Impact of personal protective equipment on the effectiveness of chest compression - A systematic review and meta-analysis

Abstract

Background and objectives To assess the impact of personal protective equipment (PPE) on different aspects of chest compression (CC) during cardiopulmonary resuscitation, we conducted this study. Methods This systematic review was performed according to the PRISMA. We searched PubMed, EMBASE and Web of Science from inception to June-6, 2020, limiting to the studies that reported the comparison of the effectiveness of CC in terms of CC rate, CC depth, the proportion of adequate CC rate, the proportion of adequate CC depth or proportion of adequate recoil; in study arms with or without PPE. Risk of bias was assessed by the ROB-2 and ROBINS-I tool. Quantitative data synthesis was done using the generic inverse variance method and the fixed-effects model. Results Five simulation-based studies were finally included. A Significant decrease in CC rate (SMD: -0.28, 95%CI: −0.47 to −0.10) and CC depth (SMD: -0.26, 95%CI: −0.44 to −0.07) were observed in the PPE arm as compared to the no-PPE arm. The difference in CC rate was more prominently seen in adult CPR than in paediatric CPR. Without PPE, the proportion of adequate CC rate delivered was 0.74, which reduced significantly to 0.60 after use of PPE ( p - 0.035). Similarly, the proportion of adequate CC depth was significantly lesser ( p - 0.001) in PPE arm (0.55), as compared to that of the no-PPE arm (0.78). Conclusion The use of PPE compromises the quality of CC during CPR significantly, and newer ways to deliver chest compression has to be investigated. This study was prospectively registered in PROSPERO (CRD42020192031).

Effect of Wearing Personal Protective Equipment (PPE) on CPR Quality in Times of the COVID-19 Pandemic—A Simulation, Randomised Crossover Trial

“…Our findings contradict a systematic review that included five trials and that subsequently concluded that the use of PPE compromises the quality of CCs during CPR [ 16 ]. However, this review has several limitations and its applicability to the current COVID-19 pandemic seems to be questionable.…”

Out-of-Hospital Cardiac Arrest in London during the COVID-19 pandemic

“…With a decreased likelihood of OHCA occurring in public due to the lockdown, and the need to assume that all patients were potentially COVID-19 positive, the dispatch of Community First Responders was suspended and, on the 23rd March, GoodSam (a mobile phone alerting system that activates volunteers trained in CPR and defibrillator use to the nearest OHCA 17 ) was switched off, affording fewer opportunities for community based rapid intervention. EMS responders were required to wear PPE, inevitably adding minutes to the time to reach the patient, potentially reducing the quality of CPR 18 and impairing non-technical skills. 19 These necessary precautions, along with an unprecedented increase in call volumes (>45,000 additional calls across the 2 month period) and extended call answering times, may have contributed to the longer response times seen, which may adversely affect outcome.…”

Diagnostic accuracy of lung ultrasound for SARS-CoV-2: a retrospective cohort study

“…While descriptive studies of lung POCUS findings in COVID-19 are numerous [ 19 , 22 , 25 ], this is most thorough investigation of a quantitative lung POCUS score to diagnose COVID-19 with data allowing maximization of sensitivity, specificity, and discriminative ability. Other studies do provide information on the test characteristics of lung POCUS in the diagnosis of COVID-19, but are limited by much smaller cohorts and unable to demonstrate the performance in populations with various comorbidities [ 26 , 27 , 29 , 31 ]. The present study provides a more comprehensive assessment of the diagnostic power of lung POCUS in a large heterogenous population, and provides vital information for properly applying lung POCUS in the diagnosis of COVID-19.…”

“…These findings correlate closely with those observed on CT [ 22 ], and demonstrate promise in trending clinical progression from onset to peak to resolution [ 21 , 24 ]. Descriptive studies [ 25 – 31 ] have revealed the potential utility of lung POCUS but are limited by small sample sizes, lack of in-depth statistical analysis, and limited evaluation of patient characteristics that impact the utility of lung POCUS. To facilitate optimal application of lung POCUS for the diagnosis of COVID-19, we report the diagnostic accuracy of lung POCUS compared the criterion standard of SARS-CoV-2 RT-PCR test.…”