Life-Saving Procedures Performed While Wearing CBRNe Personal Protective Equipment

Abstract

Introduction: Chemical-biological-radiological-nuclear-explosive (CBRNe) are complex events. Decontamination is mandatory to avoid harm and contain hazardous materials, but can delay care. Therefore, the stabilization of patients in the warm zone seems reasonable, but research is limited. Moreover, subjects involved in biological events are considered infectious even after decontamination and need to be managed while wearing personal protective equipment (PPE), as seen with Ebola and COVID-19 pandemic. With this simulation mannequin trial, we assessed the impact of CBRNe PPE on cardiopulmonary resuscitation and combat casualty care procedures. Methods: We compared procedures performed by emergency medicine and anesthesiology senior residents, randomized in 2 groups (CBRNe PPE vs. no PPE). Chest compression (CC) depth was defined as the primary outcome. Time to completion was calculated for the following: tourniquet application; tension pneumothorax needle decompression; peripheral venous access (PVA) and intraosseous access positioning; and drug preparation and administration. A questionnaire was delivered to evaluate participants' perception. Results: Thirty-six residents participated. No significant difference between the groups in CC depth (mean difference = 0.26 cm [95% confidence interval = −0.26 to 0.77 cm, P = 0.318]), as well as for CC rate, CC complete release, and time for drugs preparation and administration was detected. The PPE contributed to significantly higher times for tourniquet application, tension pneumothorax decompression, peripheral venous access, and intraosseous access positioning. The residents found simulation relevant to the residencies' core curriculum. Conclusions: This study suggests that cardiopulmonary resuscitation can be performed while wearing PPE without impacting quality, whereas other tasks requiring higher dexterity can be significantly impaired by PPE. Trial Registration Number: NCT04367454, April 29, 2020 (retrospectively registered).

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

“…Overall, these studies were all simulation-based RCTs including medical personnel who performed chest compression on a manikin with and without the use of PPE. Two of the studies were performed before the occurrence of COVID-19 (9, 10), while the other four were performed after COVID-19 (11)(12)(13)(14). These RCTs were performed in China (9,14), Korea (10), Italy (12,13), and Austria (11).…”

“…Two of the studies were performed before the occurrence of COVID-19 (9, 10), while the other four were performed after COVID-19 (11)(12)(13)(14). These RCTs were performed in China (9,14), Korea (10), Italy (12,13), and Austria (11). Four of them were randomized crossover studies (9-11, 13), while the remaining two were randomized parallel-group studies (12,14).…”

“…Since there is evidence for COVID-19 infection transmission during chest compressions, use of personal protective equipment (PPE) has been recommended for health care personnel involved in resuscitating of patients with confirmed or suspected COVID-19 (6)(7)(8). However, studies evaluating the influence of PPE use on the quality of chest compression showed inconsistent results (9)(10)(11)(12)(13)(14). Some simulation-based randomized controlled trials (RCTs) suggested that use of PPE by the CPR providers was associated with compromised quality of chest compression (9,14), while others did not show significant difference regarding the performance of chest compression (10)(11)(12)(13)).…”

“…However, studies evaluating the influence of PPE use on the quality of chest compression showed inconsistent results (9)(10)(11)(12)(13)(14). Some simulation-based randomized controlled trials (RCTs) suggested that use of PPE by the CPR providers was associated with compromised quality of chest compression (9,14), while others did not show significant difference regarding the performance of chest compression (10)(11)(12)(13)). An early metaanalysis including five studies (three RCTs and two observational studies) supported that the use of PPE may compromise the quality of chest compression during CPR (15).…”

“…However, including observational studies may confound the results (15). Since three additional RCTs have been published since the metaanalysis (11)(12)(13), we performed an updated meta-analysis to provide an overview of current understanding regarding the influence of PPE use on quality of chest compression during the process of CPR.…”