Effects of personal protective equipment on cardiopulmonary resuscitation quality and outcomes: A systematic review

Sung Phil Chung¹, Ziad Nehme^{2

3}, Nicholas J Johnson⁴, Anthony Lagina⁵, Janet Bray^{3

6}; International Liaison Committee on Resuscitation ILCOR Basic Life Support Task Force

Affiliations

¹ Department of Emergency Medicine, Yonsei University of Medical College, Seoul, Korea.
² Centre for Research and Evaluation, Ambulance Victoria, Victoria, Australia.
³ School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.
⁴ Department of Emergency Medicine & Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA, USA.
⁵ Department of Emergency Medicine, Wayne State University, Detroit, MI, USA.
⁶ Prehospital, Resuscitation and Emergency Care Research Unit, Curtin University, Perth, Western Australia, Australia.

PMID: 37265711
PMCID: PMC10230254
DOI: 10.1016/j.resplu.2023.100398

Effects of personal protective equipment on cardiopulmonary resuscitation quality and outcomes: A systematic review

Sung Phil Chung et al. Resusc Plus. 2023.

. 2023 May 24:14:100398.

doi: 10.1016/j.resplu.2023.100398. eCollection 2023 Jun.

Authors

Sung Phil Chung¹, Ziad Nehme^{2

3}, Nicholas J Johnson⁴, Anthony Lagina⁵, Janet Bray^{3

6}; International Liaison Committee on Resuscitation ILCOR Basic Life Support Task Force

Affiliations

¹ Department of Emergency Medicine, Yonsei University of Medical College, Seoul, Korea.
² Centre for Research and Evaluation, Ambulance Victoria, Victoria, Australia.
³ School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.
⁴ Department of Emergency Medicine & Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA, USA.
⁵ Department of Emergency Medicine, Wayne State University, Detroit, MI, USA.
⁶ Prehospital, Resuscitation and Emergency Care Research Unit, Curtin University, Perth, Western Australia, Australia.

PMID: 37265711
PMCID: PMC10230254
DOI: 10.1016/j.resplu.2023.100398

Abstract

Background: The impact of wearing personal protective equipment (PPE) during cardiopulmonary resuscitation (CPR) on CPR quality and patient outcomes is unclear. This systematic review aimed to examine whether wearing PPE during resuscitation affects patient outcomes, CPR quality and rescuer fatigue.

Methods: In this review registered in PROSPERO (CRD42022347746), we searched Medline, EMBASE and Cochrane library between 2000 and 2022. The inclusion criteria were studies: in actual or simulated cardiac arrest; comparing PPE with no PPE; and randomised controlled trials and observational studies with a English abstract. Risk of bias was assessed using Cochrane's Risk of Bias-2 and ROBINS-I tools and outcomes assessed with GRADE. We conducted a meta-analysis according to the study design. Quantitative data synthesis was done using a random-effect model incorporating the potential heterogeneity.

Results: A total of 17 simulation-based studies and 1 clinical study were included. All outcomes were judged to be very low certainty of evidence, subject to high risk of bias. The clinical study showed no difference in survival comparing enhanced and conventional PPE. Meta-analysis of 11 RCTs and 6 observational studies found no difference in CPR quality in rescuers wearing PPE compared with no PPE. Pooled rescuer fatigue was significantly worse in the PPE group (mean difference, 2.7 VAS score out of 10; 95% CI, 1.4-4.0).

Conclusions: PPE was not associated with reduced CPR quality or lower cardiac arrest survival. Rescuers wearing PPE may report more fatigue. This finding was mainly derived from simulation studies, additional clinical studies are needed.

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

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. JB is an Associate Editor of Resuscitation Plus.

Figures

**Fig. 1**
PRISMA diagram for study selection.

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Effects of personal protective equipment on cardiopulmonary resuscitation quality and outcomes: A systematic review

Affiliations

Effects of personal protective equipment on cardiopulmonary resuscitation quality and outcomes: A systematic review

Authors

Affiliations

Abstract

Conflict of interest statement

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