Impact of personal protective equipment on neonatal resuscitation procedures: a randomised, cross-over, simulation study

Abstract

Background and objectiveHealthcare providers should use personal protective equipment (PPE) when performing aerosol-generating medical procedures during highly infectious respiratory pandemics. We aimed to compare the timing of neonatal resuscitation procedures in a manikin model with or without PPE for prevention of SARS-COVID-19 transmission.MethodsA randomised controlled cross-over (AB/BA) trial of resuscitation with or without PPE in a neonatal resuscitation scenario. Forty-eight participants were divided in 12 consultant–nurse teams and 12 resident–nurse teams. The primary outcome measure was the time of positive pressure ventilation (PPV) initiation. The secondary outcome measures were duration of tracheal intubation procedure, time of initiation of chest compressions, correct use of PPE and discomfort/limitations using PPE.ResultsThere were significant differences in timing of PPV initiation (consultant–nurse teams: mean difference (MD) 6.0 s, 95% CI 1.1 to 10.9 s; resident–nurse teams: MD 11.0 s, 95% CI 1.9 to 20.0 s), duration of tracheal intubation (consultant–nurse teams: MD 22.0 s, 95% CI 7.0 to 36.9 s; resident–nurse teams: MD 9.1 s, 95% CI 0.1 to 18.1 s) and chest compressions (consultant–nurse teams: MD 32.3 s, 95% CI 14.4 to 50.1 s; resident–nurse teams: MD 9.1 s, 95% CI 0.1 to 18.1 s). Twelve participants completed the dressing after entering the delivery room. PPE was associated with visual limitations (43/48 participants), discomfort in movements (42/48), limitations in communication (32/48) and thermal discomfort (29/48).ConclusionsIn a manikin model, using PPE delayed neonatal resuscitation procedures with potential clinical impact. Healthcare workers reported limitations and discomfort when wearing PPE.Trial registration numberNCT04666233.

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.…”

Personal protective equipment can affect the timing of the neonatal resuscitation interventions

“…The purpose of the study3 was to compare the timing of neonatal resuscitation procedures in a manikin model with or without PPE for prevention of SARS-CoV-2 transmission. In a manikin model simulating a neonate needing resuscitation after birth, the researchers used a randomised controlled trial of resuscitation with or without PPE for prevention SARS-CoV-2 infection.…”

“…Patients with SARS-CoV-2 infection in many cases do not have an exclusive unit for their care, which may be in individual isolation in a clinical, surgical, intensive or emergency unit. Thus, the adoption of PPE protocols can influence the time of care and consequent patient outcome, especially in the context of neonatal resuscitation 3…”

“…This study focused on how the use of PPE alters the perceptions of discomfort or limitations of healthcare workers and its impacts on the timing of the neonatal resuscitation interventions 3. Visual and movement limitations were reported as the main discomfort factors for professionals, directly affecting the process of neonatal resuscitation interventions.…”