TY - JOUR

T1 - Comparison of intravascular access methods applied by nurses wearing personal protective equipment in simulated COVID-19 resuscitation

T2 - A randomized crossover simulation trial

AU - Drozd, Anna

AU - Smereka, Jacek

AU - Pruc, Michal

AU - Malysz, Marek

AU - Gasecka, Aleksandra

AU - Sonmez, Leyla Ozturk

AU - Cyran, Maciej

AU - Konge, Lars

AU - Szarpak, Lukasz

N1 - Funding Information: The study was supported by the ERC Research Net and by the Polish Society of Disaster Medicine. Publisher Copyright: © 2021 Elsevier Inc.

PY - 2021

Y1 - 2021

N2 - Background: Prehospital emergency care of children is challenging. In the era of the COVID-19 pandemic, when medical personnel should use personal protective equipment against aerosol-generating procedures, the efficiency of medical procedures may decrease. The study objective was to evaluate the effectiveness of different intravascular access methods applied by nurses wearing biosafety Level-2 suits in simulated paediatric COVID-19 resuscitation. Methods: A prospective, randomized, crossover, single-blinded simulation trial was performed. Nursing staff attending Advanced Cardiovascular Life Support courses accredited by the American Heart Association participated in the study. A total of 65 nurses were recruited and randomly assigned to different study groups. They received standard training on intravascular access methods employing distinct devices. The participants wore biosafety Level-2 suits and performed vascular access with the following intraosseous devices: NIO-P, EZ-IO, and Jamshidi needle; intravenous (IV) access was used as a reference method. Both the order of participants and the access methods were random. Each participant performed intravascular access with each of the four methods tested. The effectiveness of the first attempt to obtain intravascular access and the following time parameters were analysed: the time between grasping the intravascular device out of the original packing until infusion line connection. The ease of the procedure was measured with a visual analogue scale (1 – easy; 10 – difficult). Results: The first attempt success rate of intravascular access by using NIO-P and EZ-IO equalled 100% and was statistically significantly higher than that with the Jamshidi needle (80.0%; p = 0.02) and with the IV method (69.2%; p = 0.005). The time required to connect the infusion line varied and amounted to 33 ± 4 s for NIO-P compared to 37 ± 6.7 s for EZ-IO (p < 0.001), 43 ± 7 s for Jamshidi (p < 0.001), and 98.5 ± 10 s for IV access (p < 0.001). The procedure was easiest in the case of NIO-P and EZ-IO (2 ± 1 points; p = 1.0) compared with Jamshidi (5 ± 3 points; p < 0.001) and IV access (7 ± 2 points; p < 0.001). Conclusion: The study provides evidence that nurses wearing biosafety Level-2 suits were able to obtain intraosseous access faster and more effectively as compared with IV access during simulated COVID-19 paediatric resuscitation. The most effective method of intravascular access was the NIO-P intraosseous device. Further clinical trials are necessary to confirm the results.

AB - Background: Prehospital emergency care of children is challenging. In the era of the COVID-19 pandemic, when medical personnel should use personal protective equipment against aerosol-generating procedures, the efficiency of medical procedures may decrease. The study objective was to evaluate the effectiveness of different intravascular access methods applied by nurses wearing biosafety Level-2 suits in simulated paediatric COVID-19 resuscitation. Methods: A prospective, randomized, crossover, single-blinded simulation trial was performed. Nursing staff attending Advanced Cardiovascular Life Support courses accredited by the American Heart Association participated in the study. A total of 65 nurses were recruited and randomly assigned to different study groups. They received standard training on intravascular access methods employing distinct devices. The participants wore biosafety Level-2 suits and performed vascular access with the following intraosseous devices: NIO-P, EZ-IO, and Jamshidi needle; intravenous (IV) access was used as a reference method. Both the order of participants and the access methods were random. Each participant performed intravascular access with each of the four methods tested. The effectiveness of the first attempt to obtain intravascular access and the following time parameters were analysed: the time between grasping the intravascular device out of the original packing until infusion line connection. The ease of the procedure was measured with a visual analogue scale (1 – easy; 10 – difficult). Results: The first attempt success rate of intravascular access by using NIO-P and EZ-IO equalled 100% and was statistically significantly higher than that with the Jamshidi needle (80.0%; p = 0.02) and with the IV method (69.2%; p = 0.005). The time required to connect the infusion line varied and amounted to 33 ± 4 s for NIO-P compared to 37 ± 6.7 s for EZ-IO (p < 0.001), 43 ± 7 s for Jamshidi (p < 0.001), and 98.5 ± 10 s for IV access (p < 0.001). The procedure was easiest in the case of NIO-P and EZ-IO (2 ± 1 points; p = 1.0) compared with Jamshidi (5 ± 3 points; p < 0.001) and IV access (7 ± 2 points; p < 0.001). Conclusion: The study provides evidence that nurses wearing biosafety Level-2 suits were able to obtain intraosseous access faster and more effectively as compared with IV access during simulated COVID-19 paediatric resuscitation. The most effective method of intravascular access was the NIO-P intraosseous device. Further clinical trials are necessary to confirm the results.

KW - Cardiopulmonary resuscitation

KW - Child

KW - Coronavirus

KW - COVID-19

KW - Infection

KW - Intraosseous access

KW - Intravascular access

KW - Medical simulation

KW - Personal protective equipment

KW - SARS-CoV-2

U2 - 10.1016/j.ajem.2021.05.080

DO - 10.1016/j.ajem.2021.05.080

M3 - Journal article

C2 - 34126564

AN - SCOPUS:85107614631

VL - 49

SP - 189

EP - 194

JO - American Journal of Emergency Medicine

JF - American Journal of Emergency Medicine

SN - 0735-6757

ER -