From the Department of Medicine (DIMED) (G.M., M.P., C.A., S.S., F.F.), University of Padova, Padova; Venice Emergency Medical Service Operations Center (N.B., D.P.), Venezia; and Istituto di Anestesia e Rianimazione-Azienda Ospedaliera Universitaria di Padova (A.G., P.N.), Padova, Italy.
Simul Healthc. 2021 Dec 1;16(6):e200-e205. doi: 10.1097/SIH.0000000000000540.
Chemical-biological-radiological-nuclear-explosive (CBRNe) are complex events. Decontamination is mandatory to avoid harm and contain hazardous materials, but can delay care. Therefore, the stabilization of patients in the warm zone seems reasonable, but research is limited. Moreover, subjects involved in biological events are considered infectious even after decontamination and need to be managed while wearing personal protective equipment (PPE), as seen with Ebola and COVID-19 pandemic. With this simulation mannequin trial, we assessed the impact of CBRNe PPE on cardiopulmonary resuscitation and combat casualty care procedures.
We compared procedures performed by emergency medicine and anesthesiology senior residents, randomized in 2 groups (CBRNe PPE vs. no PPE). Chest compression (CC) depth was defined as the primary outcome. Time to completion was calculated for the following: tourniquet application; tension pneumothorax needle decompression; peripheral venous access (PVA) and intraosseous access positioning; and drug preparation and administration. A questionnaire was delivered to evaluate participants' perception.
Thirty-six residents participated. No significant difference between the groups in CC depth (mean difference = 0.26 cm [95% confidence interval = -0.26 to 0.77 cm, P = 0.318]), as well as for CC rate, CC complete release, and time for drugs preparation and administration was detected. The PPE contributed to significantly higher times for tourniquet application, tension pneumothorax decompression, peripheral venous access, and intraosseous access positioning. The residents found simulation relevant to the residencies' core curriculum.
This study suggests that cardiopulmonary resuscitation can be performed while wearing PPE without impacting quality, whereas other tasks requiring higher dexterity can be significantly impaired by PPE.Trial Registration Number: NCT04367454, April 29, 2020 (retrospectively registered).
化学-生物-放射-核-爆炸（CBRNe）是复杂的事件。为了避免伤害和控制危险材料，去污是强制性的，但这可能会延迟治疗。因此，在温暖区域稳定患者似乎是合理的，但研究有限。此外，即使在去污后，参与生物事件的人员也被认为具有传染性，需要在穿戴个人防护设备（PPE）的情况下进行管理，正如埃博拉和 COVID-19 大流行期间所见。通过这项模拟人体模型试验，我们评估了 CBRNe PPE 对心肺复苏和战伤救治程序的影响。
我们比较了急诊医学和麻醉学高级住院医师在两组（CBRNe PPE 与无 PPE）中的操作。胸外按压（CC）深度是主要结果。以下操作的完成时间计算：止血带应用；张力性气胸针减压；外周静脉通路（PVA）和骨髓内通路定位；以及药物准备和给药。还发放了一份问卷，以评估参与者的感知。
36 名住院医师参与了研究。两组 CC 深度（平均差异=0.26cm[95%置信区间=0.26-0.77cm，P=0.318]）无显著差异，CC 频率、CC 完全释放以及药物准备和给药时间也无显著差异。PPE 使止血带应用、张力性气胸减压、外周静脉通路和骨髓内通路定位的时间显著增加。住院医师认为模拟与住院医师核心课程相关。
本研究表明，佩戴 PPE 进行心肺复苏不会影响其质量，而其他需要更高灵巧性的任务则会因 PPE 而受到显著影响。
NCT04367454，2020 年 4 月 29 日（回溯注册）。
