An optimal chest compression technique using personal protective equipment during resuscitation in the COVID-19 pandemic: a randomized crossover simulation study

Background: Cardiopulmonary resuscitation with the use of personal protective equipment (PPE) for aerosol generating procedures (AGP) in patients with suspected or confirmed coronavirus disease 2019 (COVID‑19) remains challenging. Aims: The aim of this study was to compare 3 chest compression (CC) methods used by paramedics wearing PPE. Methods: The single‑blinded, multicenter, randomized, crossover simulation study involved 67 paramedics wearing PPE AGP. They performed 2‑minute continuous CCs in an adult with suspected or confirmed COVID‑19 in 3 scenarios: 1) manual CCs; 2) CCs with the TrueCPR feedback device; 3) CCs with the LUCAS 3 mechanical CC device. Results: The depth of CC was more frequently correct when using LUCAS 3 compared with TrueCPR and manual CC (median [IQR] 51 [50–55] mm vs 47 [43–52] mm vs 43 [38–46] mm; P = 0.005). This was also true for the CC rate (median [IQR]102 [100–102] compressions per minute [CPM] vs 105 [98–1114] CPM vs 116 [112–129] CPM; P = 0.027) and chest recoil (median [IQR]100% [98%–100%] vs 83% [60%–92%] vs 39% [25%–50%]; P = 0.001). A detailed analysis of 2‑minute resuscitation with manual CCs showed a decrease in compression depth and full chest recoil after 1 minute of CCs. Conclusion: We demonstrated that during simulated resuscitation with the use of PPE AGP in patients with suspected or confirmed COVID‑19, CC with LUCAS 3 compared with manual CCs as well as the TrueCPR essentially increased the CC quality. In the case of manual CCs by paramedics dressed in PPE AGP, it is advisable to change the person performing resuscitation every minute.