A survey of ventilation strategies during cardiopulmonary resuscitation

Abstract

BACKGROUND: Many controversies still exist regarding ventilator parameters during cardiopulmonary resuscitation (CPR). This study aimed to investigate the CPR ventilation strategies currently being used among physicians in Chinese tertiary hospitals. METHODS:A survey was conducted among the cardiac arrest team physicians of 500 tertiary hospitals in China in August, 2018. Surveyed data included physician and hospital information, and preferred ventilation strategy during CPR.RESULTS: A total of 438 (88%) hospitals completed the survey, including hospitals from all 31 mainland Chinese provinces. About 41.1% of respondents chose delayed or no ventilation during CPR, with delayed ventilations all starting within 12 minutes. Of all the respondents who provided ventilation, 83.0% chose to strictly follow the 30:2 strategy, while 17.0% chose ventilations concurrently with uninterrupted compressions. Only 38.3% respondents chose to intubate after initiating CPR, while 61.7% chose to intubate immediately when resuscitation began. During bagvalve-mask ventilation, only 51.4% of respondents delivered a frequency of 10 breaths per minute. In terms of ventilator settings, the majority of respondents chose volume control (VC) mode (75.2%), tidal volume of 6-7 mL/kg (72.1%), PEEP of 0-5 cmH 2 O (69.9%), and an FiO 2 of 100% (66.9%). However, 62.0% of respondents had mistriggers after setting the ventilator, and 51.8% had high pressure alarms. CONCLUSION:There is a great amount of variability in CPR ventilation strategies among cardiac arrest team physicians in Chinese tertiary hospitals. Guidelines are needed with specific recommendations on ventilation during CPR.

A pulmonary source of infection in patients with sepsis-associated acute kidney injury leads to a worse outcome and poor recovery of kidney function

“…[33] Several evidences now indicate that biotrauma induced by mechanical ventilation not only affects the lung but also leads to further systemic infl ammation and organ dysfunction via the release of inflammatory cytokines. [7,26,[34][35][36] These factors, therefore, provide an explanation, at least in part, of why patients with a pulmonary source of infection have poorer outcomes.…”

Extracorporeal membrane oxygenation treatment for high-risk pulmonary embolism with cardiac arrest in a young adult male

“…However, clinicians can wait when ECMO is working. [8] After full anticoagulation, the body's fibrinolysis mechanism dissolves the fi brin and the clot. In patients unresponsive to anticoagulation, ECMO can serve as a bridge to other defi nitive advanced therapies (for example, thrombolysis orthromboembolectomy) to reduce the thrombus burden.…”

Bag-Valve-Mask versus Laryngeal Mask Airway Ventilation in Cardiopulmonary Resuscitation with Continuous Compressions: A Simulation Study

“…Liu, et al reported that approximately 20% of the study participants preferred asynchronous continuous compressions before ETI during in-hospital CPR. 11 Nichol, et al reported that survival between OHCA patients who received continuous compressions and those who received interrupted compressions by EMS providers had no difference. 12 In the current literature, limited data on CPR performed with continuous compressions and asynchronous ventilation with BVM are available.…”