Possible SARS coronavirus transmission during cardiopulmonary resuscitation

Emerg Infect Dis. 2004 Feb;10(2):287-93. doi: 10.3201/eid1002.030700.


Infection of healthcare workers with the severe acute respiratory syndrome-associated coronavirus (SARS-CoV) is thought to occur primarily by either contact or large respiratory droplet transmission. However, infrequent healthcare worker infections occurred despite the use of contact and droplet precautions, particularly during certain aerosol-generating medical procedures. We investigated a possible cluster of SARS-CoV infections in healthcare workers who used contact and droplet precautions during attempted cardiopulmonary resuscitation of a SARS patient. Unlike previously reported instances of transmission during aerosol-generating procedures, the index case-patient was unresponsive, and the intubation procedure was performed quickly and without difficulty. However, before intubation, the patient was ventilated with a bag-valve-mask that may have contributed to aerosolization of SARS-CoV. On the basis of the results of this investigation and previous reports of SARS transmission during aerosol-generating procedures, a systematic approach to the problem is outlined, including the use of the following: 1) administrative controls, 2) environmental engineering controls, 3) personal protective equipment, and 4) quality control.

Publication types

  • Case Reports

MeSH terms

  • Aerosols
  • Aged
  • Air Microbiology
  • Cardiopulmonary Resuscitation / adverse effects*
  • Female
  • Humans
  • Infectious Disease Transmission, Patient-to-Professional
  • Ontario / epidemiology
  • Personnel, Hospital
  • Protective Devices / standards
  • Quality Control
  • Severe Acute Respiratory Syndrome / epidemiology
  • Severe Acute Respiratory Syndrome / prevention & control
  • Severe Acute Respiratory Syndrome / transmission*


  • Aerosols