Management of first responder programmes for out-of-hospital cardiac arrest during the COVID-19 pandemic in Europe

Aim: First responder (FR) programmes dispatch professional FRs (police and/or firefighters) or citizen responders to perform cardiopulmonary resuscitation (CPR) and use automated external defibrillators (AED) in out-of-hospital cardiac arrest (OHCA). We aimed to describe management of FR-programmes across Europe in response to the Coronavirus Disease 2019 (COVID-19) pandemic. Methods: In June 2020, we conducted a cross-sectional survey sent to OHCA registry representatives in 18 European countries with active FRprogrammes. The survey was administered by e-mail and included questions regarding management of both citizen responder and FR-programmes. A follow-up question was conducted in October 2020 assessing management during a potential second wave of COVID-19. Results: All representatives responded (response rate = 100%). Fourteen regions dispatched citizen responders and 17 regions dispatched professional FRs (9 regions dispatched both). Responses were post-hoc divided into three categories: FR activation continued unchanged, FR activation continued with restrictions, or FR activation temporarily paused. For citizen responders, regions either temporarily paused activation (n = 7, 50.0%) or continued activation with restrictions (n= 7, 50.0%). The most common restriction was to omit rescue breaths and perform compression-only CPR. For professional FRs, nine regions continued activation with restrictions (52.9%) and five regions (29.4%) continued activation unchanged, but with personal protective equipment available for the professional FRs. In three regions (17.6%), activation of professional FRs temporarily paused. Conclusion: Most regions changed management of FR-programmes in response to the COVID-19 pandemic. Studies are needed to investigate the consequences of pausing or restricting FR-programmes for bystander CPR and AED use, and how this may impact patient outcome.

Automated summary

In response to the COVID-19 pandemic, most regions in Europe adjusted the management of FR programmes. The majority either implemented restrictions or temporarily paused the programmes, with common measures including omission of rescue breaths for citizen responders and provision of personal protective equipment for professional FRs. Further studies are needed to explore the impact of these changes on bystander CPR and AED use, as well as patient outcomes.