A mannequin based comparative study of quality of chest compression with or without personal protective equipment (PPE)

Abstract

Background & Objective: The use of Personal Protective Equipment (PPE) is highly recommended during chest compression in COVID-19 patients, as it can generate aerosols. It was thought that quality of chest compression might be affected by the use of PPE. We compared the quality of chest compression with or without PPE using a mannequin to formulate practical recommendations. Methodology: This observational analytical study used randomised crossover design, and was carried out in Cipto Mangunkusumo National General Hospital from December 2020 to July 2021. After a thorough assessment, a total of 92 samples fulfilled the inclusion and exclusion criteria. The chosen participants were postgraduate residents, and they were asked to do chest compression on a mannequin with (Group-I) and without PPE (Group-II) and with breaks in between. The quality of CPR was measured using feedback tool CPR R Series® Monitor (Zoll Inc., USA). After a break the groups were crossed over and re-evaluated. Results: Sixty-five (35.3%) non-PPE participants did quality compression, but only 16 (8.7%) did quality compression when using PPE (P < 0.001). Effective compression was done by 80 (43.5%) of the non-PPE participants, compared to 61 (33.2%) participants doing the compression effectively when using PPE (P = 0.002). Eighty-two (44.6%) non-PPE participants did adequate compressions compared to 61 (33.2%) participants when using PPE (P < 0.001). Meanwhile, the post-compression fatigue level was 7 (6.00-9.00) when using PPE compared to 5 (3.00-7.00) when not using PPE (P < 0.001). Conclusion: The use of PPE during chest compressions can reduce the quality of compression and increase the level of post-compression fatigue compared to performing chest compressions without PPE. PPE use was also associated with low levels of effectiveness, and adequacy of the chest compression.