How effective are chest compressions when wearing mask? A randomised simulation study among first-year health care students during the COVID-19 pandemic

Abstract

Background The resuscitation guidelines provided for the COVID-19 pandemic strongly recommended wearing personal protective equipment. The current study aimed to evaluate and compare the effectiveness of chest compressions and the level of fatigue while wearing two different types of mask (surgical vs. cloth). Methods A randomized, non-inferiority, simulation study was conducted. Participants were randomised into two groups: surgical mask group (n = 108) and cloth mask group (n = 108). The effectiveness (depth and rate) of chest compressions was measured within a 2-min continuous chest-compression-only CPR session. Data were collected through an AMBU CPR Software, a questionnaire, recording vital parameters, and using Borg-scale related to fatigue (before and after the simulation). For further analysis the 2-min session was segmented into 30-s intervals. Results Two hundred sixteen first-year health care students participated in our study. No significant difference was measured between the surgical mask and cloth mask groups in chest compression depth (44.49 ± 10.03 mm vs. 45.77 ± 10.77 mm), rate (113.34 ± 17.76/min vs. 111.23 ± 17.51/min), and the level of fatigue (5.72 ± 1.69 vs. 5.56 ± 1.67) (p > 0.05 in every cases). Significant decrease was found in chest compression depth between the first 30-s interval and the second, third, and fourth intervals (p < 0.01). Conclusion The effectiveness of chest compressions (depth and rate) was non-inferior when wearing cloth mask compared to wearing surgical mask. However, the effectiveness of chest compressions decreased significantly in both groups during the 2-min chest-compression-only CPR session and did not reach the appropriate chest compression depth range recommended by the ERC.

Effects of personal protective equipment on cardiopulmonary resuscitation quality and outcomes: A systematic review

“…Our search strategy identified 5,203 unique articles of which 26 were selected for full-text review. Of these, one clinical study 11 and 17 simulation studies (11 RCTs 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 and 6 non-RCTs 11 , 23 , 24 , 25 , 26 , 27 , 28 ) were included ( Table 1 ). In the case of studies comparing different types of PPE, meta-analysis was not performed because the types of PPE varied widely between studies.…”

“…The included studies were conducted from 10 countries including Austria, 17 , 18 Canada, 28 China, 15 , 22 Hungary, 12 Italy, 14 , 20 , 21 Korea, 11 , 19 , 27 Spain, 13 , 16 Sweden, 23 Turkey, 25 , 26 and USA. 24 Studies were published between January 2015 and May 2022.…”

“… 11 , 17 , 18 PAPR was used in one study, 11 and 3 studies used only face masks. 12 , 22 , 26 Most studies used adult manikins for CPR simulation, although pediatric 24 and infant 14 manikins were used in two studies. In addition, there were 13 studies comparing PPE to no PPE, 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 23 , 24 , 25 , 26 , 27 and 5 studies comparing effects between PPE types.…”

“…In addition, there were 13 studies comparing PPE to no PPE, 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 23 , 24 , 25 , 26 , 27 and 5 studies comparing effects between PPE types. 22 , 12 , 13 CPR providers also varied and included students, 12 lifeguards, 13 firefighters, 23 , 28 EMTs, 19 , 27 and in-hospital healthcare professionals. 11 , 20 , 15 , 16 Many studies used crossover design, while some used parallel comparison.…”

“… 11 , 20 , 15 , 16 Many studies used crossover design, while some used parallel comparison. 12 , 20 , 22 , 23 , 28 Simulated CPR length was varied from 2 min, 4 min, 19 , 27 5 min, 24 12 min, 17 , 18 and 20 min. 16 , 21 , 25 Standard CPR with ventilation was usually performed but some studies 12 , 15 , 22 , 24 , 25 simulated compression only CPR.…”