Methods
shockable, OHCA
Ethical approval for this study (Ethical Committee No 2021-414-f-S) was granted on July, 2th 2021 by the Ethical Committee of the University Hospital of Muenster, Muenster, Germany (Chairperson Prof W.E. Berdel). The study was performed at a training center for paramedics in Bielefeld, Germany in August 2021 (‘Studieninstitut für kommunale Verwaltung Westfalen-Lippe, Fachbereich Medizin und Rettungswesen’). This manuscript adheres to the applicable CONSORT guidelines. After providing written informed consent, 60 paramedics were randomly allocated into 30 fixed teams, simulating the crew of an ambulance, and asked to perform a basic-life-support (BLS) OHCA scenario according to the guidelines of the European Resuscitation Council (ERC) 2021 [
The laryngeal mask modified with a shower capFollowing the training, the previously formed teams were randomised via balanced randomization into two groups to investigate the effects on each initial rhythm: The first group completed the three scenarios of ERC COVID-19-adapted guidelines with a shockable, the second group with a non-shockable rhythm using each of the previously trained airway devices [
Flowchart of the group allocation processThe target for the participants was to achieve the highest possible resuscitation quality with regard to protection specificities due to the COVID-19 pandemic [The Laerdal Resusci Anne QCPR manikin (Laerdal Medical GmbH, Lilienthalstr.5, 82,178 Puchheim, Germany, To visualize the simulated aerosol release, the breathing system of the Laerdal Resusci Anne QCPR manikin was modified using the ‚Look Tiny Cx fog machine‘ (Look Solutions GmbH & Co. KG, Bünteweg 33, DE-30,989 Gehrden, Data were transmitted via WLAN to the SimPad PLUS (SimPad PLUS, Laerdal Medical 2016, The duration of each scenario was limited to 5 min. During the COVID-19 scenarios, participants wore PPE as recommended in the COVID-19-adapted guidelines (FFP3 mask (equivalent to the US N95 standard), eye and face protection, long-sleeved gown, and gloves) [After completion of all scenarios, the participants were asked to anonymously provide information on their subjective assessment of the amount of aerosol release (0 = no release – 10 = maximum release) and the feeling of safety using the different airway devices (safe, rather safe, rather unsafe, unsafe), the assessment of the quality of the different resuscitation scenarios with regard to the shortest possible no-flow time (good quality, rather good quality, rather bad quality, bad quality) and optimal protection of the rescuer (good protection, rather good protection, rather bad protection, bad protection).The primary outcome was no-flow time, defined as time without chest compressions. Secondary outcomes were the established quality indicators of resuscitation as mentioned above as well as the results of the participants survey on rescuer safety.