Quantitative Analysis of Bioaerosol Hazards and Mitigation Strategies During Mechanical and Hands-On CPR

Rationale: CPR is known to generate aerosols, increasing the risk of transmitting airborne diseases. This study evaluated aerosol exposure during manual and mechanical CPR, noting that pressure-driven mechanical CPR might exacerbate aerosol dispersion.

Objectives: The objectives were to measure aerosol exposure to health workers during manual and mechanical CPR and to evaluate the efficacy of mitigation strategies.

Methods: A high-fidelity mannequin simulated CPR at 110 compressions per minute, assessing the effectiveness of mask coverings, supraglottic airways, endotracheal tubes, HEPA filters, and evacuators in reducing aerosol dispersion.

Measurements: Aerosol concentrations were continuously measured at the mannequin’s head, trunk, and feet for 10 min.

Results: Mechanical CPR produced less aerosol than hands-on CPR. Surgical masks and N95 respirators reduced aerosol levels, while sealed airway devices with HEPA filters further minimized dispersion. HEPA evacuators provided the most significant reduction.

Conclusion: In conclusion, MCPR reduces aerosol production compared to HCPR by avoiding personnel rotation and creating horizontal airflow instead of upward airflow. Aerosol mitigation is effectively enhanced through the use of properly fitted masks and well-sealed SGAs or ETs equipped with HEPA filters. Notably, HEPA evacuators are highly effective in minimizing aerosol dispersion. Implementing MCPR, wearing N95 masks, ensuring a proper mask fit for face coverings, transitioning early to ETs, and using HEPA evacuators are critical measures for enhancing health worker safety during CPR.