International Journal of Environmental Research and Public Health Article Analysis of Physiological Response during Cardiopulmonary Resuscitation with Personal Protective Equipment: A Randomized Crossover Study María Fernández-Méndez 1,2,3,4 , Martín Otero-Agra 2,3 , Felipe Fernández-Méndez 1,2,3,4, * , Santiago Martínez-Isasi 1,4,5 , Myriam Santos-Folgar 2,3,6 , Roberto Barcala-Furelos 1,2,4 and Antonio Rodríguez-Núñez 1,4,5,7   Citation: Fernández-Méndez, M.; Otero-Agra, M.; Fernández-Méndez, F.; Martínez-Isasi, S.; Santos-Folgar, M.; Barcala-Furelos, R.; Rodríguez-Núñez, A. Analysis of Physiological Response during Cardiopulmonary Resuscitation with Personal Protective Equipment: A Randomized Crossover Study. Int. J. Environ. Res. Public Health 2021, 18, 7093. https://doi.org/10.3390/ ijerph18137093 Academic Editors: Stefan Mandi´ c-Rajˇ cevi´ c, Melissa McDiarmid and Claudio Colosio Received: 18 March 2021 Accepted: 29 June 2021 Published: 2 July 2021 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affil- iations. Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). 1 CLINURSID Research Group, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain; mariajosefernandezmendez@gmail.com (M.F.-M.); smtzisasi@gmail.com (S.M.-I.); roberto.barcala.furelos@gmail.com (R.B.-F.); Antonio.Rodriguez.Nunez@sergas.es (A.R.-N.) 2 REMOSS Research Group, Faculty of Education and Sports Science, University of Vigo, 36005 Pontevedra, Spain; martinoteroagra@gmail.com (M.O.-A.); m.santos.folgar@gmail.com (M.S.-F.) 3 Pontevedra School of Nursing, University of Vigo, 36004 Pontevedra, Spain 4 Santiago de Compostela’s Health Research Institute (IDIS), 15706 Santiago de Compostela, Spain 5 Faculty of Nursing, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain 6 Department of Obstetrics, Complexo Hospitalario of Pontevedra, Sergas, 36001 Pontevedra, Spain 7 Pediatric Intensive Care Unit, University Clinical Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain * Correspondence: fernandez.mendez.felipe@gmail.com Abstract: The use of personal protective equipment (PPE) is required for the self-protection of health- care workers during cardiopulmonary resuscitation (CPR) in patients at risk of aerosol transmission of infectious agents. The aim of this study was to analyze the impact of personal protective equipment on physiological parameters during CPR. A randomized, quasi-experimental, crossover design was used. The study was carried out in a training and simulation emergency box and the total sample consisted of 20 healthcare professionals. Two CPR tests were compared with the recommended sequence of 30 chest compressions and 2 ventilations. The duration of each test was 20 min. One of the CPR tests was carried out without using any PPE (CPR_control), i.e., performed with the usual clothing of each rescuer. The other test was carried out using a CPR test with PPE (i.e., CPR_PPE). The main variables of interest were: CPR quality, compressions, ventilations, maximum heart rate, body fluid loss, body temperature, perceived exertion index, comfort, thermal sensation and sweating. The quality of the CPR was similar in both tests. The maximum heart rate was higher in the active intervals (compressions + bag-valve-mask) of the test with PPE. CPR_PPE meant an increase in the perceived effort, temperature at the start of the thermal sensation test, thermal comfort and sweating, as opposed to CPR performed with usual clothing. Performing prolonged resuscitation with PPE did not influence CPR quality, but caused significant physiological demands. Rescuers were more fatigued, sweated more and their thermal comfort was worse. These results suggest that physical preparation should be taken into account when using PPE and protocols for physiological recovery after use should also be established. Keywords: cardiopulmonary resuscitation; personal protective equipment; physical effort; thermal stress; thermoregulation 1. Introduction The evolution of out-of-hospital medicine towards care and treatment in new environ- ments with viral contamination (EBOLA, Severe Acute Respiratory Syndrome, Middle East Respiratory Syndrome), biological attacks of terrorist origin or environmental/industrial Int. J. Environ. Res. Public Health 2021, 18, 7093. https://doi.org/10.3390/ijerph18137093 https://www.mdpi.com/journal/ijerph