BJS Prize 3 PPE-induced systemic hypercapnic-hypoxaemia: translational implications for impaired cognitive-clinical-functional performance

Abstract Background Personal Protective Equipment (PPE) has been reported to adversely influence pulmonary gas exchange, resulting in systemic hypercapnic-hypoxaemia and cerebral hyperperfusion-induced cephalalgia. This study aimed determine what extent these changes impact functional cognition manual dexterity given their relevance surgical performance. Method Thirty-one trainees (20 male, 11 female, aged 29 yr. (29.2 ± 2) participated a randomised single-blind repeated measures crossover trial, completing one-hour of standardised laparoscopic simulation tasks, on two separate occasions (same day), once Standard Operating Attire (SOA), full PPE (including FFP3 mask). Global Cerebral Blood Flow (gCBF) was determined using duplex arterial ultrasound. Cognition were assessed by timed Grooved Pegboard novel measure bead placement. Results Following simulation, (compared with SOA) increased heart rate (93 13 b/min vs. 79 b/min, p=0.001), decreased peripheral O2 saturation (96.9% ±1% 97.9% ±1%, gCBF (Δ+7 8 mL/min/100g + 1 mL/min/100g, p=0.016; reflecting hypercapnic-hypoxic vasodilatation) skin temperature 0.6°C (p=0.001). Cephalalgia 21 (67.7%) participants wearing (41.9%) SOA Dominant hand pegboard performance both impaired PPE: 71.1s (±12) 61.4s (±12), p=0.001; 270.7s (±135) 192.5s (±67), p=0.001 respectively. Conclusion Collectively, findings are the first demonstrate that PPE-induced is associated important cognitive-clinical-functional may have cerebrovascular basis.