Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2020;27(5):497-506.
doi: 10.5603/CJ.a2020.0068. Epub 2020 May 18.

Resuscitation of the patient with suspected/confirmed COVID-19 when wearing personal protective equipment: A randomized multicenter crossover simulation trial

Marek Malysz  1 , Marek Dabrowski  2 , Bernd W Böttiger  3 , Jacek Smereka  4   1 , Klaudia Kulak  5 , Agnieszka Szarpak  6 , Milosz Jaguszewski  7 , Krzysztof J Filipiak  8 , Jerzy R Ladny  9   1 , Kurt Ruetzler  10 , Lukasz Szarpak  11   12
Affiliations
Randomized Controlled Trial

Resuscitation of the patient with suspected/confirmed COVID-19 when wearing personal protective equipment: A randomized multicenter crossover simulation trial

Marek Malysz et al. Cardiol J. 2020.

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: COVID-19; SARS-CoV-2; cardiopulmonary resuscitation; chest compression; medical simulation; quality.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: Bernd W. Böttiger is European Resuscitation Council (ERC) Board Director Science and Research; Chairman of the German Resuscitation Council (GRC); Member of the, Advanced Life Support (ALS) Task Force of the International Liaison Committee on Resuscitation, Member of the executive committee of the German Interdisciplinary Association for Intensive and Emergency Medicine (DIVI); Associated Editor of the European Journal of Anaesthesiology (EJA), Co-Editor of “Resuscitation”; Editor of the Journal “Notfall + Rettungsmedizin”. He received professional fees for lectures from the following companies: Medupdate GmbH, “Forum für medizinische Fortbildung (FomF)”, Baxalta Deutschland GmbH, Bayer Vital GmbH, ZOLL Medical Deutschland GmbH, C.R. Bard GmbH, GS Elektromedizinische Geräte G. Stemple GmbH. Others authors have no potential conflict of interest relevant to this article.

Figures

Figure 1
Figure 1
Rescuer with personal protective equipment for aerosol generating procedures.
Figure 2
Figure 2
Randomization flow chart; CC — chest compression.
Figure 3
Figure 3
Chest compression (CC) depth parameters relative to time intervals; *Significant difference (p < 0.05) compared to the time of 20 s of an appropriate CC technique.
Figure 4
Figure 4
Chest compression (CC) rate parameters relative to time intervals; *Significant difference (p < 0.05) compared to the time of 20 s of an appropriate CC technique.
Figure 5
Figure 5
Percentage of correct chest recoil parameters relative to time intervals; *Significant difference (p < 0.05) compared to the time of 20 s of an appropriate chest compression (CC) technique.
See this image and copyright information in PMC

References

    1. Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun. 2020;109:102433. doi: 10.1016/j.jaut.2020.102433. - DOI - PMC - PubMed
    1. 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. doi: 10.1056/NEJMc2004973. - DOI - PMC - PubMed
    1. Dzieciatkowski T, Szarpak L, Filipiak KJ, et al. COVID-19 challenge for modern medicine. Cardiol J. 2020;27(2):175–183. doi: 10.5603/CJ.a2020.0055. - DOI - PMC - PubMed
    1. 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. doi: 10.1002/14651858.CD011621.pub2. - DOI - PMC - PubMed
    1. Smereka J, Szarpak L. COVID 19 a challenge for emergency medicine and every health care professional. Am J Emerg Med. 2020 doi: 10.1016/j.ajem.2020.03.038. [Epub ahead of print] - DOI - PMC - PubMed

Publication types

MeSH terms