The use of personal protection equipment does not impair the quality of cardiopulmonary resuscitation

Abstract

Aim: Prior studies suggest that the use of personal protective equipment might impair the quality of critical care. We investigated the influence of personal protective equipment on out-of-hospital cardiopulmonary resuscitation. Methods: Randomised controlled non-inferiority triple-crossover study. Forty-eight emergency medical service providers, randomized into teams of two, performed 12 min of basic life support (BLS) on a manikin after climbing 3 flights of stairs. Three scenarios were completed in a randomised order: Without personal protective equipment, with personal protective equipment including a filtering face piece (FFP) 2 mask with valve, and with personal protective equipment including an FFP2 mask without valve. The primary outcome was mean depth of chest compressions with a pre-defined non-inferiority margin of 3.5 mm. Secondary outcomes included other measurements of CPR quality, providers' subjective exhaustion levels, and providers' vital signs, including end-tidal CO 2. Results: Differences regarding the primary outcome were well below the pre-defined non-inferiority margins for both control vs. personal protective equipment without valve (absolute difference 1 mm, 95% CI [À1, 2]) and control vs. personal protective equipment with valve (absolute difference 1 mm, [À0.2, 2]). This was also true for secondary outcomes regarding quality of chest compressions and providers' vital signs including etCO 2. Subjective physical strain after BLS was higher in the personal protective equipment groups (Borg 4 (SD 3) without valve, 4 (SD 2) with valve) than in the control group (Borg 3 (SD 2)). Conclusion: PPE including masks with and without expiration valve is safe for use without concerns regarding the impairment of CPR quality.

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

“…These differences are similar to those obtained in a previous study in which they compared the quality of cardiopulmonary resuscitation in two environments with different temperatures, at 25 °C and 37 °C, respectively [ 10 ]. The increase in RPE reflected when performing CPR with PPE is in concordance with other studies, in which perceived fatigue shows higher values when wearing PPE than when not wearing PPE [ 16 , 32 , 33 ]. It would be advisable for healthcare professionals to rest after performing CPR with PPE until their sense of fatigue decreases.…”

“…Due to the decrease in CPR quality evidenced in their systematic review, Sahu et al recommend finding ways to improve CPR without compromising on the safety of the healthcare worker [ 2 ]. Both Kienbacher et al and this study provide evidence for the non-inferiority of resuscitation in longer scenarios [ 33 ]. This study shows a significant decrease in HR during the CPR support phase.…”

“…On the other hand, Kienbacher et al conducted a study with a 30:2 protocol of a 12 min duration performed in pairs changing roles every 2 min. This study did not show a lower quality of CPR when EPP was used, compared to not using EPP [ 33 ]. Our study confirms the message of Kienbacher et al by providing evidence of a longer resuscitation duration.…”

Guidelines for Mountain Rescue During the COVID-19 Pandemic: Official Guidelines of the International Commission for Alpine Rescue

“…Some studies suggest that physically demanding tasks may be impeded by the mask (Chen et al, 2016 ; Fikenzer et al, 2020 ). Others suggest that while perceived respiratory effort may be increased, vigorous exercise and CPR quality are not affected by masking (Hopkins et al, 2020 ; Kienbacher et al, 2021 ). Mask performance may be reduced by moisture from sweating or heavy breathing.…”

Influence of Personal Protective Equipment on the Quality of Chest Compressions: A Meta-Analysis of Randomized Controlled Trials

“…Since there is evidence for COVID-19 infection transmission during chest compressions, use of personal protective equipment (PPE) has been recommended for health care personnel involved in resuscitating of patients with confirmed or suspected COVID-19 (6)(7)(8). However, studies evaluating the influence of PPE use on the quality of chest compression showed inconsistent results (9)(10)(11)(12)(13)(14). Some simulation-based randomized controlled trials (RCTs) suggested that use of PPE by the CPR providers was associated with compromised quality of chest compression (9,14), while others did not show significant difference regarding the performance of chest compression (10)(11)(12)(13)).…”