High-fidelity simulation training with PPE may optimise resuscitation outcomes in the COVID-19 era

ABSTRACT

High-fidelity simulation training in CPR (CPR-HFST) could identify weaknesses in pre-COVID-19 Code Blue (CB) practices. Importantly, PPE donning may delay CPR thus worsening patient outcomes. We sought to determine the effect of our CPR-HFST on clinical practice. A retrospective review of CB events in a 1000-bedded hospital, pre- and intra-pandemic was conducted from 01/05/2019 to 30/10/2020. Onset of the pandemic was taken as 04/02/2020. CPR-HFST commenced in January 2020. The primary objective was to determine pre- and intra-pandemic response times. Intubation times, patient outcomes (quantified by CB survival rates and the CPC score), and incidence of HCW infection were our secondary objectives. The CCI score was used to stratify patients with similar comorbidities. Two-tailed Chi-square and Mann-Whitney tests were used for statistical comparisons, alpha = 0.05. 158 CB events were reviewed. Median response time was longer intra-pandemic compared to prepandemic;4.0 mins (IQR 3-5) vs. 3.0 mins (IQR1-4), p=0.0007. Cardiac rhythms were asystole (25.5%), PEA (53.8%), VT (5.7%), and VF (11.3%). 67.1% of patients required CPR, of which, 88.7% were intubated. There were no significant differences in median intubation times 12.0 (prepandemic) vs. 11.0 mins (intra-pandemic), p=0.89. Survival to hospital discharge were similar;14.1% (pre-pandemic) vs. 21.4% (intra-pandemic), p=0.33. We did not find any significant differences in survival rates and CPC scores (Table 1). There were no HCW infections. Survival to hospital discharge rates of patients requiring in-hospital CPR may be lower intrapandemic;Miles et al reported 3.2% vs 12.8% respectively, p<0.01. These were significantly different compared to our intra-pandemic cohort (3.2% vs. 21.4%, p<0.01) but not in our pre-pandemic cohort (12.8% vs. 14.1%, p=0.82). Reasons for the differences are likely multifactorial. Nonetheless, in our experience and data, we believe CPR-HFST prevents deterioration in the standards of care and may help in optimising CPR outcomes. (Table Presented) .