Analysis of Physiological Response during Cardiopulmonary Resuscitation with Personal Protective Equipment: A Randomized Crossover Study

Abstract

The use of personal protective equipment (PPE) is required for the self-protection of healthcare workers during cardiopulmonary resuscitation (CPR) in patients at risk of aerosol transmission of infectious agents. The aim of this study was to analyze the impact of personal protective equipment on physiological parameters during CPR. A randomized, quasi-experimental, crossover design was used. The study was carried out in a training and simulation emergency box and the total sample consisted of 20 healthcare professionals. Two CPR tests were compared with the recommended sequence of 30 chest compressions and 2 ventilations. The duration of each test was 20 min. One of the CPR tests was carried out without using any PPE (CPR_control), i.e., performed with the usual clothing of each rescuer. The other test was carried out using a CPR test with PPE (i.e., CPR_PPE). The main variables of interest were: CPR quality, compressions, ventilations, maximum heart rate, body fluid loss, body temperature, perceived exertion index, comfort, thermal sensation and sweating. The quality of the CPR was similar in both tests. The maximum heart rate was higher in the active intervals (compressions + bag-valve-mask) of the test with PPE. CPR_PPE meant an increase in the perceived effort, temperature at the start of the thermal sensation test, thermal comfort and sweating, as opposed to CPR performed with usual clothing. Performing prolonged resuscitation with PPE did not influence CPR quality, but caused significant physiological demands. Rescuers were more fatigued, sweated more and their thermal comfort was worse. These results suggest that physical preparation should be taken into account when using PPE and protocols for physiological recovery after use should also be established.

Risk of Dehydration Due to Sweating While Wearing Personal 2 Protective Equipment in COVID-19 Clinical Care: A Pilot Study

“…The final sample consisted of sixteen (16) RNs. Previous studies [ 11 , 12 , 17 , 18 ] have also included a similar number as the study sample. The RNs performed the scenario two times—once with PPE-Conv and another time with PPE-PAPR.…”

“…Experimental studies have assessed the impact of the use of PPE on professionals but in settings that are far different from the clinical environment, using very low-fidelity activities, without the main objective of measuring the impact of one’s own use of PPE [ 11 , 12 ].…”

Impact of Personal Protective Equipment on the Quality of Chest Compressions in Prehospital Care: A Prospective Randomized Crossover Study

“…This time was intended for physiological adjustment to environmental conditions and to allow cortisol and lactate concentrations to adjust to a resting state. 10 During this timeframe, the participants remained seated in a chair. The study took place from 8:30AM to 11:30AM (time of relatively higher levels of cortisol).…”

“…2 However, these studies have been performed in single-rescuer situations, without the possibility of rest periods, and resuscitations of short durations (two-to-four minutes). 8,10 The effect of PPE on resuscitation is not consistent. While some studies have found significant changes in CPR quality, 11,12 a recent systematic review and meta-analysis showed that the rate and depth of chest compressions are not inferior when wearing PPE.…”

“…14 This research was followed by Fernandéz-Méndez, et al who published the results of a randomized quasi-experimental crossover study of 20 minutes of CPR (also 30:2), where the use of PPE also showed no impact on the quality of CPR. 10 The primary objective in this study was to determine differences in mean chest compressions rate and depth while wearing PPE and not wearing PPE during 20-minute resuscitation with proper rest phases, as recommended by the resuscitation guidelines. The secondary objectives of this study were to describe the changes in salivary cortisol, lactate, end-tidal carbon dioxide (EtCO 2 ), and body temperature when providing chest compressions.…”