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Occupational Health

Effectiveness of Elastomeric Half-Mask Respirators vs N95 Filtering Facepiece Respirators During Simulated ResuscitationA Nonrandomized Controlled Trial

Educational Objective
To identify the key insights or developments described in this article

1 Credit CME

JAMA Network Open

Published Online: March 16, 2021

Research Letter

Article Information and Disclosures

Andrew J. Barros, MD¹;

Costi D. Sifri, MD^2,3;

Taison D. Bell, MD^1,2;

Joshua C. Eby, MD^2,4;

Kyle B. Enfield, MD¹

Author Affiliations

¹Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia School of Medicine, Charlottesville
²Division of Infectious Disease and International Health, Department of Medicine, University of Virginia, School of Medicine, Charlottesville
³Office of Hospital Epidemiology/Infection Prevention & Control, UVA Health, Charlottesville, Virginia
⁴Employee Health, UVA Health, Charlottesville, Virginia

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Respirators provide protection from airborne particles, and the N95 filtering facepiece respirator (FFR) is the most commonly used type in health care. Recent FFR shortages have led to increased interest in reusable elastomeric half-mask respirators (EHMRs),¹^,2 which have a flexible interface and larger straps than FFRs. Data from simulation and industrial settings suggests that EMHRs may provide higher respiratory protection than FFRs.³ Case reports in previous severe acute respiratory syndrome coronavirus pandemics have suggested transmission during cardiopulmonary resuscitation (CPR) despite FFR use,⁴ and simulation studies have demonstrated an unacceptable leak during CPR in up to 40% FFR users.⁵ Owing to shortages of FFR models, individuals who could not be fit in an available FFR model were fit for an EMHR. We assessed whether EHMRs provide improved fit during simulated CPR compared with FFRs.

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Article Information

Accepted for Publication: January 21, 2021.

Published: March 16, 2021. doi:10.1001/jamanetworkopen.2021.1564

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Barros AJ et al. JAMA Network Open.

Corresponding Author: Andrew J. Barros, MD, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia School of Medicine, PO Box 800546, Charlottesville, VA 22908-0546 (abarros@virginia.edu).

Author Contributions: Drs Barros and Enfield had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: Barros, Sifri, Bell, Enfield.

Drafting of the manuscript: Barros, Enfield.

Critical revision of the manuscript for important intellectual content: Sifri, Bell, Eby, Enfield.

Statistical analysis: Barros.

Administrative, technical, or material support: Barros, Eby, Enfield.

Supervision: Barros, Sifri, Bell, Enfield.

Conflict of Interest Disclosures: Dr Sifri reported receiving grants from University of Virginia Global Infectious Disease Institute outside the submitted work. No other disclosures were reported.

Additional Contributions: We thank the staff in the UVA Health special pathogen units for their participation in the study. Amy Warren, MS (Clinical Trials Office, School of Medicine, University of Virginia), assisted with preparing the trial protocol for institutional review board submission and was not compensated for this work.

References

Hamby C. They evoke Darth Vader, but these masks may save your doctor’s life. The New York Times. Published May 27, 2020. Accessed July 1, 2020. https://www.nytimes.com/2020/05/27/us/coronavirus-masks-elastomeric-respirators.html

Pompeii LA , Kraft CS , Brownsword EA , et al. Training and fit testing of health care personnel for reusable elastomeric half-mask respirators compared with disposable N95 respirators. JAMA. 2020;323(18):1849-1852. doi:10.1001/jama.2020.4806 PubMed Google Scholar

Committee on the Use of Elastomeric Respirators in Health Care, Board on Health Sciences Policy, Health and Medicine Division, National Academies of Sciences, Engineering, and Medicine. Clever LH, Rogers BME, Yost OC, Liverman CT, eds. Reusable elastomeric respirators in health care: considerations for routine and surge use. National Academies Press; 2019.

Christian MD , Loutfy M , McDonald LC , et al; SARS Investigation Team. Possible SARS coronavirus transmission during cardiopulmonary resuscitation. Emerg Infect Dis. 2004;10(2):287-293. doi:10.3201/eid1002.030700 PubMed Google Scholar Crossref

Hwang SY , Yoon H , Yoon A , et al. N95 filtering facepiece respirators do not reliably afford respiratory protection during chest compression: a simulation study. Am J Emerg Med. 2020;38(1):12-17. doi:10.1016/j.ajem.2019.03.041 PubMed Google Scholar Crossref

Des Jarlais DC , Lyles C , Crepaz N ; TREND Group. Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: the TREND statement. Am J Public Health. 2004;94(3):361-366. doi:10.2105/AJPH.94.3.361 PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.