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Background: Cardiopulmonary resuscitation (CPR) with the use of personal protective equipment (PPE) for aerosol generating procedures (AGP) in patients with suspected/confirmed COVID-19 remains challenging.
Aim: The aim of this study was to compare three chest compression methods applied by paramedics wearing PPE.
Methods: The single-blinded, multi...
Context in source publication
Context 1
... differences in the rate of chest compressions during the 2-minute chest compression period were observed in manual compressions and the TrueCPR method (see Figure 4). The percentage of correctly performed chest recoil was the lowest for the manual method and decreased over time as the chest compressions were performed, starting from the first minute of compressions (see Figure 5). ...
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Background: High-quality chest compression is one of the key elements of resuscitation to return of spontaneous circulation. In the COVID-19 era, medical personnel should wear personal protective equipment (PPE) against aerosol generating procedures (AGP) during resuscitation. However, the use of this personal protection equipment may reduce the ef...
Background and aims:
Many health care staff have been pressed into coronavirus disease-19 patient care with little experience of working in bio-hazard zones because of the overwhelming requirements of manpower. They wear personal protective equipment (PPE) and follow all rules for their safety. However, despite precautions, during doffing, they ca...
Citations
... Already at this point, attention was drawn to the possible role of the PPE to further optimize CPR for COVID-19 and the need for scientific research in this topic [3,4]. Until now, there are no large, randomized trials on the impact of PPE on CPR; available data mostly stems from smaller studies investigating the quality of chest compressions of single rescuers in simulated arrests [5][6][7][8][9][10][11] with partially contradictory results ranging from no [8,9] to even negative effects of PPE [5,[10][11][12][13]. Whereas beneficial effects of PPE include protection of the carrier from aerosol or droplet based transmission [1,2,14], particularly delays by "donning" PPE in COVID-19 CPR and hygienic issues have been discussed [2,15,16], but published data preferentially did not show any relevant delay during life-saving procedures in various populations [8,17]. ...
Background
Personal protective equipment (PPE) protects healthcare workers and patients. Data on guideline compliance on how to dress (donning) or remove (doffing) PPE and the assistance among multiple participants (buddying) are limited. This study assesses the quality of donning, doffing, and buddying of PPE in a simulated medical emergency.
Method
Physicians handling a simulated cardiac arrest of a COVID-19 patient. Adjacent to the victim, PPE was available. The appropriateness of PPE choice was assessed by using video recordings, with each individual participant being analyzed from the beginning of the simulation scenario from two perspectives regarding the selection of items during donning and doffing, hygiene aspects, time, and team support (buddying). The primary outcome was the number of participants being appropriately protected, defined as both wearing (a) all PPE items provided, and (b) all PPE items correctly at the time of first patient contact (FPC). Secondary outcomes included the timing of participants being appropriately protected. Statistical analysis was performed using SPSS (version 28). Mann–Whitney test, chi-square test, and linear regression analysis were performed as appropriate.
Results
At first patient contact 21% (91/437) were correctly protected. One or more incorrect PPE items were found in 4% (19/437), whereas 61% (265/437) wore one or more PPE items incorrectly. In 14% (62/437), one or more PPE items were missing. The time interval between donning start and FPC was 66 (55–78) sec. Time to FPC was longer in correctly than in incorrectly protected participants 77 (66–87) vs. 64 (54–75) sec; p < 0.001) and decreased by 7 ± 2 s per PPE item omitted (P = 0.002). Correct doffing was observed in 192/345 (56%), while buddying occurred in 120 participants (27%), indicating that they either assisted other participants in some manner (verbally or physically) or received assistance themselves.
Conclusions
Our findings imply a need for education in correct and timely PPE donning and doffing. Donning PPE as intended delayed FPC. This and the influence of buddying needs further investigation (German study register number DRKS00023184).
... The results of searching, selecting and assessing the quality of the literature obtained as many as 10 (ten) journals/articles that carried out literature reviews. Of the ten journals/articles, research was conducted in 7 (seven) countries, including Italy research (Moscarelli et al., 2020), Poland 2 studies (Moscarelli et al., 2020) and (Małysz et al., 2020), Austria 2 studies ( Kienbacher et al., 2022) and (Kienbacher et al., 2021), Chinese research (Cui and Jiang, 2021), Australian 2 Number of articles that are not full text (n= 48) ...
... Manual chest compressions are described as effective when given in the center of the chest, at a rate of 100-120 minutes (Moscarelli et al., 2020). The target set according to the 2015 quality standard set by the ERC is a speed of 100 to 120 compressions per minute (Małysz et al., 2020). The rate of chest compressions in the AHA guidelines is specifically stated to be 100-120 times per minute. ...
... As for the heart massage technique in the face-down position using 2 hands and 1 hand for adults and the fingers of one hand in pediatric patients, the facedown position is recommended for severe hypoxemic respiratory failure, based on clinical trial data showing reduced mortality with treatment this (Moscarelli et al., 2020), there are also those who still use manual techniques in a supine position. The face down position as a treatment for acute respiratory distress syndrome (ARDS) was first described in 1976, there are 3 techniques reviewed in one of the articles by (Małysz et al., 2020) with mentions of Manual technique, CPR feedback device, LUCAS 3 device, and some use standard live CPR techniques with alternative training methods such as hybrid or online-only (AT) training. The aim was to compare learning outcomes between standard instructor-led, class-based CPR training with alternative training methods among lay people (Ali et al., 2021). ...
Cardiac resuscitation in the era of the COVID-19 pandemic meets its challenges; in addition to the high prevalence of cardiac and pulmonary arrest events in these patients, the transmission rate to health workers who carry out CPR assistance is also relatively high. Therefore, it is necessary to develop CPR techniques in COVID-19 patients that can increase the success of CPR and reduce transmission rates. The purpose of the study was to explain how CPR techniques are in COVID-19 patients. The literature review method through data collection with an electronic database and evaluation of the literature review will use Critical Appraisal to test validity. Data collection with electronic databases was conducted through PubMed, Tailor, Francis, and Google Scholar with the keyword "CPR," "COVID-19," and " technique. "The data was successfully collected in the database of 548 articles then filtered the inclusion and exclusion criteria into ten pieces; then the article passed the Critical Appraisal test. Hasil Literature review CPR technique in covid patients added is the use of PPE level C/3; The recommended compression depth is 2-2.4 inches (5-6cm); manual chest compression is described as effective when administered in the middle of the chest, at a rate of 100-120 minutes. , The recommended position is prone and supine.
... However, the outcomes of mechanical CPR are not always uniform. In clinical studies, some research has demonstrated positive outcomes of mechanical CPR [12,13], especially in the process of transportation, which can continuously provide stable chest compressions [14][15][16]. Nevertheless, other research found mechanical CPR has no superiority over manual CPR [17][18][19], and even causes greater harm to patients [20][21][22]. ...
The waveform of chest compressions directly affects the blood circulation of patients with cardiac arrest. Currently, few pieces of research have focused on the influence of the cardiopulmonary resuscitation (CPR) device’s mechanical waveform on blood circulation. This study investigates the effect of the mechanical waveform from a novel CPR prototype on blood circulation and explores the optimal compression parameters of the mechanical waveform to optimize blood circulation. A novel CPR prototype was designed and built to establish a kinetic model during compressions. The prototype’s mechanical waveforms at various operating conditions were obtained for comparison with manual waveforms and the investigation of the optimal compression parameters. The novel CPR prototype can complete chest compressions quickly and stably. The cardiac output (CO), coronary perfusion pressure (CPP), and cerebral flow (CF) obtained by mechanical waveform compressions (1.22367 ± 0.00942 L/min, 30.95083 ± 0.24039 mmHg, 0.31992 ± 0.00343 L/min, respectively) were significantly better than those obtained by manual waveform compressions (1.10783 ± 0.03601 L/min, 21.39210 ± 1.42771 mmHg, 0.29598 ± 0.01344 L/min, respectively). With the compression of the prototype, the blood circulation can be optimized at the compression depth of 50 mm, approximately 0.6 duty cycle, and approximately 110 press/min, which is of guiding significance for the practical use of CPR devices to rescue patients with cardiac arrest.
... The authors of both studies advocate the need for further studies of CPR in COVID-19 and claim that strategies are needed to further optimize CPR for COVID-19, including the use of PPE [6,7]. Current data on the impact of PPE on CPR mostly relate to small studies investigating the quality of chest compressions of single rescuers' in simulated arrests [8][9][10][11][12][13][14][15]. Results are conflicting with studies reporting no effect of PPE [11,12] or negative effects [8,[13][14][15][16]. ...
... By contrast, a simulator-based randomized study involving 80 participants (23 physicians, 57 nurses) reported that compared to wearing a surgical mask, wearing an N95 mask increases a rescuer's fatigue and decreases the chest compression quality during CPR [15]. In simulator-based randomized cross-over studisssses with participants dressed in full PPE during the pandemic, an automated chest compression device proved to be superior over manual chest compressions in both 35 students after the successful completion of an ACLS course [10] and 67 paramedics [9]. Of note, all above mentioned studies assessed the quality of performance of single rescuers only and only one [15] included data on hands-on time, the primary outcome of our trial. ...
Background: Guidelines of cardiopulmonary resuscitation (CPR) recommend the use of personal protective equipment (PPE) during the resuscitation of COVID-19 patients. Data on the effects of PPE on rescuers’ stress level and quality of CPR are sparse and conflicting. This trial investigated the effects of PPE on team performance in simulated cardiac arrests. Methods: During the pandemic period, 198 teams (689 participants) performed CPR with PPE in simulated cardiac arrests (PPE group) and were compared with 423 (1451 participants) performing in identical scenarios in the pre-pandemic period (control group). Video recordings were used for data analysis. The primary endpoint was hands-on time. Secondary endpoints included a further performance of CPR and the perceived task load assessed by the NASA task-load index. Results: Hands-on times were lower in PPE teams than in the control group (86% (83–89) vs. 90% (87–93); difference 3, 95% CI for difference 3–4, p < 0.0001). Moreover, PPE teams made fewer change-overs and delayed defibrillation and administration of drugs. PPE teams perceived higher task loads (57 (44–67) vs. 63 (53–71); difference 6, 95% CI for difference 5–8, p < 0.0001) and scored higher in the domains physical and temporal demand, performance, and effort. Leadership allocation had no effect on primary and secondary endpoints. Conclusions: Having to wear PPE during CPR is an additional burden in an already demanding task. PPE is associated with an increase in perceived task load, lower hands-on times, fewer change-overs, and delays in defibrillation and the administration of drugs. (German study register number DRKS00023184).
... Както дълбочината, така и честотата на гръдните компресии с механичното устройство по-често са отговаряли на изискваните. Също така авторите препоръчват смяна на здравния работник, като се прилага мануална гръдна компресия на всяка минута, когато той или тя носят PPE AGP [14]. ...
... Because of the risk of SARS-CoV-2 infection, resuscitation of a patient with suspected or confirmed COVID-19 should be carried out using personal protective equipment (PPE) [23,24]. However, as shown by many studies [25,26], the use of PPE for aerosol generating procedures (AGPs) may adversely affect the quality of chest compression. In order to improve the quality of the conducted resuscitation, Malysz et al. [27] compared two techniques of manual chest compression -demonstrating that paramedics wearing PPE-AGP achieved better chest compression depth for over-the-head position compared to the standard chest position, however, over-the-head position resuscitation causes a lower full chest relaxation. ...
Background: The main purposes of this meta-analysis are to update the information about the impact of coronavirus disease 2019 (COVID-19) pandemic on outcomes of in-hospital cardiac arrest (IHCA) and to investigate the impact of being infected by by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) on IHCA outcomes.
Methods: The current meta-analysis is an update and follows the recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).
Results: In analyses, pre- and intra-COVID-19 periods were observed for: shockable rhythms in 17.6% vs. 16.2% (odds ratio [OR]: 1.11; 95% confidence interval [CI]: 0.71–1.72; p = 0.65), return of spontaneous circulation (ROSC) in 47.4% vs. 44.0% (OR: 1.36; 95% CI: 0.90–2.07; p = 0.15), 30-day mortality in 59.8% vs. 60.9% (OR: 0.95; 95% CI: 0.75–1.22; p = 0.69) and overall mortality 75.8% vs. 74.7% (OR: 0.80; 95% CI: 0.49–1.28; p = 0.35), respectively. In analyses, SARS-CoV-2 positive and negative patients were observed for: shockable rhythms in 9.6% vs. 19.8% (OR: 0.51; 95% CI: 0.35–0.73; p < 0.001), ROSC in 33.9% vs. 52.1% (OR: 0.47; 95% CI: 0.30–0.73; p < 0.001), 30-day mortality in 77.2% vs. 59.7% (OR: 2.08; 95% CI: 1.28–3.38; p = 0.003) and overall mortality in 94.9% vs. 76.7% (OR: 3.20; 95% CI: 0.98–10.49; p = 0.05), respectively.
Conclusions: Despite ROSC, 30-day and overall mortality rate were not statistically different in pre vs. intra-COVID-19 periods, a lower incidence of ROSC and higher 20-day mortality rate were observed in SARS-CoV-2 (+) compared to SARS-CoV-2 (–) patients.
... However, due to the non-randomized nature and lack of a control group without PPE, these results are difficult to interpret. Besides, automated chest compression devices and reduced duration of the cycle of CPR have also been suggested for patients with suspected or confirmed COVID-19 during CPR (21,22). The optimal PPE may be that has minimized influence on the quality of chest compression, but has adequacy protection for the healthcare providers. ...
Background: Randomized controlled trials (RCTs) evaluating the influence of personal protective equipment (PPE) on quality of chest compressions during cardiopulmonary resuscitation (CPR) showed inconsistent results. Accordingly, a meta-analysis was performed to provide an overview.
Methods: Relevant studies were obtained by search of Medline, Embase, and Cochrane's Library databases. A random-effect model incorporating the potential heterogeneity was used to pool the results.
Results: Six simulation-based RCTs were included. Overall, pooled results showed that there was no statistically significant difference between the rate [mean difference (MD): −1.70 time/min, 95% confidence interval (CI): −5.77 to 2.36, P = 0.41, I ² = 80%] or the depth [MD: −1.84 mm, 95% CI: −3.93 to 0.24, P = 0.11, I ² = 73%] of chest compressions performed by medical personnel with and without PPE. Subgroup analyses showed that use of PPE was associated with reduced rate of chest compressions in studies before COVID-19 (MD: −7.02 time/min, 95% CI: −10.46 to −3.57, P < 0.001), but not in studies after COVID-19 (MD: 0.14 time/min, 95% CI: −5.77 to 2.36, P = 0.95). In addition, PPE was not associated with significantly reduced depth of chest compressions in studies before (MD: −3.34 mm, 95% CI: −10.29 to −3.62, P = 0.35) or after (MD: −0.97 mm, 95% CI: −2.62 to 0.68, P = 0.25) COVID-19. No significant difference was found between parallel-group and crossover RCTs ( P for subgroup difference both > 0.05).
Conclusions: Evidence from simulation-based RCTs showed that use of PPE was not associated with reduced rate or depth of chest compressions in CPR.
... poor mobility, early fatigue, impairment in performing endotracheal intubation and/or establishing vascular access. 17,[30][31][32][33] However, waiving off PPe is not an option in view of the risk of transmission. 4, 5 on one hand, helpers themselves may belong to vulnerable groups, while on the other, the resulting duty for quarantine after un- ...
Background:
To evaluate the effects of European Resuscitation Council (ERC) COVID-19-guidelines on resuscitation quality emphasizing advanced airway management in out-of-hospital-cardiacarrest.
Methods:
In a 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.
Results:
Thirty resuscitation scenarios were completed. No-flow-time was markedly prolonged in COVID-19-minimal-personnel [113±37sec] compared to Control [55±9sec] and COVID-19-advanced-airway-manager [76±38sec](p<0.001 each). In both COVID-19-groups chest compressions started later [COVID-19-minimal-personnel:32±6sec; COVID-19-advancedairway-manager:37±7sec; each p<0.001 vs. Control (21±5sec)], but oxygen supply [COVID-19-minimal-personnel:29±5sec; COVID-19-advanced-airway-manager:34±7sec; each p<0.001 vs. Control (77±19sec)] and first intubation attempt [COVID-19-minimalpersonnel: 111±14sec; COVID-19-advanced-airway-manager:131±20sec; each p<0.001 vs. Control (178±44sec)] were performed earlier. However, time interval to successful intubation was similar [Control:198±48sec; COVID-19-minimal-personnel:181±42sec; COVID-19-advanced-airway-manager:130±25sec] due to a longer intubation time in COVID-19-minimalpersonnel [61±35sec] compared to COVID-19-advanced-airway-manager (p=0.002) and control [19±6sec;p<0.001]. Time to first rhythm analysis was more than doubled in COVID-19-minimal-personnel [138±96sec] compared to control [50±12sec;p<0.001].
Conclusions:
Delayed chest compressions and prolonged no-flow-time markedly reduced the quality of resuscitation. These negative effects were attenuated by increasing the number of staff and by adding an experienced airway manager. The use of endotracheal intubation for reducing aerosol release during resuscitation should be discussed critically as its priorization is associated with an increase in no-flow-time.
... In the guidelines, wearing personal protective equipment (PPE) with an N-95 mask is especially recommended. However, there are potential disadvantages, including communication difficulties between team members and a decreased quality of the resuscitation such as chest compression procedures [3][4][5][6][7][8] . Even though the safety of health care provider is the first priority, the prognosis of OHCA patients is also an important issue. ...
This study aimed to determine the association between cardiopulmonary resuscitation (CPR) under the coronavirus 2019 (COVID-19) safety protocols in our hospital and the prognosis of out-of-hospital cardiac arrest (OHCA) patients, in an urban area, where the prevalence of COVID-19 infection is relatively low. This was a single-center, retrospective, observational, cohort study conducted at a tertiary critical care center in Kyoto City, Japan. Adult OHCA patients arriving at our hospital under CPR between January 1, 2019, and December 31, 2020 were included. Our hospital implemented a revised resuscitation protocol for OHCA patients on April 1, 2020 to prevent COVID-19 transmission. This study defined the conventional CPR period as January 1, 2019 to March 31, 2020, and the COVID-19 safety protocol period as April 1, 2020 to December 31, 2020. Throughout the prehospital and in-hospital settings, resuscitation protocols about wearing personal protective equipment and airway management were revised in order to minimize the risk of infection; otherwise, the other resuscitation management had not been changed. The primary outcome was hospitalization survival. The secondary outcomes were return of spontaneous circulation after hospital arrival and 1-month survival after OHCA occurrence. The adjusted odds ratios with 95% confidence intervals (CI) were calculated for outcomes to compare the two study periods, and the multivariable logistic model was used to adjust for potential confounders. The study analyzed 443 patients, with a median age of 76 years (65–85), and included 261 men (58.9%). The percentage of hospitalization survivors during the entire research period was 16.9% (75/443 patients), with 18.7% (50/267) during the conventional CPR period and 14.2% (25/176) during the COVID-19 safety protocol period. The adjusted odds ratio for hospitalization survival during the COVID-19 safety protocol period was 0.61 (95% CI 0.32–1.18), as compared with conventional CPR. There were no cases of COVID-19 infection among the staff involved in the resuscitation in our hospital. There was no apparent difference in hospitalization survival between the OHCA patients resuscitated under the conventional CPR protocol compared with the current revised protocol for controlling COVID-19 transmission.
... Accordingly, the authors suggest changing the healthcare giver performing manual chest compressions every minute when he or she is wearing a PPE AGP. 14 Kaufmann and Huber from Austria published in German the most often asked questions from patients with respect to COVID-19 and cardiovascular diseases to provide helpful answers that were given by ESC experts. Such an approach was perceived very useful among readers. ...
