ABSTRACT
Background: The COVID-19 pandemic had placed constraints on cardiopulmonary resuscitation (CPR), including early intubation, minimizing bag-valve mask ventilation1, and using protective equipment and barriers during resuscitation. Patient barrier devices have been introduced in emergency departments and operating rooms, consisting of plastic drapes over the patient9, or the use of an acrylic box.2 Both of these adjuncts reduce aerosolization of oropharyngeal particles from the patient, and can facilitate video-based intubation.2,3 However, it is unknown whether these devices help or hinder the ultimate resuscitation quality in cardiopulmonary arrest patients. Our specific question addresses the effect of a patient barrier device and COVID-19 resuscitation recommendations on resuscitation quality. We hypothesize that a simple patient barrier consisting of a plastic drape reduces healthcare worker (HCW) contamination without affecting resuscitation quality. Methods: This was a single-center randomized controlled pilot trial, in which in-hospital teams of 4 to 6 HCWs were randomized to either use a plastic drape (intervention) or no plastic drape (control) for a simulated adolescent cardiopulmonary arrest. The manikin was modified to emanate simulated viral particles (GloGerm®, Moab, UT) from the trachea detectable using ultraviolet light. Teams managed a cardiopulmonary arrest until intubation, using Personal Protective Equipment (PPE) and PALS/ACLS algorithms. Data were captured via arbitrated video review. Resuscitation data included time-to-bagging, time-to-intubation, and chest compression quality metrics - depth, rate, and lean. Contamination data were collected visually, marking the number of PPE equipment with visible fluorescence. Mean NASA-TLX and NOTECHS scores measured workload and team performance. Descriptive and univariate statistics were used to determine differences between intervention and control teams. Results: Fifteen simulations were conducted from 2020 to 2021;one was excluded from analysis as a performance outlier, leaving 7 intervention vs. 7 control teams. Scenarios lasted an average of 10.4+/- 3 minutes. Time-to-bagging, time-to-intubation, and intubation duration were not different between groups (72.1+/-22.4 vs 56.7+/-30.9 sec, 536+/-289 vs 544+/-127 sec, 78.9+/-73.0 vs 95.7+/-113 sec, p>0.3), and CPR quality for mean depth, rate, and lean were also not different (36.1+/-11.6 vs 30.9+/-13.2 cm, 108+/-13 vs 112+/-8/min, 8.7+/-5.2 vs 4.5+/-4.3 cm, p>0.14). Contamination rates were lower for the intubating physician (2.3+/-0.5 vs 4.1+/-0.9 surfaces, p<0.001) and for all participants (2.8+/-0.7 vs 3.7+/-0.9 surfaces, p=0.05) when using a barrier. No other contamination rate changes were observed. Participants noted no differences in team performance (22.4+/-1.6 vs 20.8+/-1.8, p=0.5) but a slight trend towards higher workload with the plastic barrier (+9.5+/-7.7 vs -0.1+/-11.5, p=0.09). Conclusion: The use of a plastic drape as a patient barrier appears to reduce simulated virus contamination for HCWs, particularly for the intubation physician during a simulated cardiopulmonary arrest without affecting resuscitation performance. Perceived workload increases with the drape, and further studies are needed to substantiate these findings in larger samples and in different settings.
ABSTRACT
BACKGROUND: Patient barriers to protect health care workers from COVID-19 exposure have been studied for airway management. Few are tested for cardiopulmonary resuscitation (CPR). We sought to determine whether a plastic drape barrier affects resuscitation performance and contamination risks for a simulated cardiopulmonary arrest scenario. METHODS: This pilot trial randomized in-hospital resuscitation teams of 4 to 6 participants to a plastic drape or without a drape in an in situ cardiopulmonary arrest simulation. The mannequin's airway emanated simulated virus particles (GloGerm, Moab, UT), detectable through UV light. Primary outcomes included airway management and CPR quality measures. Secondary outcomes included visible contamination on personal protective equipment (PPE). We used the Non-Technical Skills (NO-TECHS) instrument to measure perceived team performance and the NASA Task Load Index (NASA-TLX) to measure individual workload. Outcome variables were analyzed using an analysis of covariance (ANCOVA) with participant number as a covariate. RESULTS: Seven teams were allocated to the intervention (plastic drape) group and 7 to the control. Intubation and ventilation performance (η2 = 0.09, P > 0.3) and chest compression quality (η2 = 0.03-0.19, P > 0.14) were not affected by the plastic drape. However, mean contaminated PPE per person decreased with the drape (2.8 ± 0.3 vs. 3.7 ± 0.3, partial η2 = 0.29, P = 0.05). No differences in perceived workload nor team performance were noted (P > 0.09). CONCLUSIONS: In this pilot study, the use of a plastic drape barrier seems not to affect resuscitation performance on simulated cardiopulmonary arrest but decreases health care worker contamination risk. Further implementation trials could characterize the true risk reduction and any effect on resuscitation outcomes.
ABSTRACT
Keywords: Simulation;On-call;Respiratory Purpose: Some newly qualified physiotherapists had reported feeling anxious about at being the respiratory physiotherapist on call. While this is a common theme with each year's new starters, this is likely exacerbated by the changes to some of their placements in their final year due to Covid-19. Alongside this, we were aware that there was a great demand on the on-call respiratory physiotherapy team due to Covid-19, and there was also a need to make them familiar with the PPE required for the treatment they may wish to perform;particularly for those physiotherapists working in MSK out-pts for whom this was unfamiliar. We wanted to put something in place to support these new graduates. Methods: A teaching package was designed with teaching in simulation for newly qualified physiotherapists about to go on the respiratory physiotherapy on-call rota focusing on common on-call scenarios. It was delivered by physiotherapists, an ACP and a consultant anaesthetist (who attended virtually). Scenarios were broken down into 3 competents: (1) do I have to go in? How to get the right information over the phone to decide. (2) what do I want done while I am travelling in? What advice to give to stabilise the pt while on route, what equipment to get ready, what PPE to get ready, etc., (3) What do I do when I get there – A–E assessment of the pt, treatment and ongoing management plan. Feedback on the sessions was collected from participants by anonymous questionnaire. In the simulation room attendees scan a QR code which generates a MS teams electronic feedback form. Results: Positive feedback -informative, interesting session, met their learning outcomes, reduced anxiety. ‘We were allowed time to practice in a safe environment and ask anything that may concern us’, increased confidence. Conclusion(s): Provision of simulation for newly qualified physiotherapists is helpful at preparing them for being the on-call respiratory physiotherapist. Impact: Funding is now being sort to make this part of standard induction each year at the Trust for newly qualified physiotherapists. We have liaised with the West Midlands sim lead to see if they will recommend this across the West Midlands. Funding acknowledgements: Not funded.