Cent Eur J Public Health 2026, 34(3):185-190 | DOI: 10.21101/cejph.a8785

Spirometry and end-tidal carbon dioxide changes during chest compressions with PPE: a simulation randomized crossover study

Patrik Cmorej1, 2, Petr Bureš1, 2, Ondřej Kounovský1, 2, Alena Kohlová2, 3, Danka Boguská4, Dana Rebeka Ralbovská5, Karel Hrach2, Robin Šín6, Jaroslav Pekara7
1 Emergency Medical Services of Ústecký Region, Ústí nad Labem, Czech Republic
2 Faculty of Health Studies, Jan Evangelista Purkyně University, Ústí nad Labem, Czech Republic
3 Faculty of Health and Social Work of St. Ladislav, St. Elisabeth University of Health Care and Social Work in Bratislava, Nové Zámky, Slovakia
4 Faculty of Health Care, University of Prešov in Prešov, Prešov, Slovakia
5 Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic
6 Department of Infectious Diseases and Travel Medicine, Faculty of Medicine in Pilsen, Charles University, Faculty Hospital Pilsen, Pilsen, Czech Republic
7 Medical College, Prague, Czech Republic

Objectives: Personal protective equipment (PPE) use in prehospital emergency care has increased significantly since the coronavirus pandemic onset in 2019. Few studies have been published on the PPE effects on spirometry parameters and end-tidal carbon dioxide (Et-CO2). This study aimed to determine whether PPE use affects spirometric parameters and Et-CO2 during chest compressions.

Methods: This was a randomized crossover simulation study with 35 emergency medical service providers who performed 20 minutes of intermittent chest compressions on a mannikin (five 2 min cycles alternated by 2 min of rest). Two iterations were completed in randomized order: without PPE and with PPE. Spirometry parameters (forced vital capacity, forced expiratory volume in 1 s, peak expiratory flow, and Tiffeneau index) and end-tidal carbon dioxide were measured.

Results: No spirometry parameter differences were noted between the two groups (p > 0.05). When using PPE with an FFP2 mask, Et-CO2 was higher at the end of the first and fifth chest compression cycles (p ≤ 0.001).

Conclusion: PPE use during simulated resuscitation was not associated with deterioration of spirometric parameters. Although Et-CO2 increased slightly during selected CPR cycles, these changes were unlikely to represent clinically relevant respiratory impairment.

Keywords: chest compressions, COVID-19, end-tidal carbon dioxide, personal protective equipment, spirometry

Received: September 11, 2025; Revised: June 26, 2026; Accepted: June 26, 2026; Published: September 30, 2026  Show citation

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Cmorej P, Bureš P, Kounovský O, Kohlová A, Boguská D, Ralbovská DR, et al.. Spirometry and end-tidal carbon dioxide changes during chest compressions with PPE: a simulation randomized crossover study. Cent Eur J Public Health. 2026;34(3):185-190. doi: 10.21101/cejph.a8785.
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