Use of personal protective equipment and cognitive load during cardiopulmonary resuscitation – A randomized cross-over simulation-based study

Abstract

Background

The use of personal protective equipment (PPE) is essential during cardiopulmonary resuscitation (CPR) to prevent disease transmission, but its impact on rescuer fatigue and CPR quality remains debated.

Aim

To simultaneously evaluate the effect of PPE on cognitive load and resuscitation quality.

Methods

In a simulation-based trial at a German tertiary care hospital, 31 healthcare workers performed two 2-minute chest compression (CC) cycles on a manikin, once with PPE and once without. Compression quality (rate, depth, hand position, chest recoil) was assessed. Cognitive load was measured post-task using NASA- and Simulation Task Load Index (NASA- and SIM-TLX). Primary outcome was the difference in cognitive load with and without PPE, and secondary outcomes included differences in CC quality parameters.

Results

SIM-TLX identified a significant impact of PPE on task complexity and perceptual strain, while situational stress, distractions, task control, and NASA-TLX parameters (mental, physical, temporal demand, frustration, effort, performance) showed no significant differences. No significant differences were found in compression rate (113 bpm without PPE vs. 109 bpm with PPE), depth (61 mm without vs. 62 mm with PPE), correct hand position (81% without vs. 78% with PPE), and complete chest recoil (94% without vs. 84% with PPE). However not significant, PPE use showed more negative outliers in hand position and chest recoil.

Conclusion

PPE increases values on two subscales of the SIM-TLX (task complexity and perceptual strain), but does not significantly impact chest compression quality in CPR simulations.