Resuscitation of the patient with suspected/confirmed COVID-19 when wearing personal protective equipment: A randomized multicenter crossover simulation trial

Małysz, Marek; Dąbrowski, Marek; Böttiger, Bernd W.; Smereka, Jacek; Kulak, Klaudia; Szarpak, Agnieszka; Jaguszewski, Miłosz; Filipiak‬, Krzysztof J.; Ładny, Jerzy Robert; Ruetzler, Kurt; Szarpak, Łukasz

doi:10.5603/cj.a2020.0068

Cited by 49 publications

(56 citation statements)

References 53 publications

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“…In Polish settings, EMS personnel are usually equipped with a full protective suit, a mask with FFP2 or FFP3 class filter, protective glasses, visor and double gloves. This garment reduces the risk of infection but, as numerous studies have shown, makes it difficult to perform medical procedures, including those so important for cardiopulmonary resuscitation, such as chest compressions [11], airway management [12,13], obtaining vascular access [14,15], or the administration of drugs and fluids during resuscitation [16,17].…”

Section: Introductionmentioning

confidence: 99%

Out-of-hospital cardiac arrest treated by emergency medical service teams during COVID-19 pandemic: A retrospective cohort study

Borkowska¹,

Smereka

Safiejko³

et al. 2021

Cardiol J.

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Background: Out-of-hospital cardiac arrest (OHCA) is a challenge for medical personnel, especially in the current COVID-19 pandemic, where medical personnel should perform resuscitation wearing full personal protective equipment. This study aims were to assess the characteristics and outcomes of adults who suffered an out-of-hospital cardiac arrest in the COVID-19 pandemic treated by emergency medical service (EMS) teams. Methods: All EMS-attended OHCA adults over than 18 years in the Polish EMS registry were analyzed. The retrospective EMS database was conducted. EMS interventions performed between March 1, and April 30, 2020 were retrospectively screened. Results: In the study period EMS operated 527 times for OHCA cases. The average age of patients with OHCA was 67.8 years. Statistically significantly more frequently men were involved (64.3%). 298 (56.6%) of all OHCA patients had resuscitation attempted by EMS providers. Among resuscitated patients, 73.8% were cardiac etiology. 9.4% of patients had return of spontaneous circulation, 27.2% of patients were admitted to hospital with ongoing chest compression. In the case of 63.4% cardiopulmonary resuscitation was ineffective and death was determined. Conclusions: The present study found that OHCA incidence rate in the Masovian population (central region of Poland) in March-April 2020 period was 12.2/100,000 adult inhabitants. Return of spontaneous circulation in EMS was observed only in 9.4% of resuscitated patients. The presence of shockable rhythms was associated with better prognosis. The prehospital mortality, even though it was high, did not differ from those reported by other studies.

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Section: Introductionmentioning

confidence: 99%

Out-of-hospital cardiac arrest treated by emergency medical service teams during COVID-19 pandemic: A retrospective cohort study

Borkowska¹,

Smereka

Safiejko³

et al. 2021

Cardiol J.

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“…Performing medical procedures when healthcare workers are wearing PPE-AGP may reduce the effectiveness of the procedures performed by extending the duration of these procedures as well as reducing the effectiveness of individual attempts to perform the procedure. This applies to both obtaining intravascular access [11], advanced airway management [12], as well as the effectiveness of chest compression [13]. Chen et al [14] indicated significant deterioration of CC performance in HCWs with the use of a level-C personal protective equipment, which may be a disadvantage for enhancing the survival of cardiac arrest.…”

Section: Discussionmentioning

confidence: 99%

“…Donghue also indicates that that Pediatric Basic Life Support recommendations for CC providers to switch every 2 minutes need not be altered with PPE use. The research of Malysz et al [13] indicates that in the case of adult resuscitation, the use of PPE reduces the quality of chest compression, including a reduction in the depth of chest compressions and the correctness of chest relaxation with time. The differences between these two studies can be explained by the fact that resuscitation was carried out concerning the various simulators: an adult and a child.…”

Section: Discussionmentioning

confidence: 99%

“…Limitations of the medical simulation trials have been previously described [13]. In addition, only a group of paramedics participated in the study, however, it was a deliberate action dictated by the fact that paramedics are the first line of contact with OHCA patients and are relatively often forced to undertake resuscitation measures in pre-hospital conditions, and in the time of the prevailing COVID pandemic -19, these procedures should be performed in PPE-AGP.…”

Section: Limitations and Strengthsmentioning

confidence: 99%

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Comparison of different chest compression positions for use while wearing CBRN-PPE: a randomized crossover simulation trial

Małysz¹,

Jaguszewski

Szarpak

et al. 2020

Disaster Emerg Med J

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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.

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“…Return of spontaneous circulation and the neurological outcome are significantly influenced by the quality of resuscitation, especially the quality of chest compressions [1,[36][37][38]. Unfortunately, the analyzed studies did not routinely use devices and methods to monitor the quality of chest compression, and chest compression depth and rate, as well as full chest recoil, which has a significant impact on the overall quality of CPR and the overall outcome of the rescue procedure.…”

Section: Limitations Of the Studymentioning

confidence: 99%

Systematic review and meta-analysis appraising efficacy and safety of adrenaline for adult cardiopulmonary resuscitation

Ludwin¹,

Safiejko²,

Smereka

et al. 2021

Cardiol J.

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Background: There is a beneficial effect of adrenaline during adult cardiopulmonary resuscitation (CPR) from cardiac arrest but there is also uncertainty about its safety and effectiveness. The aim of this study was to evaluate the use of adrenaline versus nonadrenaline CPR. Methods: PubMed, ScienceDirect, Embase, CENTRAL (Cochrane Central Register of Controlled Trials) and Google Scholar databases were searched from their inception up to 1 st July 2020. Two reviewers independently assessed eligibility and risk of bias, with conflicts resolved by a third reviewer. Risk ratio (RR) or mean difference of groups were calculated using fixed or random-effect models. Results: Nineteen trials were identified. The use of adrenaline during CPR was associated with a significantly higher percentage of return of spontaneous circulation (ROSC) compared to non-adrenaline treatment (20.9% vs. 5.9%; RR = 1.87; 95% confidence interval [CI] 1.37-2.55; p < 0.001). The use of adrenaline in CPR was associated with ROSC at 19.4% and for non-adrenaline treatment-4.3% (RR = 3.23; 95% CI 1.89-5.53; p < 0.001). Survival to discharge (or 30-day survival) when using adrenaline was 6.8% compared to non-adrenaline treatment (5.5%; RR = 0.99; 95% CI 0.76-1.30; p = 0.97). However, the use of adrenaline was associated with a worse neurological outcome (1.6% vs. 2.2%; RR = 0.57; 95% CI 0.42-0.78; p < 0.001). Conclusions: This review suggests that resuscitation with adrenaline is associated with the return of spontaneous circulation and survival to hospital discharge, but no higher effectiveness was observed at discharge with favorable neurological outcome. The analysis showed higher effectiveness of ROSC and survival to hospital discharge in non-shockable rhythms. But more multicenter randomized controlled trials are needed in the future.

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Resuscitation of the patient with suspected/confirmed COVID-19 when wearing personal protective equipment: A randomized multicenter crossover simulation trial

Cited by 49 publications

References 53 publications

Out-of-hospital cardiac arrest treated by emergency medical service teams during COVID-19 pandemic: A retrospective cohort study

Out-of-hospital cardiac arrest treated by emergency medical service teams during COVID-19 pandemic: A retrospective cohort study

Comparison of different chest compression positions for use while wearing CBRN-PPE: a randomized crossover simulation trial

Systematic review and meta-analysis appraising efficacy and safety of adrenaline for adult cardiopulmonary resuscitation

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