Comparison of different chest compression positions for use while wearing CBRN-PPE: a randomized crossover simulation trial

Abstract

INTRODUCTION: The prevailing COVID-19 pandemic forces paramedics to take medical rescue operations using personal protective equipment (PPE) for aerosol-generating procedures (AGP). The use of PPE-AGP may reduce the effectiveness of the procedures performed, including airway management, intravascular access, or chest compression. The goal of the current study was to compare the quality by which a chest compression during simulated COVID-19 resuscitation while wearing PPE-AGP. A secondary goal was to assess provider preferences with standard versus OHD chest compression methods while wearing PPE-AGP. MeThODS: This is a randomized cross-over single-blinded study involving 37 paramedics performing 2-min continuous chest compression using two methods: the standard chest compression (CC) method during which the rescuer takes a position to the side of the victim (STD) and over-the-head position (OHD). During cardiopulmonary resuscitation, study participants wore Class C PPE-AGP. Both the order of study participants and compression methods were random. The results were blinded before statistical analysis. The compression rate per minute (CPM), CC depth as well as full chest recoil were measured. The analysis was undertaken using STATISTICA (V13.3EN). ReSULTS: Mean chest compression depth using distinct CC methods varied and amounted to 42 ± 2mm for STD vs. 46 ± 4mm for OHD (p < 0.001). Chest compressions based on the OHD method were associated with a lower frequency of chest compressions (107 ± 7CPM) compared with STD (114.5 ± 8; p< 0.001). A higher percentage of full chest recoil was observed in the case of STD (42 ± 6%) than in the case of OHD (34 ± 10%). CONCLUSIONS: Based on the current simulation trial, it is impossible to clearly determine which method (STD vs. OHD) is more effective in resuscitation with PPE-AGP. Paramedics wearing PPE-AGP achieved better chest compression depth for OHD compared to the STD, however, OHD resuscitation causes a lower degree of full chest relaxation. A further well-designed clinical study looking at efficacy, safety, and outcomes is needed to confirm current results.

Meta-analysis of chest compression-only versus conventional cardiopulmonary resuscitation by bystanders for adult with out-of-hospital cardiac arrest

“…These include the fact that shared secretions that occur from mouth-tomouth resuscitation serves as an impediment for adoption in unrelated bystanders, and because it is easier to instruct an unexperienced provider by telephone in the performance of chest compression only CPR when guidance is obtained remotely [35,36]. Furthermore, in the time of a global pandemic, the performance of rescue breathing must be considered an avoidable high-risk activity for the transmission of pathogens from the patient to the rescue breathing provider [37][38][39][40].…”

Chest Compression Methods Simulated Covid-19 Patient Resuscitation: A Randomized Cross-Oversimulation Trial

“…Study was conducted in Warsaw, Poznan and Wroclaw in the period from January to February 2020. The study is a continuation of the research undertaken by the authors, aimed at evaluating various methods of cardiopulmonary resuscitation during the use of PPE-AGP [8,14]. Participants Thirty-two medical students who completed advanced cardiovascular life support training took part in the study.…”

“…Statistical analysis Sample size calculations were performed based on a two-sided paired t-test assuming 80% power and a significance level of 0.05. Assumptions for expected results were based upon the work of Malysz et al [14]. Those calculations indicated that a sample size of 32 participants would be required to power the trial adequately to detect a difference of 5 millimeters between the two modalities.…”

Mechanical chest compression devices as an option for out-of-hospital cardiac arrest in COVID-19 pandemic

“…We read with great interest an article by Malysz et al [1]. In this manuscript, authors showed that over-the-head position is much more effective than standard position during chest compression.…”