The use of personal protection equipment does not negatively affect paramedics’ attention and dexterity: a prospective triple-cross over randomized controlled non-inferiority trial

Abstract

Background The COVID-19 pandemic led to widespread use of personal protection equipment (PPE), including filtering face piece (FFP) masks, throughout the world. PPE. Previous studies indicate that PPE impairs neurocognitive performance in healthcare workers. Concerns for personnel safety have led to special recommendations regarding basic life support (BLS) in patients with a potential SARS-CoV-2 infection, including the use of PPE. Established instruments are available to assess attention and dexterity in BLS settings, respectively. We aimed to evaluate the influence of PPE with different types of FFP masks on these two neuropsychological components of EMS personnel during BLS. Methods This was a randomized controlled non-inferiority triple-crossover study. Teams of paramedics completed three 12-min long BLS scenarios on a manikin after having climbed three flights of stairs with equipment, each in three experimental conditions: (a) without pandemic PPE, (b) with PPE including a FFP2 mask with an expiration valve and (c) with PPE including an FFP2 mask without an expiration valve. The teams and intervention sequences were randomized. We measured the shift in concentration performance using the d2 test and dexterity using the nine-hole peg test (NHPT). We compared results between the three conditions. For the primary outcome, the non-inferiority margin was set at 20 points. Results Forty-eight paramedics participated. Concentration performance was significantly better after each scenario, with no differences noted between groups: d2 shift control versus with valve − 8.3 (95% CI − 19.4 to 2.7) points; control versus without valve − 8.5 (− 19.7 to 2.7) points; with valve versus without valve 0.1 (− 11.1 to 11.3) points. Similar results were found for the NHPT: + 0.3 (− 0.7 to 1.4), − 0.4 (− 1.4 to 0.7), 0.7 (− 0.4 to 1.8) s respectively. Conclusion Attention increases when performing BLS. Attention and dexterity are not inferior when wearing PPE, including FFP2 masks. PPE should be used on a low-threshold basis.

COVID-19 CPR—Impact of Personal Protective Equipment during a Simulated Cardiac Arrest in Times of the COVID-19 Pandemic: A Prospective Comparative Trial

“…In keeping with our findings of increased physical demand, performance, and effort in PPE teams, Chen et al reported that rescuers’ increases in heart rate, mean arterial pressure, and subjective fatigue scores were significantly more obvious with the use of PPE, which was associated with a significant decrease in effective chest compressions [ 8 ]. By contrast, Kienbacher et al were able to demonstrate increased attention when performing basic life support while attention and dexterity were not inferior when wearing PPE, including N95 masks [ 29 ]. However, in light of a PPE-related gradual decrease in effective chest compressions resulting from increased rescuers’ fatigue, our finding of too few change-overs in PPE teams is worrisome.…”

The influence of N95 and FFP2 masks on cardiorespiratory variables in healthy individuals during aerobic exercise: a systematic review and meta-analysis

“…As intervenções incluíram caminhada, (5,20) caminhada em esteira, (18,19) exercício intervalado de média a alta intensidade em cicloergômetro (6,12,16,21) e subir e descer escadas. (22)…”

“…Apenas 8 dos 10 estudos incluídos nesta revisão forneceram dados suficientes para analisar PA, FC, FR e SpO 2 em intervenções aeróbicas com e sem máscaras N95/PFF2. (6,12,16,18,19,(21)(22)(23) Portanto, apenas esses 8 estudos foram incluídos em nossa meta-análise, num total de 166 voluntários. A diferença média padronizada variou de −0,32 a 0,17 para PA, de −0,27 a 0,13 para SpO 2 , de −0,10 a 0,27 para FC e de −0,16 a 0,28 para FR com um modelo de efeitos fixos e sem alterações estatisticamente significativas em nenhuma das variáveis.…”

“…Como se pode observar na Figura 2, o uso de máscaras N95/PFF2 durante o exercício aeróbico não teve efeito significativo na PA em nenhum dos estudos analisados, como evidencia o losango cruzando a linha vertical de efeito nulo, sendo que o losango representa a síntese de intervalos de confiança e riscos relativos. (16) Epstein 2021 (6) Fikenzer 2020 (12) Kienbacher 2021 (22) Mapelli 2021 (21) Shi 2016 (23) subtotal (95% Cl)…”

“…Heterogeneity Chi 2 = 1.95, df = 5 (P = 0.86); I 2 = 0% Test for overall effect: z = 0.57 (P = 0.57) (6) Goh 2019 (18) Kienbacher 2021 (22) Kim 2016 (19) Mapelli 2021 (21) subtotal (95% Cl) Heterogeneity Chi 2 = 5.59, df = 4 (P = 0. (16) Epstein 2021 (6) Fikenzer 2020 (12) Goh 2019 (18) Kienbacher 2021 (22) Kim 2016 (19) Mapelli 2021 (21) subtotal (95% Cl) Heterogeneity Chi 2 = 3.69, df = 6 (P = 0.72); I 2 = 0% Test for overall effect: z = 0.89 (P = 0.37) Figura 3.…”