that person if CPR is delayed. These guidelines focus specifically on patients with suspected or confirmed COVID-19. The guidelines include the delivery of basic and advanced life support in adults and children and recommendations for delivering training during the pandemic. Where uncertainty exists treatment should be informed by a dynamic risk assessment which may consider current COVID-19 prevalence, the person’s presentation (e.g. history of COVID-19 contact, COVID-19 symptoms), likelihood that treatment will be effective, availability of personal protective equipment (PPE) and personal risks for those providing treatment. These guidelines will be subject to evolving knowledge and experience of COVID-19. As countries are at different stages of the pandemic, there may some international variation in practice.
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Structured, complex, multifaceted interventions in the context of advance care planning and shared decision making may effectively prevent disproportionate/unwanted end-of-life care and accordingly reduce use of healthcare resources.
“Structured, complex, multifaceted interventions in the context of advance care planning and shared decision making may effectively prevent disproportionate/unwanted end-of-life care and accordingly reduce use of healthcare resources. 4,7,44,72,355,398”
From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [4]
The section “Ethics and end-of-life decisions during the COVID-19 pandemic” recommends considering advance care planning and assessing each patient’s expected use of resources (page not provided). It does not describe structured, multifaceted interventions or say that advance care planning and shared decision-making prevent unwanted end-of-life care or reduce healthcare resource use. (LLM, conf=0.82)
Experimental — accuracy not yet measuredNot performing CPR (or with substantial delay) will reduce the likelihood of a good outcome for many victims.
“Whilst not performing CPR (or with substantial delay) will reduce the likelihood of a good outcome for many victims, bystanders should try to limit the associated risk of disease transmission by doing CPR. 3,257”
From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [3]
Effective use of advance directives relies on the accurate and efficient exchange of information about patient values, goals, and preferences, and available treatment options.
“Effective use of advance directives relies on the accurate and efficient exchange of information about patient values, goals, and preferences, and available treatment options. 4”
From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [4]
The Ethics and end-of-life decisions section (page unavailable) recommends considering advance care planning, and the In-hospital cardiac arrest section (page unavailable) says decisions not to resuscitate must be communicated. Neither passage addresses whether effective use of advance directives depends on exchanging information about patient values, goals, preferences, and treatment options. Searches for those terms and for advance-care-planning communication found no passage making that point. (LLM, conf=0.72)
Experimental — accuracy not yet measuredVideo decision support tools depicting CPR, resuscitation preference options and different levels of care are associated with higher rates of understanding of the purpose of CPR and resuscitation options.
“Video decision support tools depicting CPR, resuscitation preference options and different levels of care are associated with higher rates of understanding of the purpose of CPR and resuscitation options. 4,17,272”
From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [4]
The Resuscitation education and COVID-19 section recommends distance and virtual learning for CPR teaching, while the Ethics and end-of-life decisions section discusses advance care planning. Neither reports whether video decision-support tools improve understanding of CPR or resuscitation options (searched for video decision aids and understanding of resuscitation options). No page numbers were provided in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measuredEvidence from two systematic reviews suggests that the use of advance directives is associated with reductions in emergency room visits, hospital admissions, health care costs, and more preference for comfort care as opposed to life-sustaining treatments.
“Evidence from two systematic reviews suggests that the use of advance directives is associated with reductions in emergency room visits, hospital admissions, health care costs, and more preference for comfort care as opposed to life-sustaining treatments. 4,8”
From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [4]
Split into 2 atoms — 0 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 2 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured
Despite study limitations, findings of studies of advance directives generally support the use of structured communication tools.
“Despite study limitations, findings of studies of advance directives generally support the use of structured communication tools. 4”
From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [4]
The Ethics and end-of-life decisions section recommends considering advance care planning during the COVID-19 pandemic, but does not discuss findings from studies of advance directives or structured communication tools. Searches for those terms and for study limitations found no passage addressing the claim. (LLM, conf=0.73)
Experimental — accuracy not yet measuredSeveral structured communication tools (e.g. paper, video, or computer decision aids, and educational interventions) have been developed to facilitate end-of-life decision-making.
“Consequently, several, structured communication tools (e.g. paper, video, or computer decision aids, and educational interventions) have been developed to facilitate endof-life decision-making. 4”
From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [4]
The Ethics and end-of-life decisions section recommends considering advance care planning but does not describe structured communication tools or their development. Searches for decision aids and end-of-life communication tools found only unrelated CPR education guidance and video consultation for pre-delivery discussions; the cited paper does not address the claim. (LLM, conf=0.72)
Experimental — accuracy not yet measuredEvidence from 13 RCTs and from 8 nonrandomised studies included in 3 systematic reviews suggests associations of communication interventions with an increased frequency of DNACPR orders.
“Evidence from 13 RCTs and from 8 nonrandomised studies included in 3 systematic reviews suggests associations of communication interventions with an increased frequency of DNACPR orders. 4,7,8,10”
From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [4]
The In-hospital cardiac arrest section recommends making and communicating DNACPR decisions for certain patients with severe COVID-19 respiratory failure. It does not report whether communication interventions increase DNACPR orders. Searches for the claimed 13 RCTs, 8 nonrandomised studies, and 3 systematic reviews found no supporting passage in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measuredData from eight RCTs included in three systematic reviews indicated that communication interventions aiding the completion of advance directives had no significant effect on patient/family satisfaction with end-of-life care.
“Data from eight RCTs included in three systematic reviews indicated that communication interventions aiding the completion of advance directives had no significant effect on patient/family satisfaction with end-of-life care. 4,7,8”
From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [4]
The ‘Ethics and end-of-life decisions during the COVID-19 pandemic’ section recommends considering advance care planning where possible, but does not report its effect on patient or family satisfaction. Searches for the eight RCTs, three systematic reviews, advance directives, and satisfaction found no passage addressing the claimed finding; page numbers are unavailable in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measuredVariability in terminology, definitions, type and delivery of interventions, and outcome choice makes it challenging to identify and assimilate research evidence on interventions for safeguarding patient autonomy.
“Variability in terminology, definitions, type and delivery of interventions, and outcome choice makes it challenging to identify and assimilate research evidence in this area. 4,5”
From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [4]
The Ethics and end-of-life decisions section discusses COVID-19 resuscitation decisions and pandemic-related knowledge gaps, not the difficulty of synthesizing evidence on interventions for safeguarding patient autonomy. Searches for variability in terminology, intervention delivery, and outcome choice found no passage addressing that claim. (LLM, conf=0.75)
Experimental — accuracy not yet measuredEducational CPR videos and structured patient-centred interviews can be helpful in decision making, with more patients likely to forgo CPR and focus on comfort.
“Educational CPR videos and structured patient-centred interviews can be helpful in decision making with more patients likely to forgo CPR and focus on comfort. 4,45,70,273,274”
From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [4]
The Ethics and end-of-life decisions section (page unavailable) recommends considering advance care planning, while the Basic courses section discusses video instruction for teaching CPR to laypeople. Neither addresses educational videos or structured patient-centred interviews as decision aids, or reports that they lead more patients to forgo CPR in favour of comfort care (searched those terms and related decision-making language). (LLM, conf=0.73)
Experimental — accuracy not yet measuredDespite the limitations of the currently available, substantial but still heterogenous, body of evidence, the presence of either positive or neutral RCTs on structured communication tools aimed at facilitating the completion of advance care directives and plans suggests a class effect and increased likelihood of benefit compared with usual care.
“Despite the limitations of the currently available, substantial but still heterogenous, body of evidence, the presence of either positive or neutral RCTs on structured communication tools aimed at facilitating the completion of advance care directives and plans suggests a class effect and increased likelihood of benefit compared with usual care. 4,7”
From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [4]
Split into 2 atoms — 0 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 2 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured
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Self-citationEuropean Resuscitation Council Guidelines 2021: Executive summary
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Self-citationCOVID‐19 epidemic: Disease characteristics in children
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Self-citationEuropean Resuscitation Council Guidelines 2021: Education for resuscitation
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Self-citationEuropean Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions
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“Whilst not performing CPR (or with substantial delay) will reduce the likelihood of a good outcome for many victims, bystanders should try to limit the associated risk of disease transmission by doing CPR.3,257 The specific risk-benefit will be a function of factors such as the current regional COVID-19 prevalence, th…”
BackgroundInfluentialSelf-citationEffects of COVID-19 pandemic on out-of-hospital cardiac arrests: A systematic review
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Self-citationEuropean Resuscitation Council Guidelines 2025 Adult Advanced Life Support
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European Resuscitation Council Guidelines 2025 Executive Summary
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Self-citationErweiterte lebensrettende Maßnahmen für Erwachsene
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Self-citationKreislaufstillstand unter besonderen Umständen
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Lebensrettende Maßnahmen bei Kindern (Paediatric Life Support, PLS)
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2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 3. Adult basic life support
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Self-citationThe Repurposed Drugs Suramin and Quinacrine Cooperatively Inhibit SARS-CoV-2 3CLpro In Vitro
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Ethik der Reanimation und Entscheidungen am Lebensende
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Self-citationVersorgung und Reanimation des Neugeborenen nach der Geburt
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Transmission of Infections during Cardiopulmonary Resuscitation
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Review—Recent Development of Detection Methods for Controlling COVID-19 Outbreak
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Self-citationBronchoscopy during COVID-19 pandemic, ventilatory strategies and procedure measures
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Self-citationCardiopulmonary resuscitation in the prone position
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Self-citation
- Authors
- Nolan, J. P., Monsieurs, K. G., Bossaert, L., Böttiger, B. W., Greif, R., Lott, C., Madar, J., Olasveengen, T. M., Roehr, C. C., Semeraro, F., Soar, J., Van de Voorde, P., Zideman, D. A., Perkins, G. D., Ainsworth, S., Biarent, D., Bingham, B., Blom, M. T., Borra, V., Bossaert, L., Böttiger, B. W., Brissaud, O., Carli, P., Cassan, P., Castrén, M., Cimpoesu, D., Couper, K., Deakin, C. D., Buck, E. D., Lucas, N. D., Djakow, J., Djärv, T., Druwé, P., Ersdal, H., Handley, A., Hoffmann, F., Klaassen, B., Kuzovlev, A., Lauritsen, T., Lilja, G., Lott, C., Lulic, I., Maconochie, I., Madar, J., Martinez, A. M., Mentzelopoulos, S., Meyran, D., Monsieurs, K. G., Morley, C., Nolan, J. P., Olasveengen, T., Paal, P., Pellis, T., Perkins, G. D., Raffay, V., Ristagno, G., Roehr, C., Rüdiger, M., Sandroni, C., Semeraro, F., Singletary, E., Skåre, C., Smyth, M., Soar, J., Svavarsdóttir, H., Szczapa, T., Pas, A. T., Trevisanuto, D., Turner, N. M., Urlesberger, B., Voorde, P. V. D., Wilkinson, D., Wyllie, J., & Zideman, D. A.
- Affiliations
- Sigmund Freud Privatuniversität Wien (AT)
- University of Warwick (GB)
- Thames Valley Air Ambulance (GB)
- University Hospitals Birmingham NHS Foundation Trust (GB)
- Ghent University Hospital (BE)
- North Bristol NHS Trust (GB)
- ORCID
- Greif, R.
- Blom, M.T.
- Borra, V.
- Brissaud, O.
- Carli, P.
- Cassan, P.
- Castrén, M.
- Cimpoesu, D.
- Couper, K.
- Deakin, C.D.
- Buck, E.De
- Lucas, N.De
- Djakow, J.
- Djärv, T.
- Druwé, P.
- Ersdal, H.
- Hoffmann, F.
- Kuzovlev, A.
- Lauritsen, T.
- Lilja, G.
- Maconochie, I.
- Mentzelopoulos, S.
- Paal, P.
- Pellis, T.
- Raffay, V.
- Ristagno, G.
- Rüdiger, M.
- Sandroni, C.
- Singletary, E.
- Skåre, C.
- Szczapa, T.
- Trevisanuto, D.
- Urlesberger, B.
- Wilkinson, D.
- Wyllie, J.
- Venue
- Resuscitation
- Publisher
- Elsevier BV
- Published
- 2020-08
- Volume
- 153
- Pages
- 45-55
- ISSN
- 0300-9572 (ISSN-L)
- PMC
- PMC7276132
- OpenAlex
- W3033709386
- Semantic Scholar
- 0178b41b24469b2c204c158d66f9a34aa7eed98c
- Cited by
- 347
- References
- 63
- Citations by year
- 2026: 7 · 2025: 20 · 2024: 28 · 2023: 44 · 2022: 61 · 2021: 133 · 2020: 53 · 2015: 1
- FWCI
- 69.93
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Resuscitation (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Kölner Universitäts PublikationsServer (Universität zu Köln) (publishedVersion)
- Pure Amsterdam UMC (publishedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion)
- Bern Open Repository and Information System (University of Bern) (submittedVersion)
- Bristol Research (University of Bristol) (submittedVersion, other-oa)
- Padua Research Archive (University of Padova) (submittedVersion)
- Topics
- Health Sciences › Medicine › Emergency Medicine › Cardiac Arrest and Resuscitation
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Infection Control and Ventilation
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Keywords
- COVID-19 pandemic, cardiopulmonary resuscitation, cardiac arrest, personal protective equipment, advanced life support, basic life support, resuscitation training, COVID-19 prevalence, rescuer safety
- MeSH terms
- Personal Protective Equipment, Betacoronavirus, COVID-19, SARS-CoV-2, Europe, Heart Arrest, Humans, Pneumonia, Viral, Societies, Medical, Cardiopulmonary Resuscitation, Coronavirus Infections, Risk Assessment, Pandemics
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