Influence of Personal Protective Equipment on the Quality of Chest Compressions: A Meta-Analysis of Randomized Controlled Trials

Abstract

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, I2 = 80%] or the depth [MD: −1.84 mm, 95% CI: −3.93 to 0.24, P = 0.11, I2 = 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.

Cardiopulmonary Resuscitation Techniques in the COVID-19 Pandemic Era: Literature Review

“…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) studies (Couper et al, 2020) and (Ha, 2020), Indonesian research (Nabilah and Sonia, 2021 ), and Pakistan with research (Ali et al, 2021). (Cui and Jiang, 2021), the only article mentioning the gender of the respondent was male, and in research (Kienbacher et al, 2022;Malysz et al, 2020), articles that mention the respondent's gender is female.…”

“…Based on table 1, it is known that the number of respondents was 1.633 respondents, with male respondents 60 and female respondents 29. Based on table 2, it explains that the PPE used in cardiopulmonary resuscitation techniques in the era of the covid-19 pandemic uses Level C / Level 3, namely in research (Cui and Jiang, 2021;Nabilah and Sonia., 2021) using Level B / Level 2 in research (Ha, 2020). Meanwhile, other studies did not include the level of PPE used.…”

“…Based on table 3 it is known that research (Malysz et al, 2020) chest compression depth is 50-60 mm, in research (Mocarelli et al, 2020) with a depth of 5-6 cm, in research (Cui and jiang, 2021) with a depth of 1.3 mm, in research (Ali et al, 2021) with a depth of 36-57 mm, whereas in studies (Kienbacher et al, 2022;Kienbacher et al, 2021;Couper et al, 2020, Nabilah andSonia, 2021;Ha, 2020) does not include depth when perform chest compressions on patients suspected of Covid-19. Based on table 4. it is known that in studies (Moscarelli et al, 2020;Malysz et al, 2020;Kienbacher et al, 2022;Kienbacher et al, 2021;Malysz et al, 2020) in studies (Ali et al, 2021) with compression velocity chest 109-114 x/minute.…”

“…Based on table 1, the distribution of respondents based on gender in the study articles contained men and women with a total number of 1.633 respondents with 60 men and 29 women. You can sort the respondent's data from the most, namely from the article (Couper et al, 2020) with a total of 1,141 respondents without explaining what gender the respondents belonged to, (Cui and Jiang, 2021) there were 258 respondents with 60 male gender, (Malysz et al, 2020) with a total of 67 respondents with a total gender of 25 female, (Kienbacher et al, 2021) with a total of 48 respondents without explaining how many genders are male or female, (Kienbacher et al, 2022 ) with a total of 48 respondents stating that 4 respondents were female, (Moscarelli et al, 2020) with 36 respondents, and(Malysz et al, 2020) with a total of 35 respondents.…”

“…Based on table 2, it explains that PPE is divided into 2 levels, according to the table it is explained that there is use of PPE with Level C/Level 3 and use of Level B/Level 2. Recommendations for PPE during CPR have been issued during the Covid-19 pandemic, including wearing protective gowns with masks, gloves, and eye protection to protect medical personnel (Cui and Jiang, 2021). So, the researchers concluded that the use of PPE when performing CPR in the era of the Covid-19 pandemic consisted of gowns with masks, gloves, and eye protection.…”