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Minerva Anestesiologica 2021 Jul 14

DOI: 10.23736/S0375-9393.21.15621-4

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Impact of COVID-19 adapted guidelines on resuscitation quality in out-of-hospital-cardiac-arrest: a manikin study

Gerrit JANSEN 1 , Nicole EBELING 1, Eugen LATKA 2, Stefan KRÜGER 1, Sean S. SCHOLZ 1, Simon TRAPP 1, Julia J. GRANNEMAN 3, Daniel THAEMEL 1, Suraj CHANDWANI 4, Odile SAUZET 5, Sebastian W. REHBERG 1, Rainer BORGSTEDT 1

1 Department of Anesthesiology, Intensive Care, Emergency Medicine, Transfusion Medicine, and Pain Therapy, Protestant Hospital of the Bethel Foundation, University Hospital of Bielefeld, Bielefeld, Germany; 2 Department of Medical and Emergency Services, Study Institute Westfalen-Lippe, Bielefeld, Germany; 3 Department of Anesthesiology, Operative Intensive Care Medicine, Emergency Medicine and Pain therapy, Bielefeld Municipal Hospital, Bielefeld, Germany; 4 Clinic for Internal Medicine and Gastroenterology, Protestant Hospital of the Bethel Foundation, University Hospital of Bielefeld, Bielefeld, Germany; 5 Epidemiology and International Public Health, Bielefeld School of Public Health & Center for Statistics, Bielefeld University, Bielefeld, Germany


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BACKGROUND: To evaluate the effects of European Resuscitation Council (ERC) COVID-19-guidelines on resuscitation quality emphasizing advanced airway management in out-of-hospital-cardiacarrest.
METHODS: In a manikin study paramedics and emergency physicians performed Advanced-Cardiac-Life-Support in three settings: ERC guidelines 2015 (Control), COVID-19-guidelines as suggested with minimum staff (COVID-19-minimal-personnel); COVID-19-guidelines with paramedics and an emergency physician (COVID-19-advanced-airway-manager). Main outcome measures were no-flow-time, quality metrics as defined by ERC and time intervals to first chest compression, oxygen supply, intubation and first rhythm analysis. Data were presented as mean±standard deviation.
RESULTS: Thirty resuscitation scenarios were completed. No-flow-time was markedly prolonged in COVID-19-minimal-personnel [113±37sec] compared to Control [55±9sec] and COVID-19-advanced-airway-manager [76±38sec](p<0.001 each). In both COVID-19-groups chest compressions started later [COVID-19-minimal-personnel:32±6sec; COVID-19-advancedairway-manager:37±7sec; each p<0.001 vs. Control (21±5sec)], but oxygen supply [COVID-19-minimal-personnel:29±5sec; COVID-19-advanced-airway-manager:34±7sec; each p<0.001 vs. Control (77±19sec)] and first intubation attempt [COVID-19-minimalpersonnel: 111±14sec; COVID-19-advanced-airway-manager:131±20sec; each p<0.001 vs. Control (178±44sec)] were performed earlier. However, time interval to successful intubation was similar [Control:198±48sec; COVID-19-minimal-personnel:181±42sec; COVID-19-advanced-airway-manager:130±25sec] due to a longer intubation time in COVID-19-minimalpersonnel [61±35sec] compared to COVID-19-advanced-airway-manager (p=0.002) and control [19±6sec;p<0.001]. Time to first rhythm analysis was more than doubled in COVID-19-minimal-personnel [138±96sec] compared to control [50±12sec;p<0.001].
CONCLUSIONS: Delayed chest compressions and prolonged no-flow-time markedly reduced the quality of resuscitation. These negative effects were attenuated by increasing the number of staff and by adding an experienced airway manager. The use of endotracheal intubation for reducing aerosol release during resuscitation should be discussed critically as its priorization is associated with an increase in no-flow-time.


KEY WORDS: Advanced life support; Cardiopulmonary resuscitation; ERC guidelines; Orotracheal intubation; Out-of-hospital CPR; Sars-CoV-2

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