Impact of personal protective equipment on neonatal resuscitation procedures: a randomised, cross-over, simulation study

Cavallin, Francesco; Lupi, Fiorenzo; Bua, Benedetta; Bellutti, Marion; Staffler, Alex; Trevisanuto, Daniele

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.