The Effect of a Plastic Barrier Drape on Resuscitation Performance and Provider Contamination: A Randomized Controlled Simulation-Based Pilot Trial.

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 (η 2 = 0.09, P > 0.3) and chest compression quality (η 2 = 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 η 2 = 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.

Compatibility of ZOLL Defibrillators in Simulation-Based Training.

INTRODUCTION: In response to the need for high-quality cardiopulmonary resuscitation (CPR) during cardiac arrest, our institution recently purchased ZOLL R Series monitor/defibrillators. This defibrillator provides CPR quality metrics and displays a filtered rhythm through compressions. Purchase of this defibrillator resulted in a practice change and heavily impacted our simulation-based training courses by requiring providers to practice CPR and defibrillation in as close to the real environment as possible. Thus, our objective was to determine which commercial simulators would be compatible with the ZOLL R Series defibrillator system and its CPR feedback functionality in a simulation-based training setting. METHODS: Our simulation center uses primarily Gaumard Scientific and Laerdal Medical simulators ranging in size from neonate to adult. Through an iterative process in the laboratory, we evaluated if, and to what level, the CPR display metrics, filtered rhythm, and idle time display could be demonstrated with CPR on the different simulators using infant, pediatric, and adult pads. RESULTS: Certain simulators allow demonstration and real-time practice of defibrillator functions better than others with the ZOLL R Series system when used in the context of CPR training. We have no high-fidelity infant-sized simulators that can meet the depth recommendation for chest compressions given by the American Heart Association. Ventricular fibrillation is the only rhythm that offers a filtered option. Idle time can be reliably displayed for simulators where CPR is detected. CONCLUSIONS: When a primary learning objective for simulation-based training involves training on the ZOLL R Series defibrillator, there are a limited number of simulators and rhythms that can accurately represent its features.