Impact of personal protective equipment on the effectiveness of chest compression - A systematic review and meta-analysis

Abstract

Background and objectives: To assess the impact of personal protective equipment (PPE) on different aspects of chest compression (CC) during cardiopulmonary resuscitation, we conducted this study.

Methods: This systematic review was performed according to the PRISMA. We searched PubMed, EMBASE and Web of Science from inception to June-6, 2020, limiting to the studies that reported the comparison of the effectiveness of CC in terms of CC rate, CC depth, the proportion of adequate CC rate, the proportion of adequate CC depth or proportion of adequate recoil; in study arms with or without PPE. Risk of bias was assessed by the ROB-2 and ROBINS-I tool. Quantitative data synthesis was done using the generic inverse variance method and the fixed-effects model.

Results: Five simulation-based studies were finally included. A Significant decrease in CC rate (SMD: -0.28, 95%CI: -0.47 to -0.10) and CC depth (SMD: -0.26, 95%CI: -0.44 to -0.07) were observed in the PPE arm as compared to the no-PPE arm. The difference in CC rate was more prominently seen in adult CPR than in paediatric CPR. Without PPE, the proportion of adequate CC rate delivered was 0.74, which reduced significantly to 0.60 after use of PPE (p - 0.035). Similarly, the proportion of adequate CC depth was significantly lesser (p - 0.001) in PPE arm (0.55), as compared to that of the no-PPE arm (0.78).

Conclusion: The use of PPE compromises the quality of CC during CPR significantly, and newer ways to deliver chest compression has to be investigated. This study was prospectively registered in PROSPERO (CRD42020192031).

Keywords: Cardiopulmonary resuscitation; Chest compression; Personal protective equipment.

Fig. 1

Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flow diagram.

Fig. 2

Forest plot summarising the standardised mean difference (SMD) of chest compression rate (per minute). Footnotes ‘PPE’ – study arm with personal protective equipment, ‘no-PPE’ - study arm without personal protective equipment, I2 – heterogeneity statistics.

Fig. 3

Forest plot summarising the standardised mean difference (SMD) of chest compression depth (in millimetres). Footnotes ‘PPE’ – study arm with personal protective equipment, ‘no-PPE’ - study arm without personal protective equipment, I2 – heterogeneity statistics.

Fig. 4

Figure showing a significant reduction of the proportion of ‘Adequate chest compression rate’ provided in ‘no-PPE’ versus ‘PPE’ arms (chi-square p-value: 0.035). Footnotes: ‘PPE’ – study arm with personal protective equipment, ‘no-PPE’ - study arm without personal protective equipment, I2 – heterogeneity statistics.

Fig. 5

Figure showing a significant reduction of the proportion of ‘Adequate chest compression depth’ provided in ‘no-PPE’ versus ‘PPE’ arms (chi-square p-value < 0.001).