Background:The aim of the study was to evaluate various methods of chest compressions in patients with suspected/confirmed SARS-CoV-2 infection conducted by medical students wearing full personal protective equipment (PPE) for aerosol generating procedures (AGP). Methods: This was prospective, randomized, multicenter, single-blinded, crossover simulation trial. Thirty-five medical students after an advanced cardiovascular life support course, which included performing 2-min continuous chest compression scenarios using three methods: (A) manual chest compression (CC), (B) compression with CPRMeter, (C) compression with LifeLine ARM device. During resuscitation they are wearing full personal protective equipment for aerosol generating procedures. Results: The median chest compression depth using manual CC, CPRMeter and LifeLine ARM varied and amounted to 40 (38-45) vs. 45 (40-50) vs. 51 (50-52) mm, respectively (p = 0.002). The median chest compression rate was 109 (IQR; 102-131) compressions per minute (CPM) for manual CC, 107 (105-127) CPM for CPRMeter, and 102 (101-102) CPM for LifeLine ARM (p = 0.027). The percentage of correct chest recoil was the highest for LifeLine ARM -100% (95-100), 80% (60-90) in CPRMeter group, and the lowest for manual . Conclusions: According to the results of this simulation trial, automated chest compression devices (ACCD) should be used for chest compression of patients with suspected/confirmed COVID-19. In the absence of ACCD, it seems reasonable to change the cardiopulmonary resuscitation algorithm (in the context of patients with suspected/confirmed COVID-19) by reducing the duration of the cardiopulmonary resuscitation cycle from the current 2-min to 1-min cycles due to a statistically significant reduction in the quality of chest compressions among rescuers wearing PPE AGP.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives 4.0 International License (CC BY-NC-ND 4.0), allowing third parties to download articles and share them with others, provided the original work is properly cited, not changed in any way, distributed under the same license, and used for noncommercial purposes only.
INTRODUCTION: The prevailing COVID-19 pandemic forces paramedics to take medical rescue operations using personal protective equipment (PPE) for aerosol-generating procedures (AGP). The use of PPE-AGP may reduce the effectiveness of the procedures performed, including airway management, intravascular access, or chest compression. The goal of the current study was to compare the quality by which a chest compression during simulated COVID-19 resuscitation while wearing PPE-AGP. A secondary goal was to assess provider preferences with standard versus OHD chest compression methods while wearing PPE-AGP. MeThODS: This is a randomized cross-over single-blinded study involving 37 paramedics performing 2-min continuous chest compression using two methods: the standard chest compression (CC) method during which the rescuer takes a position to the side of the victim (STD) and over-the-head position (OHD). During cardiopulmonary resuscitation, study participants wore Class C PPE-AGP. Both the order of study participants and compression methods were random. The results were blinded before statistical analysis. The compression rate per minute (CPM), CC depth as well as full chest recoil were measured. The analysis was undertaken using STATISTICA (V13.3EN). ReSULTS: Mean chest compression depth using distinct CC methods varied and amounted to 42 ± 2mm for STD vs. 46 ± 4mm for OHD (p < 0.001). Chest compressions based on the OHD method were associated with a lower frequency of chest compressions (107 ± 7CPM) compared with STD (114.5 ± 8; p< 0.001). A higher percentage of full chest recoil was observed in the case of STD (42 ± 6%) than in the case of OHD (34 ± 10%). CONCLUSIONS: Based on the current simulation trial, it is impossible to clearly determine which method (STD vs. OHD) is more effective in resuscitation with PPE-AGP. Paramedics wearing PPE-AGP achieved better chest compression depth for OHD compared to the STD, however, OHD resuscitation causes a lower degree of full chest relaxation. A further well-designed clinical study looking at efficacy, safety, and outcomes is needed to confirm current results.
Background Endotracheal intubation (ETI) is still the gold standard of airway management, but in cases of sudden cardiac arrest in patients with suspected SARS-CoV-2 infection, ETI is associated with risks for both the patient and the medical personnel. We hypothesized that the Vie Scope® is more useful for endotracheal intubation of suspected or confirmed COVID-19 cardiac arrest patients than the conventional laryngoscope with Macintosh blade when operators are wearing personal protective equipment (PPE). Methods Study was designed as a prospective, multicenter, randomized clinical trial performed by Emergency Medical Services in Poland. Patients with suspected or confirmed COVID-19 diagnosis who needed cardiopulmonary resuscitation in prehospital setting were included. Patients under 18 years old or with criteria predictive of impossible intubation under direct laryngoscopy, were excluded. Patients were randomly allocated 1:1 to Vie Scope® versus direct laryngoscopy with a Macintosh blade. Study groups were compared on success of intubation attempts, time to intubation, glottis visualization and number of optimization maneuvers. Results We enrolled 90 out-of-hospital cardiac arrest (OHCA) patients, aged 43–92 years. Compared to the VieScope® laryngoscope, use of the Macintosh laryngoscope required longer times for tracheal intubation with an estimated mean difference of −48 s (95%CI confidence interval [CI], −60.23, −35.77; p < 0.001). Moreover VieScope® improved first attempt success rate, 93.3% vs. 51.1% respectively (odds ratio [OR] = 13.39; 95%CI: 3.62, 49.58; p < 0.001). Conclusions The use of the Vie Scope® laryngoscope in OHCA patients improved the first attempt success rate, and reduced intubation time compared to Macintosh laryngoscope in paramedics wearing PPE for against aerosol generating procedures. Trial registration : ClinicalTrials registration number NCT04365608
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.