The Royal College of Physicians of Edinburgh (the ‘College’) has backed a statement by Resuscitation Council UK (RCUK), which highlights concerns that chest compressions are designated as non-Aerosol Generating Procedures (AGPs).

RCUK have produced COVID-19 guidance which recognises the risk associated with chest compressions during the pandemic, and states that Level 3 personal protective equipment (PPE) should be donned before chest compressions are undertaken by healthcare professionals. RCUK also advise that a defibrillator should be employed at the earliest opportunity, as it buys crucial time for patients and healthcare professionals, and provides the most appropriate balance of safety and care for patients.

The RCUK guidance is based upon WHO and International Liaison Committee on Resuscitation (ILCOR) guidance and the emerging evidence available. The College believes that this guidance is the ‘gold standard’ and can be used to avoid confusion for staff as to the safest procedures for patients and clinicians.

The COVID-19 pandemic is an unprecedented challenge in which clinicians are understandably balancing the need to provide care with their own safety. According to the GMC, if the recommended level of PPE is not immediately available, decisions need to be made quickly about the safest and best course of action, taking account of the clinical situation. These decisions will include:

  • what course of action is likely to result in the least harm in the circumstances;
  • whether alternative actions or additional steps can be taken to minimise the risk of transmission;
  • whether treatment can be delayed, or provided by another team;
  • whether any doctors or other healthcare professionals are at a higher risk from infection than other colleagues.

As such, clinical judgement will need to be exercised by each doctor or team of doctors in each situation. The College will support colleagues who are required to exercise their judgement in this way.