The quality of CPR delivered by EMS personnel wearing enhanced personal protective equipment during the COVID-19 pandemic: a retrospective cohort study from Perth, Australia

Abstract

Purpose

To measure the quality of cardiopulmonary resuscitation (CPR) provided by Emergency Medical Services (EMS) personnel wearing ‘enhanced’ personal protective equipment (PPE) during the COVID-19 pandemic in Perth, Australia.

Methods

We undertook a retrospective cohort study of adult, non-traumatic, non-EMS-witnessed out-of-hospital cardiac arrests (OHCA) with resuscitation attempted by St John (Ambulance) Western Australia (SJWA) between 16/03/2020–16/05/2021; corresponding to the first 14 months of the COVID-19 pandemic. We reported the median (interquartile range [IQR]) compression depth, rate and fraction across the cohort, along with the proportion of cases compliant with resuscitation guidelines issued by the Australian and New Zealand Committee on Resuscitation (ANZCOR). We also looked for evidence of rescuer fatigue by comparing CPR quality during the first 10 min of resuscitation to the remaining CPR effort.

Results

Of 659 adult, non-traumatic, non-EMS-witnessed OHCA with SJWA-attempted resuscitation, 467 cases (71 %) had usable CPR quality data. The median (IQR) compression depth was 5.9 (5.4, 6.5) cm; with 89.5 % of cases having an average depth ≥5 cm as stipulated by ANZCOR guidelines. The median (IQR) compression rate was 108 (106, 110) min⁻¹; with 99.8 % of cases having an average rate within the recommended range 100–120 min⁻¹. The median (IQR) compression fraction was 91 (87, 93) %; ANZCOR recommends minimizing interruptions to compressions. Among 369 cases of sufficient duration to compare the first 10 min of resuscitation to the remaining CPR effort, we found no significant deterioration in CPR quality.

Conclusion

EMS personnel in Perth delivered high quality CPR, without evidence of fatigue, despite wearing enhanced PPE during the initial stages of the COVID-19 pandemic.