1. Impact of personal protective equipment on neonatal resuscitation procedures: a randomised, cross-over, simulation study
- Author
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Francesco Cavallin, Alex Staffler, Marion Bellutti, Daniele Trevisanuto, Fiorenzo Lupi, and Benedetta Bua
- Subjects
Resuscitation ,medicine.medical_specialty ,Time Factors ,Consultants ,medicine.medical_treatment ,resuscitation ,Nursing Staff, Hospital ,Manikins ,neonatology ,Positive-Pressure Respiration ,Intensive Care Units, Neonatal ,Intubation, Intratracheal ,medicine ,Humans ,Positive pressure ventilation ,Trial registration ,Pandemics ,Personal Protective Equipment ,Personal protective equipment ,Original Research ,Cross over ,Cross-Over Studies ,SARS-CoV-2 ,business.industry ,Tracheal intubation ,Delivery room ,Infant, Newborn ,COVID-19 ,Internship and Residency ,Obstetrics and Gynecology ,General Medicine ,Pediatrics, Perinatology and Child Health ,Emergency medicine ,business ,Neonatal resuscitation - Abstract
Background and objective Healthcare providers should use personal protective equipment (PPE) when performing aerosol-generating medical procedures during highly infectious respiratory pandemics. We aimed to compare the timing of neonatal resuscitation procedures in a manikin model with or without PPE for prevention of SARS-COVID-19 transmission. Methods A randomised controlled cross-over (AB/BA) trial of resuscitation with or without PPE in a neonatal resuscitation scenario. Forty-eight participants were divided in 12 consultant–nurse teams and 12 resident–nurse teams. The primary outcome measure was the time of positive pressure ventilation (PPV) initiation. The secondary outcome measures were duration of tracheal intubation procedure, time of initiation of chest compressions, correct use of PPE and discomfort/limitations using PPE. Results There were significant differences in timing of PPV initiation (consultant–nurse teams: mean difference (MD) 6.0 s, 95% CI 1.1 to 10.9 s; resident–nurse teams: MD 11.0 s, 95% CI 1.9 to 20.0 s), duration of tracheal intubation (consultant–nurse teams: MD 22.0 s, 95% CI 7.0 to 36.9 s; resident–nurse teams: MD 9.1 s, 95% CI 0.1 to 18.1 s) and chest compressions (consultant–nurse teams: MD 32.3 s, 95% CI 14.4 to 50.1 s; resident–nurse teams: MD 9.1 s, 95% CI 0.1 to 18.1 s). Twelve participants completed the dressing after entering the delivery room. PPE was associated with visual limitations (43/48 participants), discomfort in movements (42/48), limitations in communication (32/48) and thermal discomfort (29/48). Conclusions In a manikin model, using PPE delayed neonatal resuscitation procedures with potential clinical impact. Healthcare workers reported limitations and discomfort when wearing PPE. Trial registration number NCT04666233., Unique study of neonatal resuscitation in PPE using a simulation model which identified small but potentially important differences in timings of key resus events. Also shows the inevitable discomfort and inconvenience of PPE in this scenario.
- Published
- 2021