Vol 27, No 5 (2020)
Original Article
Published online: 2020-05-15
Resuscitation of the patient with suspected/confirmed COVID-19 when wearing personal protective equipment: A randomized multicenter crossover simulation trial
1
, 2, 3, 41, 5, 6, 7, 8, 91, 10, 51
, 2, 3, 41, 5, 6, 7, 8, 91, 10, 51
Abstract
Background: The aim of the study was to evaluate various methods of chest compressions in patients with suspected/confirmed SARS-CoV-2 infection conducted by medical students wearing full personal protective equipment (PPE) for aerosol generating procedures (AGP).
Methods: This was prospective, randomized, multicenter, single-blinded, crossover simulation trial. Thirty-five medical students after an advanced cardiovascular life support course, which included performing 2-min continuous chest compression scenarios using three methods: (A) manual chest compression (CC), (B) compression with CPRMeter, (C) compression with LifeLine ARM device. During resuscitation they are wearing full personal protective equipment for aerosol generating procedures.
Results: The median chest compression depth using manual CC, CPRMeter and LifeLine ARM varied and amounted to 40 (38–45) vs. 45 (40–50) vs. 51 (50–52) mm, respectively (p = 0.002). The median chest compression rate was 109 (IQR; 102–131) compressions per minute (CPM) for manual CC, 107 (105–127) CPM for CPRMeter, and 102 (101–102) CPM for LifeLine ARM (p = 0.027). The percentage of correct chest recoil was the highest for LifeLine ARM — 100% (95–100), 80% (60–90) in CPRMeter group, and the lowest for manual CC — 29% (26–48).
Conclusions: According to the results of this simulation trial, automated chest compression devices (ACCD) should be used for chest compression of patients with suspected/confirmed COVID-19. In the absence of ACCD, it seems reasonable to change the cardiopulmonary resuscitation algorithm (in the context of patients with suspected/confirmed COVID-19) by reducing the duration of the cardiopulmonary resuscitation cycle from the current 2-min to 1-min cycles due to a statistically significant reduction in the quality of chest compressions among rescuers wearing PPE AGP.
Keywords: chest compressioncardiopulmonary resuscitationqualityCOVID-19SARS-CoV-2medical simulation
References
- Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun. 2020; 109: 102433.
- van Doremalen N, Bushmaker T, Morris DH, et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med. 2020; 382(16): 1564–1567.
- Dzieciatkowski T, Szarpak L, Filipiak KJ, et al. COVID-19 challenge for modern medicine. Cardiol J. 2020 [Epub ahead of print].
- Verbeek JH, Rajamaki B, Ijaz S, et al. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database Syst Rev. 2016; 4: CD011621.
- Smereka J, Szarpak L. COVID 19 a challenge for emergency medicine and every health care professional. Am J Emerg Med. 2020 [Epub ahead of print].
- Smereka J, Szarpak L, Filipiak K. Modern medicine in COVID-19 era. Disaster Emerg Med J. 2020.
- Yang J, Zheng Ya, Gou Xi, et al. Prevalence of comorbidities and its effects in coronavirus disease 2019 patients: A systematic review and meta-analysis. Int J Infect Dis. 2020 [Epub ahead of print]; 94: 91–95.
- Soar J, Nolan JP, Böttiger BW, et al. Adult advanced life support section Collaborators. European Resuscitation Council Guidelines for Resuscitation 2015: Section 3. Adult advanced life support. Resuscitation. 2015; 95: 100–147.
- Truhlář A, Deakin CD, Soar J, et al. Cardiac arrest in special circumstances section Collaborators. European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac arrest in special circumstances. Resuscitation. 2015; 95: 148–201.
- Link MS, Berkow LC, Kudenchuk PJ, et al. Part 7: Adult Advanced Cardiovascular Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015; 132(18 Suppl 2): S444–S464.
- Lavonas EJ, Drennan IR, Gabrielli A, et al. Part 10: Special Circumstances of Resuscitation: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015; 132(18 Suppl 2): S501–S518.
- European Resuscitation Council. European Resuscitation Council COVID-19 Guidelines. www.erc.edu (Access: 24 April, 2020).
- Martín Rodríguez F, Fernández Pérez C, Castro Villamor M, et al. Does level D personal protective equipment guard against hazardous biologic agents during cardiopulmonary resuscitation? Emergencias. 2018; 30(2): 119–122.
- Wiechmann W, Toohey S, Majestic C, et al. Intubating ebola patients: technical limitations of extensive personal protective equipment. West J Emerg Med. 2015; 16(7): 965.
- Smereka J, Szarpak L, Filipiak KJ, et al. Which intravascular access should we use in patients with suspected/confirmed COVID-19? Resuscitation. 2020 [Epub ahead of print]; 151: 8–9.
- Koster RW, Beenen LF, van der Boom EB, et al. Safety of mechanical chest compression devices AutoPulse and LUCAS in cardiac arrest: a randomized clinical trial for non-inferiority. Eur Heart J. 2017; 38(40): 3006–3013.
- Iskrzycki L, Smereka J, Rodriguez-Nunez A, et al. The impact of the use of a CPRMeter monitor on quality of chest compressions: a prospective randomised trial, cross-simulation. Kardiol Pol. 2018; 76(3): 574–579.
- Majer J, Kaminska H, Wieczorek W, et al. Impact of a cprmeter feedback device on chest compression quality performed by nurses — a randomized crossover study. Disaster Emerg Med J. 2018; 3(1): 36–37.
- Szarpak L, Truszewski Z, Czyzewski L, et al. CPR using the lifeline ARM mechanical chest compression device: a randomized, crossover, manikin trial. Am J Emerg Med. 2017; 35(1): 96–100.
- Ewy GA, Zuercher M, Hilwig RW, et al. Improved neurological outcome with continuous chest compressions compared with 30:2 compressions-to-ventilations cardiopulmonary resuscitation in a realistic swine model of out-of-hospital cardiac arrest. Circulation. 2007; 116(22): 2525–2530.
- Smereka J, Bielski K, Ladny JR, et al. Evaluation of a newly developed infant chest compression technique: A randomized crossover manikin trial. Medicine (Baltimore). 2017; 96(14): e5915.
- Heidenreich JW, Berg RA, Higdon TA, et al. Rescuer fatigue: standard versus continuous chest-compression cardiopulmonary resuscitation. Acad Emerg Med. 2006; 13(10): 1020–1026.
- Heidenreich JW, Sanders AB, Higdon TA, et al. Uninterrupted chest compression CPR is easier to perform and remember than standard CPR. Resuscitation. 2004; 63(2): 123–130.
- Smereka J, Szarpak L, Rodríguez-Núñez A, et al. A randomized comparison of three chest compression techniques and associated hemodynamic effect during infant CPR: A randomized manikin study. Am J Emerg Med. 2017; 35(10): 1420–1425.
- Abelairas-Gómez C, Barcala-Furelos R, Szarpak Ł, et al. The effect of strength training on quality of prolonged basic cardiopulmonary resuscitation. Kardiol Pol. 2017; 75(1): 21–27.
- Adler MD, Krug S, Eiger C, et al. Impact of personal protective equipment on the performance of emergency pediatric tasks. Pediatr Emerg Care. 2020 [Epub ahead of print].
- Szarpak L, Truszewski Z, Gałązkowski R, et al. Comparison of two chest compression techniques when using CBRN-PPE: a randomized crossover manikin trial. Am J Emerg Med. 2016; 34(5): 913–915.
- Szarpak L, Truszewski Z, Smereka J, et al. Comparison of two intravascular access techniques when using CBRN-PPE: A randomized crossover manikin trial. Am J Emerg Med. 2016; 34(6): 1170–1172.
- Lamhaut L, Dagron C, Apriotesei R, et al. Comparison of intravenous and intraosseous access by pre-hospital medical emergency personnel with and without CBRN protective equipment. Resuscitation. 2010; 81(1): 65–68.
- Schumacher J, Arlidge J, Garnham F, et al. A randomised crossover simulation study comparing the impact of chemical, biological, radiological or nuclear substance personal protection equipment on the performance of advanced life support interventions. Anaesthesia. 2017; 72(5): 592–597.
- Castle N, Pillay Y, Spencer N. Comparison of six different intubation aids for use while wearing CBRN-PPE: a manikin study. Resuscitation. 2011; 82(12): 1548–1552.
- Tranberg T, Lassen JF, Kaltoft AK, et al. Quality of cardiopulmonary resuscitation in out-of-hospital cardiac arrest before and after introduction of a mechanical chest compression device, LUCAS-2; a prospective, observational study. Scand J Trauma Resusc Emerg Med. 2015; 23: 37.
- Enriquez D, Firenze L, Fernández Díaz J, et al. Changes in the depth of chest compressions during cardiopulmonary resuscitation in a pediatric simulator. Arch Argent Pediatr. 2018; 116(6): e730–e735.
- Chen J, Lu KZ, Yi B, et al. Chest compression with personal protective equipment during cardiopulmonary resuscitation: a randomized crossover simulation study. Medicine (Baltimore). 2016; 95(14): e3262.
- Gates S, Quinn T, Deakin CD, et al. Mechanical chest compression for out of hospital cardiac arrest: Systematic review and meta-analysis. Resuscitation. 2015; 94: 91–97.
- Eichhorn S, Mendoza A, Prinzing A, et al. Corpuls CPR generates higher mean arterial pressure than LUCAS II in a pig model of cardiac arrest. Biomed Res Int. 2017; 2017: 5470406.
- Kovacs A, Vadeboncoeur TF, Stolz U, et al. Chest compression release velocity: Association with survival and favorable neurologic outcome after out-of-hospital cardiac arrest. Resuscitation. 2015; 92: 107–114.
- Smereka J, Madziala M, Szarpak L. Comparison of two infant chest compression techniques during simulated newborn cardiopulmonary resuscitation performed by a single rescuer: A randomized, crossover multicenter trial. Cardiol J. 2019; 26(6): 761–768.
- Kurowski A, Szarpak Ł, Bogdański Ł, et al. Comparison of the effectiveness of cardiopulmonary resuscitation with standard manual chest compressions and the use of TrueCPR and PocketCPR feedback devices. Kardiol Pol. 2015; 73(10): 924–930.
- Majer J, Jaguszewski MJ, Frass M, et al. Does the use of cardiopulmonary resuscitation feedback devices improve the quality of chest compressions performed by doctors? A prospective, randomized, cross-over simulation study. Cardiol J. 2019; 26(5): 529–535.
- Lampe JW, Tai Y, Bratinov G, et al. Developing a kinematic understanding of chest compressions: the impact of depth and release time on blood flow during cardiopulmonary resuscitation. Biomed Eng Online. 2015; 14: 102.
- Idris AH, Guffey D, Pepe PE, et al. Chest compression rates and survival following out-of-hospital cardiac arrest. Crit Care Med. 2015; 43(4): 840–848.
- Monsieurs KG, De Regge M, Vansteelandt K, et al. Excessive chest compression rate is associated with insufficient compression depth in prehospital cardiac arrest. Resuscitation. 2012; 83(11): 1319–1323.
- Smereka J, Iskrzycki Ł, Makomaska-Szaroszyk E, et al. The effect of chest compression frequency on the quality of resuscitation by lifeguards. A prospective randomized crossover multicenter simulation trial. Cardiol J. 2019; 26(6): 769–776.
- Smereka J, Szarpak L, Czekajlo M, et al. The TrueCPR device in the process of teaching cardiopulmonary resuscitation: A randomized simulation trial. Medicine (Baltimore). 2019; 98(27): e15995.
- Truszewski Z, Szarpak L, Kurowski A, et al. Randomized trial of the chest compressions effectiveness comparing 3 feedback CPR devices and standard basic life support by nurses. Am J Emerg Med. 2016; 34(3): 381–385.
- Iskrzycki L, Smereka J, Rodriguez-Nunez A, et al. The impact of the use of a CPRMeter monitor on quality of chest compressions: a prospective randomised trial, cross-simulation. Kardiol Pol. 2018; 76(3): 574–579.
- Wattenbarger S, Silver A, Hoyne T, et al. Real-Time cardiopulmonary resuscitation feedback and targeted training improve chest compression performance in a cohort of international healthcare providers. J Emerg Med. 2019 [Epub ahead of print].
- Wagner M, Bibl K, Hrdliczka E, et al. Effects of feedback on chest compression quality: a randomized simulation study. Pediatrics. 2019; 143(2).
- Szarpak L, Filipiak KJ, Ładny JR, et al. Should nurses use mechanical chest compression devices during CPR? Am J Emerg Med. 2016; 34(10): 2044–2045.
- Truszewski Z, Szarpak L, Kurowski A, et al. Mechanical chest compression with the LifeLine ARM device during simulated CPR. Am J Emerg Med. 2016; 34(5): 917.
- Abelsson A. Learning through simulation. Disaster Emerg Med J. 2017; 2(3): 125–128.
- Adamczuk J, Nieckula M, Dabrowska A, et al. Recommendations for the use of simulation methods in a selected area of health sciences based on an example simulation scenario. Disaster Emerg Med J. 2019; 4(4): 173–179.
