The use of personal protection equipment does not impair the quality of cardiopulmonary resuscitation: A prospective triple-cross over randomised controlled non-inferiority trial. (March 2021)

• Record Type: Journal Article
• Authors: Kienbacher, Calvin Lukas; Grafeneder, Jürgen; Tscherny, Katharina; Krammel, Mario; Fuhrmann, Verena; Niederer, Maximilian; Neudorfsky, Sabine; Herbich, Klaus; Schreiber, Wolfgang; Herkner, Harald; Roth, Dominik
• Is Part Of: Resuscitation. Volume 160(2021)
• Page Start: 79
• Page End: 83
• Publication Date: 2021-03
• Subjects: BLS basic life support -- EMS emergency medical service -- ERC European Resuscitation Council -- FFP filtering face piece -- PPE personal protective equipment; Emergency medical services -- Cardiopulmonary resuscitation -- Chest compressions -- Personal protective equipment -- COVID-19 -- Manikin -- Simulation; Resuscitation -- Periodicals; Resuscitation -- Periodicals; Réanimation -- Périodiques; Electronic journals; 616.025
• DOI: 10.1016/j.resuscitation.2021.01.021
• Languages: English
• ISSNs: 0300-9572

Abstract

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 CO2 . 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 [−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)). Conclusion: PPE including masks with and without expiration valve is safe for use without concerns regarding the impairment of CPR quality.