Photo Credit: Ronnachaipark

The following is a summary of “Chest compression quality comparing 1-min vs 2-min rotation of rescuers wearing N95 masks,” published in the February 2024 issue of Emergency Medicine by Mathew, et al.

Amidst the COVID-19 pandemic, cardiopulmonary resuscitation (CPR) executed by rescuers wearing well-sealed respirators like N95 masks often resulted in a notable reduction in chest compression rate and depth. The decline was attributed to rescuer fatigue during the conventional 2-minute rotation intervals. Researchers postulated that shortening the rescuer rotations from two minutes to one minute might enhance CPR quality in such scenarios. For a study, they sought to compare the quality of chest compressions when rescuers wearing N95 masks were rotated every minute versus the standard practice of two-minute rotations.

After obtaining approval from the institutional Ethics Committee, they conducted a randomized, controlled crossover trial. Volunteering as rescuers, medical students underwent training to deliver high-quality chest compressions on a manikin. Subsequently, they were randomly paired and allocated to two trial groups: one-minute rotations crossed over to two-minute rotations, and vice versa. Each pair performed CPR sessions with one- and two-minute rotations, totaling 12 minutes per session. Outcome measures included CPR quality, compression depth, compression rate, and chest compression fraction. Rescuer fatigue was assessed using the modified Borg scale before and after each study session.

Fifty-six participants completed the study. CPR quality did not significantly differ between the study arms (median 88% vs. 81%, P = 0.09). However, minute-to-minute comparison revealed significantly lower CPR quality in the 2-minute rotation arm at minutes 4, 6, 8, 10, and 12 (respective P-values 0.03, 0.001, 0.008, 0.02, 0.002). A similar trend was observed in compression depth. Rescuer fatigue scores were significantly lower with 1-minute rotations compared to 2-minute rotations (P < 0.001). Rescuer vital signs and cardiorespiratory parameters did not differ between the rotation types.

In CPR performed by rescuers wearing N95 masks, rotating rescuers at one-minute intervals instead of two-minute intervals appears to result in superior CPR quality and reduced rescuer fatigue.

Reference: sciencedirect.com/science/article/abs/pii/S0735675723006381