Spirometry and end-tidal carbon dioxide changes during chest compressions with PPE: a simulation randomized crossover...

Personal protective equipment (PPE) use in prehospital emergency care has increased significantly since the coronavirus pandemic onset in 2019. Few studies have been published on the PPE effects on spirometry parameters and end-tidal carbon dioxide (Et-CO2). This study aimed to determine whether PPE use affects spirometric parameters and Et-CO2 during chest compressions.

This was a randomized crossover simulation study with 35 emergency medical service providers who performed 20 minutes of intermittent chest compressions on a mannikin (five 2 min cycles alternated by 2 min of rest). Two iterations were completed in randomized order: without PPE and with PPE. Spirometry parameters (forced vital capacity, forced expiratory volume in 1 s, peak expiratory flow, and Tiffeneau index) and end-tidal carbon dioxide were measured.

No spirometry parameter differences were noted between the two groups (p > 0.05). When using PPE with an FFP2 mask, Et-CO2 was higher at the end of the first and fifth chest compression cycles (p ≤ 0.001).

PPE use during simulated resuscitation was not associated with deterioration of spirometric parameters. Although Et-CO2 increased slightly during selected CPR cycles, these changes were unlikely to represent clinically relevant respiratory impairment.