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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. 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]
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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”
From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [3]
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“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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
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“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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
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“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]
Experimental — accuracy not yet measured
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“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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
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“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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“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]
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Self-citation
Metadata
- 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
- 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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