Influence of Personal Protective Equipment on the Quality of Chest Compressions: A Meta-Analysis of Randomized Controlled Trials.

ABSTRACT

Background: Randomized controlled trials (RCTs) evaluating the influence of personal protective equipment (PPE) on quality of chest compressions during cardiopulmonary resuscitation (CPR) showed inconsistent results. Accordingly, a meta-analysis was performed to provide an overview. Methods: Relevant studies were obtained by search of Medline, Embase, and Cochrane's Library databases. A random-effect model incorporating the potential heterogeneity was used to pool the results. Results: Six simulation-based RCTs were included. Overall, pooled results showed that there was no statistically significant difference between the rate [mean difference (MD) -1.70 time/min, 95% confidence interval (CI) -5.77 to 2.36, P = 0.41, I 2 = 80%] or the depth [MD -1.84 mm, 95% CI -3.93 to 0.24, P = 0.11, I 2 = 73%] of chest compressions performed by medical personnel with and without PPE. Subgroup analyses showed that use of PPE was associated with reduced rate of chest compressions in studies before COVID-19 (MD -7.02 time/min, 95% CI -10.46 to -3.57, P < 0.001), but not in studies after COVID-19 (MD 0.14 time/min, 95% CI -5.77 to 2.36, P = 0.95). In addition, PPE was not associated with significantly reduced depth of chest compressions in studies before (MD -3.34 mm, 95% CI -10.29 to -3.62, P = 0.35) or after (MD -0.97 mm, 95% CI -2.62 to 0.68, P = 0.25) COVID-19. No significant difference was found between parallel-group and crossover RCTs (P for subgroup difference both > 0.05). Conclusions: Evidence from simulation-based RCTs showed that use of PPE was not associated with reduced rate or depth of chest compressions in CPR.