The use of personal protection equipment does not impair the quality of cardiopulmonary resuscitation: A prospective triple-cross over randomised controlled non-inferiority trial

Calvin Lukas Kienbacher,Jürgen Grafeneder,Katharina Tscherny,Mario Krammel,Verena Fuhrmann,Maximilian Niederer,Sabine Neudorfsky,Klaus Herbich,Wolfgang Schreiber,Harald Herkner,Dominik Roth

doi:10.1016/j.resuscitation.2021.01.021

Calvin Lukas Kienbacher, Jürgen Grafeneder + Show 9 more

Open Access

https://doi.org/10.1016/j.resuscitation.2021.01.021

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Journal: Resuscitation	Publication Date: Jan 30, 2021
Citations: 22	License type: cc-by

Affiliation: Medical University of Vienna

Abstract

AimPrior 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. MethodsRandomised 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 CO2. ResultsDifferences 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 [−1, 2]) and control vs. personal protective equipment with valve (absolute difference 1 mm, [−0.2, 2]). This was also true for secondary outcomes regarding quality of chest compressions and providers’ vital signs including etCO2. 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)). ConclusionPPE including masks with and without expiration valve is safe for use without concerns regarding the impairment of CPR quality.

Highlights

The COVID-19 pandemic has led to widespread daily use of personal protection equipment (PPE), including various types of gowns, eye protection and masks for emergency medical care providers.[1,2] Studies prior to the pandemic suggest that PPE might impair treatment performance when treating critically ill patients.[3]
We investigated the influence of personal protective equipment on out-of-hospital cardiopulmonary resuscitation
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

Summary

Introduction

The COVID-19 pandemic has led to widespread daily use of personal protection equipment (PPE), including various types of gowns, eye protection and masks for emergency medical care providers.[1,2] Studies prior to the pandemic suggest that PPE might impair treatment performance when treating critically ill patients.[3]. Symptoms of hypercapnia include lightheadedness, dizziness, and headaches, and can lead to collapse and death.[8,9]

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