BACKGROUND: Due to the COVID-19 pandemic, Basic Life Support (BLS) training has been limited to compression-only or bag-mask ventilation. The most breathable nanofiber respirators carry the technical possibility for inflation of the mannequin. The aim of this study was to assess the efficacy of mouth-to-mouth breathing through a FFP2 respirator during BLS. METHODS: In the cross-over simulation-based study, the medical students performed BLS using a breathable nanofiber respirator for 2 min on three mannequins. The quantitative and qualitative efficacy of mouth-to-mouth ventilation through the respirator in BLS training was analyzed. The primary aim was the effectivity of mouth-to-mouth ventilation through a breathable respirator. The secondary aims were mean pause, longest pause, success in achieving the optimal breath volume, technique of ventilation, and incidence of adverse events. RESULTS: In 104 students, effective breath was reached in 951 of 981 (96.9%) attempts in Adult BLS mannequin (Prestan), 822 of 906 (90.7%) in Resusci Anne, and 1777 of 1857 (95.7%) in Resusci Baby. In Resusci Anne and Resusci Baby, 28.9%/15.9% of visible chest rises were evaluated as low-, 33.0%/44.0% as optimal-, and 28.8%/35.8% as high-volume breaths. CONCLUSIONS: Mouth-to-mouth ventilation through a breathable respirator had an effectivity greater than 90%.

Central European Institute of Technology Masaryk University Kamenice 753 5 625 00 Brno Czech Republic

Department of Anaesthesiology and Intensive Care Medicine University Hospital Brno and Faculty of Medicine Masaryk University Jihlavská 20 625 00 Brno Czech Republic

Department of Comprehensive Cancer Care Masaryk Memorial Cancer Institute Faculty of Medicine Masaryk University Žlutý kopec 534 7 656 53 Brno Czech Republic

Department of Paediatric Anaesthesiology and Intensive Care Medicine University Hospital Brno and Faculty of Medicine Masaryk University Jihlavská 20 625 00 Brno Czech Republic

Department of Simulation Medicine Faculty of Medicine Masaryk University Kamenice 5 625 00 Brno Czech Republic

Institute of Biostatistics and Analyses Faculty of Medicine Masaryk University Kamenice 126 3 625 00 Brno Czech Republic

Paediatric Intensive Care Unit NH Hospital Inc 268 01 Hořovice Czech Republic

See more in PubMed

Kim S.-Y., Shin D., Kim H.J., Karm M.-H. Changes of Knowledge and Practical Skills before and after Retraining for Basic Life Support: Focused on Students of Dental School. Int. J. Med. Sci. 2020;17:3082–3090. doi: 10.7150/ijms.47343. PubMed DOI PMC

Baldi E., Contri E., Bailoni A., Rendic K., Turcan V., Donchev N., Nadareishvili I., Petrica A.-M., Yerolemidou I., Petrenko A., et al. Final-Year Medical Students’ Knowledge of Cardiac Arrest and CPR: We Must Do More! Int. J. Cardiol. 2019;296:76–80. doi: 10.1016/j.ijcard.2019.07.016. PubMed DOI

Pande S., Pande S., Parate V., Pande S., Sukhsohale N. Evaluation of Retention of Knowledge and Skills Imparted to First-Year Medical Students through Basic Life Support Training. Adv. Physiol. Educ. 2014;38:42–45. doi: 10.1152/advan.00102.2013. PubMed DOI

Ralapanawa D.M.P.U.K., Jayawickreme K.P., Ekanayake E.M.M., Kumarasiri P.V.R. A Study on the Knowledge and Attitudes on Advanced Life Support among Medical Students and Medical Officers in a Tertiary Care Hospital in Sri Lanka. BMC Res. Notes. 2016;9:462. doi: 10.1186/s13104-016-2270-5. PubMed DOI PMC

WHO Director-General’s Opening Remarks at the Media Briefing on COVID-19. 2020. [(accessed on 3 June 2021)]. Available online: https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020.

Nolan J.P., Monsieurs K.G., Bossaert L., Böttiger B.W., Greif R., Lott C., Madar J., Olasveengen T.M., Roehr C.C., Semeraro F., et al. European Resuscitation Council COVID-19 Guidelines Executive Summary. Resuscitation. 2020;153:45–55. doi: 10.1016/j.resuscitation.2020.06.001. PubMed DOI PMC

Riva G., Ringh M., Jonsson M., Svensson L., Herlitz J., Claesson A., Djärv T., Nordberg P., Forsberg S., Rubertsson S., et al. Survival in Out-of-Hospital Cardiac Arrest After Standard Cardiopulmonary Resuscita-Tion or Chest Compressions Only Before Arrival of Emergency Medical Services. Circulation. 2019;139:2600–2609. doi: 10.1161/CIRCULATIONAHA.118.038179. PubMed DOI

Hsu C.H., Neumar R.W. To Breathe, or Not to Breathe, That Is the Question. Circulation. 2019;139:2610–2612. doi: 10.1161/CIRCULATIONAHA.119.040370. PubMed DOI PMC

Olasveengen T.M., Semeraro F., Ristagno G., Castren M., Handley A., Kuzovlev A., Monsieurs K.G., Raffay V., Smyth M., Soar J., et al. European Resuscitation Council Guidelines 2021: Basic Life Support. Resuscitation. 2021;161:98–114. doi: 10.1016/j.resuscitation.2021.02.009. PubMed DOI

Van de Voorde P., Turner N.M., Djakow J., de Lucas N., Martinez-Mejias A., Biarent D., Bingham R., Brissaud O., Hoffmann F., Johannesdottir G.B., et al. European Resuscitation Council Guidelines 2021: Paediatric Life Support. Resuscitation. 2021;161:327–387. doi: 10.1016/j.resuscitation.2021.02.015. PubMed DOI

Baldi E., Contri E., Savastano S., Cortegiani A. The Challenge of Laypeople Cardio-Pulmonary Resuscitation Training during and after COVID-19 Pandemic. Resuscitation. 2020;152:3–4. doi: 10.1016/j.resuscitation.2020.04.040. PubMed DOI PMC

Lederer W., Isser M. Barrier Resuscitation by Lay Rescuers during COVID-19 Pandemic. Med. Hypotheses. 2021;154:110648. doi: 10.1016/j.mehy.2021.110648. PubMed DOI PMC

Greif R., Lockey A., Breckwoldt J., Carmona F., Conaghan P., Kuzovlev A., Pflanzl-Knizacek L., Sari F., Shammet S., Scapigliati A., et al. European Resuscitation Council Guidelines 2021: Education for Resuscitation. Resuscitation. 2021;161:388–407. doi: 10.1016/j.resuscitation.2021.02.016. PubMed DOI

Chaplin T., McColl T., Petrosoniak A., Hall A.K. “Building the Plane as You Fly”: Simulation during the COVID-19 Pandemic. Can. J. Emerg. Med. 2020;22:576–578. doi: 10.1017/cem.2020.398. PubMed DOI PMC

Hanel E., Bilic M., Hassall K., Hastings M., Jazuli F., Ha M., Trotter B., Fraser C., Rutledge G. Virtual Application of in Situ Simulation during a Pandemic. CJEM. 2020 doi: 10.1017/cem.2020.375. PubMed DOI PMC

Zou L., Ruan F., Huang M., Liang L., Huang H., Hong Z., Yu J., Kang M., Song Y., Xia J., et al. SARS-CoV-2 Viral Load in Upper Respiratory Specimens of Infected Patients. N. Engl. J. Med. 2020;382:1177–1179. doi: 10.1056/NEJMc2001737. PubMed DOI PMC

Ueki H., Furusawa Y., Iwatsuki-Horimoto K., Imai M., Kabata H., Nishimura H., Kawaoka Y. Effectiveness of Face Masks in Preventing Airborne Transmission of SARS-CoV-2. mSphere. 2020;5:e00637-20. doi: 10.1128/mSphere.00637-20. PubMed DOI PMC

National Research Council (US) Chemical Sciences Roundtable . Commodity Polymers from Renewable Resources: Polylactic Acid. National Academies Press; Washington, DC, USA: 2001. [(accessed on 3 June 2021)]. C. Carbon Management: Implications for R&D in the Chemical Sciences and Technology: A Workshop Report to the Chemical Sciences Roundtable. Available online: https://www.ncbi.nlm.nih.gov/books/NBK44131/ PubMed

Scully J.R. The COVID-19 Pandemic, Part 1: Can Antimicrobial Copper-Based Alloys Help Suppress Infectious Transmission of Viruses Originating from Human Contact with High-Touch Surfaces? Corrosion. 2020;76:523–527. doi: 10.5006/3568. DOI

Van Doremalen N., Bushmaker T., Morris D.H., Holbrook M.G., Gamble A., Williamson B.N., Tamin A., Harcourt J.L., Thornburg N.J., Gerber S.I., et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. N. Engl. J. Med. 2020;382:1564–1567. doi: 10.1056/NEJMc2004973. PubMed DOI PMC

Hewawaduge C., Senevirathne A., Jawalagatti V., Kim J.W., Lee J.H. Copper-Impregnated Three-Layer Mask Efficiently Inactivates SARS-CoV2. Environ. Res. 2021;196:110947. doi: 10.1016/j.envres.2021.110947. PubMed DOI PMC

Soar J., Böttiger B.W., Carli P., Couper K., Deakin C.D., Djärv T., Lott C., Olasveengen T., Paal P., Pellis T., et al. European Resuscitation Council Guidelines 2021: Adult Advanced Life Support. Resuscitation. 2021;161:115–151. doi: 10.1016/j.resuscitation.2021.02.010. PubMed DOI

Adelborg K., Dalgas C., Grove E.L., Jørgensen C., Al-Mashhadi R.H., Løfgren B. Mouth-to-Mouth Ventilation Is Superior to Mouth-to-Pocket Mask and Bag-Valve-Mask Ventilation during Lifeguard CPR: A Randomized Study. Resuscitation. 2011;82:618–622. doi: 10.1016/j.resuscitation.2011.01.009. PubMed DOI

Beesems S.G., Wijmans L., Tijssen J.G.P., Koster R.W. Duration of Ventilations during Cardiopulmonary Resuscitation by Lay Rescuers and First Responders: Relationship between Delivering Chest Compressions and Outcomes. Circulation. 2013;127:1585–1590. doi: 10.1161/CIRCULATIONAHA.112.000841. PubMed DOI

Carballo-Fazanes A., Barcala-Furelos R., Eiroa-Bermúdez J., Fernández-Méndez M., Abelairas-Gómez C., Martínez-Isasi S., Murciano M., Fernández-Méndez F., Rodríguez-Núñez A. Physiological Demands of Quality Cardiopulmonary Resuscitation Performed at Simulated 3250 Meters High. Am. J. Emerg. Med. 2020;38:2580–2585. doi: 10.1016/j.ajem.2019.12.048. PubMed DOI

Simmons M., Deao D., Moon L., Peters K., Cavanaugh S. Bench Evaluation: Three Face-Shield CPR Barrier Devices. Respir. Care. 1995;40:618–623. PubMed

Ventilation efficacy during paediatric cardiopulmonary resuscitation (PEDIVENT): simulation-based comparative study