Potential harms to rescuers during cardiac arrest response and resuscitation: a scoping review
8 affiliations
- 1Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, MI, United States
- 2Paramedicine Department, School of Acute and Primary Health, Te Wānanga Aronui o Tāmaki Makaurau, Auckland University of Technology (AUT), Auckland, New Zealand
- 3Clinical Evaluation, Research and Insights, Hato Hone St John, Auckland, New Zealand
- 4Department of Anaesthesiology & Critical Care, Faculty of Medicine, University of Colombo and National Hospital of Sri Lanka, Sri Lanka
- 5North York General Hospital, Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
- 6Division of Emergency Medicine, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Department of Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- 7School of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, Australia
- 8Prehospital, Resuscitation and Emergency Care Research Unit, Curtin University, Perth, Western Australia, Australia
Abstract
Background: Rescuer safety during cardiac arrest response and resuscitation is an important consideration that may influence willingness to intervene. This scoping review identifies potential unintentional harms to rescuers responding to cardiac arrest and performing resuscitation.
Methods: This scoping review was reported in accordance with PRISMA-ScR guidelines. We searched EMBASE, Medline, and Cochrane from inception to June 16, 2026, including all human studies reporting physical harms during cardiac arrest response or resuscitation (compressions, ventilation, defibrillation). Two investigators screened studies and extracted data. Synthesis was guided by Joanna Briggs Institute methods, with narrative synthesis by harm category.
Results: Twenty studies were included: sixteen provided direct evidence from cardiac arrest or resuscitation, and four provided indirect evidence from elective cardioversion. Of the direct-evidence studies, nine examined infection transmission during CPR, two evaluated electrical exposure from implantable cardioverter-defibrillators (ICDs) during CPR, two reported physical injuries en route to arrest, and three documented drowning during rescue. Infection transmission rates varied by pathogen but were mitigated by personal protective equipment (PPE). CPR near implantable cardioverter-defibrillators (ICDs) showed potential for higher leakage. In the four indirect-evidence studies, current leakage to rescuers during external shocks delivered for elective cardioversion remained below safe thresholds. One study reported minor injuries from incorrect opening of locked AED cabinets, and another found that injuries en route to patients were rare (<0.7%). Rescue-related drowning fatalities ranged from 0.02 to 0.08 per 100,000 population annually.
Conclusions: This scoping review suggests harms to rescuers during response or resuscitation are rare. Fatal harms have been reported during water rescue. Minor harms include unsafe AED removal, current leakage during ICD shock delivery, performing CPR without appropriate PPE, and minor injuries en route to a cardiac arrest. Indirect evidence from elective cardioversion suggests external defibrillation poses minimal electrical risk.
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BibTeX
@article{lagina2026potential,
title = {{Potential harms to rescuers during cardiac arrest response and resuscitation: a scoping review}},
author = {Anthony T. Lagina and Bridget Dicker and Vihara Dassanayake and Katie Dainty and Laurie J. Morrison and Janet Bray and Micheal A. Smyth and Micheal A. Smyth and Rebecca Cash and Sung-Phil Chung and Guillaume Debaty and Maya Dewan and Fredrik Folke and Takanari Ikeyama and Carolina Malta Hansen and Tetsuo Hatanaka and Nicholas J. Johnson and George Lukas and Siobhan Masterson and Chika Nishiyama and Tatsuya Norii and Violetta Raffay and Giuseppe Ristagno and Gavin and D. Perkins and Aloka Samantaray and Federico Semeraro and Baljit Singh and Christopher M. Smith and Christian Vaillancourt},
journal = {Resuscitation Plus},
year = {2026},
month = sep,
doi = {10.1016/j.resplu.2026.101507},
url = {https://doi.org/10.1016/j.resplu.2026.101507},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Potential harms to rescuers during cardiac arrest response and resuscitation: a scoping review
AU - Anthony T. Lagina
AU - Bridget Dicker
AU - Vihara Dassanayake
AU - Katie Dainty
AU - Laurie J. Morrison
AU - Janet Bray
AU - Micheal A. Smyth
AU - Micheal A. Smyth
AU - Rebecca Cash
AU - Sung-Phil Chung
AU - Guillaume Debaty
AU - Maya Dewan
AU - Fredrik Folke
AU - Takanari Ikeyama
AU - Carolina Malta Hansen
AU - Tetsuo Hatanaka
AU - Nicholas J. Johnson
AU - George Lukas
AU - Siobhan Masterson
AU - Chika Nishiyama
AU - Tatsuya Norii
AU - Violetta Raffay
AU - Giuseppe Ristagno
AU - Gavin
AU - D. Perkins
AU - Aloka Samantaray
AU - Federico Semeraro
AU - Baljit Singh
AU - Christopher M. Smith
AU - Christian Vaillancourt
PY - 2026
DA - 2026/09/28
JO - Resuscitation Plus
DO - 10.1016/j.resplu.2026.101507
UR - https://doi.org/10.1016/j.resplu.2026.101507
AB - Background: Rescuer safety during cardiac arrest response and resuscitation is an important consideration that may influence willingness to intervene. This scoping review identifies potential unintentional harms to rescuers responding to cardiac arrest and performing resuscitation. Methods: This scoping review was reported in accordance with PRISMA-ScR guidelines. We searched EMBASE, Medline, and Cochrane from inception to June 16, 2026, including all human studies reporting physical harms during cardiac arrest response or resuscitation (compressions, ventilation, defibrillation). Two investigators screened studies and extracted data. Synthesis was guided by Joanna Briggs Institute methods, with narrative synthesis by harm category. Results: Twenty studies were included: sixteen provided direct evidence from cardiac arrest or resuscitation, and four provided indirect evidence from elective cardioversion. Of the direct-evidence studies, nine examined infection transmission during CPR, two evaluated electrical exposure from implantable cardioverter-defibrillators (ICDs) during CPR, two reported physical injuries en route to arrest, and three documented drowning during rescue. Infection transmission rates varied by pathogen but were mitigated by personal protective equipment (PPE). CPR near implantable cardioverter-defibrillators (ICDs) showed potential for higher leakage. In the four indirect-evidence studies, current leakage to rescuers during external shocks delivered for elective cardioversion remained below safe thresholds. One study reported minor injuries from incorrect opening of locked AED cabinets, and another found that injuries en route to patients were rare (<0.7%). Rescue-related drowning fatalities ranged from 0.02 to 0.08 per 100,000 population annually. Conclusions: This scoping review suggests harms to rescuers during response or resuscitation are rare. Fatal harms have been reported during water rescue. Minor harms include unsafe AED removal, current leakage during ICD shock delivery, performing CPR without appropriate PPE, and minor injuries en route to a cardiac arrest. Indirect evidence from elective cardioversion suggests external defibrillation poses minimal electrical risk.
SN - 2666-5204
ER -