Fig. 2

Possible management of the confirmed or suspected COVID-19-positive patient with OOHCA. a Bystander CCPR, with risk of aerosolisation and viral transmission: in many cases, this may not be performed on patients with known infectious status. b Ambulance service provides defibrillation and early airway securement to minimise aerosol generation. Time to don PPE and elevated system demands may delay attendance. In sustained non-shockable cardiac arrest, it may be appropriate to curtail resuscitation and avoid hospital transfer.c E-CPR if appropriate, in an isolated negative pressure environment with mechanical compressions. ECMO team should be in high-level PPE including PAPR. In non-ECPR centres, the patient may proceed to coronary angiography if appropriate intra-arrest or more typically post-ROSC. Inter-hospital transfer for ECPR or PCI would not be routine.d ICU admission is contingent upon patient prognosis and system capacity. It may be reasonable to admit only if ROSC has been achieved. Good neurological survival remains the desired outcome. Patients may receive TTM/hypothermia and ongoing mechanical circulatory support for an agreed duration. Outcomes include recovery, WLST, or brain death. Organ donation may only be considered in patients confirmed to be COVID-19 negative. CCPR, compression only CPR; PPE, personal protective equipment; TTM, targeted temperature management; WLST, withdrawal of life-sustaining therapy