What is the Impact of the European Resuscitation Council Covid-19 Guidelines on Resuscitation Quality – A Manakin Study

Abstract

BackgroundTo evaluate the effects of European Resuscitation Council (ERC) Covid-19-guidelines on resuscitation quality.MethodsIn an observational manikin study paramedics and emergency physicians performed Advanced-Cardiac-Life-Support in three settings: ERC guidelines 2015 (Control), Covid-19-guidelines as suggested with minimum staff (Covid-19-minimal-personnel); Covid-19-guidelines with paramedics and an emergency physician (Covid-19-advanced-airway-manager). Main outcome measures were no-flow-time, quality metrics as defined by ERC and time intervals to first chest compression, oxygen supply, intubation and first rhythm analysis. Data were presented as mean (standard deviation).Results30 resuscitation scenarios were completed. No-flow-time was markly prolonged in Covid-19-minimal-personnel [113±37 sec] compared to Control [55±9 sec; p<0.001] and Covid-19-advanced-airway-manager [76±38 sec; p<0.001]. In both Covid-19-groups chest compressions started later [Control: 21±5 sec, Covid-19-minimal-personnel: 32±6 sec; Covid-19-advanced-airway-manager: 37±7 sec; each p<0.001 vs. control], but oxygen supply [Control: 77±19 sec; Covid-19-minimal-personnel: 29±5 sec; Covid-19-advanced-airway-manager: 34±7 sec; each p<0.001 vs. control] and first intubation attempt [Control: 178±44 sec; Covid-19-minimal-personnel: 111±14 sec; Covid-19-advanced-airway-manager: 131±20 sec; each p<0.001 vs. control] were earlier than in the control group. However, succesful intubation was similar [Control: 198±48 sec; Covid-19-minimal-personnel: 181±42 sec; Covid-19-advanced-airway-manager: 130±25 sec] due to a longer intubation time in Covid-19-minimal-personnel [61±35 sec] compared to Covid-19-advanced-airway-manager (p=0.002) and control [19±6 sec; p<0.001]. Time to first rhythm analysis was more than doubled in Covid-19-minimal-personnel [138±96 sec] compared to control [50±12 sec, p<0.001].ConclusionCovid-19-guidelines led to earlier attempts at intubation, delay in starting chest compressions, longer interruption in chest compression and markedly worsen the quality of resuscitation. These negative effects are attenuated by increasing the number of staff and addition of an experienced airway manager. Specific indications for Covid-19-guidelines are urgently required to carefully balance the risk of infection with SARS-CoV-2 for the staff vs. the potentially worse outcome for the patients.