Table 2 Do’s and Don’ts of the COVID-19 adult BLS guideline protocols for healthcare providers

Assume an OHCA patient with suspected COVID-19 [2, 3]

Start CPR without donning appropriate transmission-based precautionary PPE [10]

Practice hand hygiene [17] before donning appropriate PPE

Use an ineffective face shield, pocket mask [10, 11], or an unfit transmission-based mask and/or unsealed goggle

Use minimum airborne-precaution PPE or droplet-precaution PPE [10] if unavailable

Delay in early defibrillation [11] due to AED retrieval delay or changing an old battery with poor functional quality

Cover the patient’s mouth and nose with a fluid-resistant surgical mask or oxygen mask if available [3, 10,11,12]

Check and attempt to clear the patient’s airway [3] in proximity and/or touch the patient’s body fluids or discharge

Check for response; if unresponsive, use mobile phones to send helper(s) or shout for nearby help to activate EMS and to fetch an AED [2, 12] or BLS-related equipment if available

Listen and feel near the patient’s mouth to check for breathing [3] in proximity

When no cervical spine injury is suspected, open the airway with a head-tilt/chin-lift [3] maneuver

Perform mouth-to-mouth or mouth-to-nose rescue breathing [10]

Check the breathing and the pulse simultaneously [2, 12]. Look for no breathing or only gasping, and palpate for thoracic respiratory movements [2]

Provide positive pressure ventilation without wearing appropriate PPE [3]

Prioritize defibrillation before chest compression [2, 3, 10, 11]

Perform BVM ventilation without a HEPA filter between the mask and the bag [10]

Prioritize oxygenation and ventilation [2, 10] if available and trained, and use BVM ventilation with a HEPA filter to provide rescue breathing if available and with two rescuers

Perform BVM ventilation by a single rescuer with a single hand holding the mask, resulting in inadequate sealing, and another hand squeezing the bag [3]

Use a mechanical chest compression device if available and trained [2, 3, 11, 12]

Perform chest compressions during BVM ventilation [3, 10, 11]

Every 2 min, rotate the rescuer, providing a 30 chest compressions/2 rescue breathing cycle [23, 24] if there are two rescuers [11], ideally during the rhythm and pulse check

Continue chest compressions if exhausted or if the rescuer develops “CPR-induced over-performing syndromes,” such as shortness of breath, hyperventilation, and chest pain [23]

Use the two-handed, two-person BVM technique: one rescuer holds the BVM with two hands to ensure a good seal, and the second rescuer squeezes the bag twice for rescue breathing when pausing after each 30 chest compressions [2, 10]

Touch the mucosae of the eye, nose, and mouth with a hand during the doffing of used PPE [40]

Doff all the used PPE in the appropriate sequence and apply hand hygiene after CPR [3]

Discard used disposable PPE in an open bin without disinfection

Clean and disinfect appropriately all the used BLS-related equipment [3]

Forget to clean and disinfect the environment [16], such as the used BLS-related equipment, the bio-waste bin, and/or the surfaces and air in the CPR room