An optimal chest compression technique using personal protective equipment during resuscitation in the COVID-19 pandemic: a randomized crossover simulation study.

BACKGROUND: Cardiopulmonary resuscitation (CPR) with the use of personal protective equipment (PPE) for aerosol generating procedures (AGP) in patients with suspected/confirmed COVID-19 remains challenging.

AIM: The aim of this study was to compare three chest compression methods applied by paramedics wearing PPE.

METHODS: The single-blinded, multi-centre, randomized, cross-over simulation study involved 67 paramedics wearing PPE AGP. They performed 2-minute continuous chest compressions (CCs) in an adult patient with suspected/confirmed COVID-19 in three scenarios: (a) manual CCs; (b) CCs with a TrueCPR feedback device; (c) CCs with a LUCAS3 mechanical CC device.

RESULTS: CC depth when using LUCAS3 compared with TrueCPR and manual CC was more frequently correct 51 [50-55] vs. 47 [43-52] vs. 43 [38-46]mm; P = 0.005) and more often performed correctly regarding CC rate 102 [100-102] vs. 105 [98-1114] vs. 116 [112-129] compressions per minute; P = 0.027) and chest recoil 100 [98-100] vs. 83 [60-92] vs. 39  [25-50]%; P = 0.001). A detailed analysis of 2-minute resuscitation with manual CCs showed a decrease in compression depth and full chest recoil after 1 minute of CCs.

CONCLUSION: We show that during simulated resuscitation with the use of PPE AGP in patients with suspected/confirmed COVID-19, CC with LUCAS3 compared with manual CCs as well as a TrueCPR feedback device essentially increased CC quality. In the case of manual CCs by paramedics dressed in PPE AGP, it is advisable to change the person performing CC every minute.