The effect of personal protective equipment on cardiac compression quality

Abstract

Introduction: Cardiac compression is a cumbersome procedure. The American Heart Association suggests switching of cardiopulmonary resuscitation (CPR) provider every 2 min to prevent any decrease in resuscitation quality. High quality CPR is associated with improved outcomes. Previous studies have highlighted the difficulties in providing high quality CPR particularly while wearing personal protective equipment (PPE). This study aimed to evaluate the impact of personal protective equipment (PPE) use on CPR quality in prehospital cardiac arrest situations.

Methods: In this prospective simulation study, we compared the cardiac compression qualities and fatigue rates among prehospital health care professionals (HCPs) who were or were not using PPE.

Results: A total of 76 prehospital HCPs comprising 38 compression teams participated in this study. The mean compression rate was 117.71 ± 8.27/min without PPE and 115.58 ± 9.02/min with PPE (p = 0.191). Overall compression score was 86.95 ± 4.39 without PPE and 61.89 ± 14.43 with PPE (p < 0.001). Post-cardiac compression fatigue score was 4.42 ± 0.5 among HCPs who used their standard uniform and 7.74 ± 0.92 among those who used PPE (p < 0.001). The overall compression score difference between the two conditions was 25.05 ± 11.74 and the fatigue score difference was 3.31 ± 0.98.

Discussion: PPE use is associated with decreased cardiac compression quality and significantly higher fatigue rates than those associated with the use of standard uniforms. Routine use of mechanical compression devices should be considered when PPE is required for out-of-cardiac arrests.

Keywords: Cardiac compression; Fatigue; Mechanic compression device; Prehospital cardiac arrest; Prehospital healthcare professionals.

Fig. 1

A participant performing CPR with PPE.