Potential Harms to Rescuers During Cardiac Arrest Response and Resuscitation: A Scoping Review

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.