The "delay effect" of donning a gown during cardiopulmonary resuscitation in a simulation model.(EM Advances)

Publication: Canadian Journal of Emergency Medicine

Publication Date: 01-JUL-08

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COPYRIGHT 2008 Canadian Medical Association

ABSTRACT

Objective: We sought to determine whether the use of currently issued gowns delays initiation of chest compressions and ventilations during cardiopulmonary resuscitation and whether simple gown modifications can reduce this delay.

Methods: Firefighter defibrillation instructors were allocated into pairs and videotaped while performing standardized cardiac arrest scenarios. Three scenarios were compared: "no gown," "standard gown" and "modified gown." Key time intervals were extracted from videotaped data.

Results: Ninety-five scenarios were analyzed. Mean time interval to chest compression was 39 seconds (95% confidence interval [CI] 34-43) for "no gown" scenarios, 71 seconds (95% CI 66-77) for "standard gown" scenarios and 59 seconds (95% CI 54-63) for "modified gown" scenarios (p < 0.001). Time to first ventilation was 146 seconds (95% CI 134-158), 238 seconds (95% CI 224-253) and 210 seconds (95% CI 198-223) in the 3 groups, respectively (p < 0.001). Post hoc testing showed that the time differences between all groups were statistically significant.

Conclusion: Standard gowns protect front-line care providers but cause significant delays to chest compressions and ventilations, potentially increasing patient morbidity and mortality. Minor gown modifications, including pre-tied neck straps and longer waist ties that tie in front, allow for easier use and shorter delays to time-critical interventions. Future research is required to reduce care delays while maintaining adequate protection of emergency medical service providers from infectious disease.

RESUME

Objectif : Nous avons cherche a determiner si l'utilisation des blouses de protection couramment distribuees retarde le debut des compressions thoraciques et des ventilations lors de la reanimation cardio-pulmonaire et si de simples modifications aux blouses pourraient reduire ce retard.

Methodes : Les pompiers instructeurs en defibrillation ont ete mis en paire et ont ete enregistres sur bande magnetoscopique pendant qu'ils realisaient des scenarios normalises d'arret cardiaque. Nous avons compare les trois scenarios suivants : >, > et >. Les intervalles de temps cles ont ete extraits des donnees de la bande video. Keywords: cardiopulmonary resuscitation, personal protective equipment, gown, prehospital, delay

Resultats : Des 95 scenarios analyses, les intervalles de temps moyen avant les compressions thoraciques etaient de 39 secondes (intervalle de confiance [IC] a 95 %, 34 a 43) pour les scenarios >, de 71 secondes (IC a 95 %, 66 a 77) pour les scenarios avec le > et de 59 secondes (IC a 95 %, 54 a 63) pour les scenarios avec le > (p < 0,001). Le temps ecoule avant la premiere ventilation etait respectivement de 146 secondes (IC a 95 %, 134 a 158), de 238 secondes (IC a 95 %, 224 a 253) et de 210 secondes (IC a 95 %, 198 a 223) pour les trois groupes (p < 0,001). Les epreuves post hoc ont montre que les differences de temps entre les groupes etaient statistiquement significatives.

Conclusion : Les modeles actuels de blouses protegent les fournisseurs de soins de premiere ligne, mais retardent de facon significative le debut des compressions...

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