Development of a Mannequin for Simulation-Based Trials Involving Respiratory Viral Spread During Respiratory Arrest and Cardiopulmonary Arrest Scenarios.

Cindy Luu,Todd Chang,Edward Guerrero,Jennifer Lau,Leo Langga,Alyssa Rake,Margaux Chan,Caulette Young,Elizabeth Bragg,Joshua Buan

doi:10.7759/cureus.20304

Abstract

During the coronavirus disease 2019 (COVID-19) pandemic, mannequin models have been developed to mimic viral spread using fluorescent particles. These models use contraptions such as a spray gun or an exploding latex balloon to emanate a sudden acceleration of particles, simulating a “cough” reflex. No models have been developed to mimic passive aerosolization of viral particles during a cardiopulmonary arrest simulation. Our novel approach to aerosolization of simulated viral spread allows for a continuous flow of particles, which allows us to maintain components of high-fidelity team-based simulations. Our simulated model emanated GloGerm (Moab, UT) from the respiratory tract using a continuous nebulization chamber. Uniquely, the construction of our apparatus allowed for the ability to perform full, simulated cardiopulmonary resuscitation scenarios (such as chest compressions, bag-mask ventilation, and endotracheal intubation) on a high-fidelity mannequin while visualizing potential contamination spread at the conclusion of the simulation.Positive feedback from users included the ability to visualize particulate contamination after cardiopulmonary resuscitations in the context of personal protective equipment usage and roles in resuscitation (i.e. physician, respiratory therapist, nurse). Negative criticism towards the simulation included the lack of certain high-fidelity feedback markers of the mannequin (auscultating breath sounds and checking pulses) due to the construction of the particle aerosolization mechanism.

Highlights

The American Heart Association (AHA) has recently provided new guidance for resuscitation management in the face of the coronavirus disease 2019 (COVID-19) pandemic, with the goal of reducing exposure to virus aerosolization during bag-valve-mask (BVM) ventilation, endotracheal intubation, and cardiopulmonary resuscitation (CPR) [1,2,3]
Prior GloGerm simulator models have focused on a cough model, in which a burst of the fluorescent material is expelled once, or in a model that requires constant darkness and blacklight. This model differs from real-life cardiopulmonary arrest scenarios, in which the rooms are typically fully lit with potentially unseen aerosolized viral particles
One of the first barriers we encountered in the design of this project was determining the correct methodology of aerosolizing an invisible, non-toxic, blacklight-fluorescent substance to mimic COVID-19 particles during simulation

Summary

Introduction

The American Heart Association (AHA) has recently provided new guidance for resuscitation management in the face of the coronavirus disease 2019 (COVID-19) pandemic, with the goal of reducing exposure to virus aerosolization during bag-valve-mask (BVM) ventilation, endotracheal intubation, and cardiopulmonary resuscitation (CPR) [1,2,3] While these recommendations address concerns regarding a healthcare team’s excess exposure to aerosolized particles, they could potentially have a negative impact on resuscitation quality. Prior GloGerm simulator models have focused on a cough model, in which a burst of the fluorescent material is expelled once, or in a model that requires constant darkness and blacklight This model differs from real-life cardiopulmonary arrest scenarios, in which the rooms are typically fully lit with potentially unseen aerosolized viral particles

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