Association of ventilation with outcomes from out-of-hospital cardiac arrest

Chang, Mary P.; Lu, Yuanzheng; Aramendi, Elisabete; Owens, Pamela; Wang, Henry E.; Idris, Ahamed H.

doi:10.1016/j.resuscitation.2019.05.006

Cited by 38 publications

(22 citation statements)

References 27 publications

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“…Although the CPR guideline recommendation on the target tidal volume is 400-700ml during CPR, the previous studies have showed that a tidal volume of 300-500ml is sufficient to achieve a visible chest rise and ensure gas exchange in the lungs. 4,17 On the other hand, the recommended tidal volumes vary between 4.0-8.0ml/kg (280-560ml for a 70kg adult) in lung-protective ventilation strategies. 18 A recent experimental study revealed that ultra-low-volume ventilation (tidal volume of 2.0-3.0ml/kg) strategy during CPR might provide neurological outcome improvement and lung protective benefits.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 However, other basic and advanced airway tools, such as bag-valve-mask (BVM), laryngeal mask airway (LMA), and laryngeal tube, have been widely used by rescuers because ETI requires advanced training and skills. [3][4][5][6] The best airway strategy to be used during CPR and the most appropriate time to perform ETI are still unclear. 6 Most of the recent studies on out-of-hospital cardiac arrest (OHCA) patients have revealed that the survival rate is higher in patients resuscitated without an advanced airway than those resuscitated with an advanced airway.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Dündar

Ayrancı

Koçak

et al. 2021

Prehosp. Disaster med.

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Introduction: The 2017 International Liaison Committee on Resuscitation (ILCOR) guideline recommends that Emergency Medical Service (EMS) providers can perform cardiopulmonary resuscitation (CPR) with synchronous or asynchronous ventilation until an advanced airway has been placed. In the current literature, limited data on CPR performed with continuous compressions and asynchronous ventilation with bag-valve-mask (BVM) are available. Study Objective In this study, researchers aimed to compare the effectiveness of asynchronous BVM and laryngeal mask airway (LMA) ventilation during CPR with continuous chest compressions. Methods: Emergency medicine residents and interns were included in the study. The participants were randomly assigned to resuscitation teams with two rescuers. The cross-over simulation study was conducted on two CPR scenarios: asynchronous ventilation via BVM during a continuous chest compression and asynchronous ventilation via LMA during a continuous chest compression in cardiac arrest patient with asystole. The primary endpoints were the ventilation-related measurements. Results: A total of 92 volunteers were included in the study and 46 CPRs were performed in each group. The mean rate of ventilations of the LMA group was significantly higher than that of the BVM group (13.7 [11.7-15.7] versus 8.9 [7.5-10.3] breaths/minute; P <.001). The mean volume of ventilations of the LMA group was significantly higher than that of the BVM group (358.4 [342.3-374.4] ml versus 321.5 [303.9-339.0] ml; P = .002). The mean minute ventilation volume of the LMA group was significantly higher than that of the BVM group (4.88 [4.15-5.61] versus 2.99 [2.41-3.57] L/minute; P <.001). Ventilations exceeding the maximum volume limit occurred in two (4.3%) CPRs in the BVM group and in 11 (23.9%) CPRs in the LMA group (P = .008). Conclusion: The results of this study show that asynchronous BVM ventilation with continuous chest compressions is a reliable and effective strategy during CPR under simulation conditions. The clinical impact of these findings in actual cardiac arrest patients should be evaluated with further studies at real-life scenes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Dündar

Ayrancı

Koçak

et al. 2021

Prehosp. Disaster med.

View full text Add to dashboard Cite

show abstract

“…2 The impact of ventilation during CPR on patient-important outcomes is less understood. 3 However, ventilating a patient in accordance with the current OHCA management guidelines poses numerous challenges to health care professionals. 4 For instance, during OHCA, ventilation often requires a dedicated paramedic.…”

Section: Introductionmentioning

confidence: 99%

Continuous flow insufflation of oxygen compared with manual ventilation during out-of-hospital cardiac arrest: A survey of the paramedics

et al. 2021

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Introduction: In 2018, a continuous flow insufflation of oxygen (CFIO) device (b-card™, Vygon (USA)) placed on a supraglottic airway (SGA) became the standard of care to ventilate patients during adult out-of-hospital cardiac arrest (OHCA) care in Quebec–Capitale-Nationale region, Canada. This study aims to assess the paramedics’ perception as well as the disadvantages and the benefits relative to the use of CFIO during OHCA management. Methods: An invitation to complete an online survey (Survey Monkey™) was sent to all 560 paramedics who are working in our region. The survey included 22 questions of which 9 aimed to compare the traditional manual ventilation with a bag to the CFIO using a 5-point Likert-type scale. Results: A total of 244 paramedics completed the survey, of which 189 (77.5%) had used the CFIO device during an OHCA at least once. Most respondents felt that the intervention was faster (70.2%) and easier (86.5%) with the CFIO device compared with manual ventilation. CFIO was also associated with perceived increased patient safety (64.4%) as well as paramedic safety during the evacuation (88.9%) and the ambulance transport (88.9%). Paramedics reported that physical (48.1%) and cognitive (52.9%) fatigue were also improved with CFIO. The main reported barriers were the bending of the external SGA tube and the loss of capnography values. Conclusion: The use of CFIO during adult OHCA care allows a simplified approach and was perceived as safer for the patient and the paramedics compared with manual ventilation. Its impact on patient-centred outcomes needs to be assessed.

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“…TI is typically available much earlier, as it is recorded by most defibrillation equipment concurrently with the ECG. Moreover, the amplitudes of the ventilation waveforms in the TI can be taken as surrogate measures of insufflated air volumes and can be associated with survival outcomes [4].…”

Section: Introductionmentioning

confidence: 99%

An Impedance-based Algorithm to Detect Ventilations During Cardiopulmonary Resuscitation

Jaureguibeitia

Irusta

Aramendi

et al. 2020

2020 Computing in Cardiology Conference (CinC)

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Cardiopulmonary resuscitation (CPR) is a core therapy to treat out-of-hospital cardiac arrest (OHCA). Thoracic impedance (TI) can be used to assess ventilations during CPR, but the signal is also affected by chest compression (CC) artifacts. This study presents a method for TI-based ventilation detection during concurrent manual CCs. Data from 152 OHCA patients were analyzed. A total of 423 TI segments of at least 60 s during ongoing CCs were extracted. True ventilations were annotated using the capnogram. The final dataset comprised 1210 min of TI recordings and 9665 ground truth ventilations. A three-stage detection algorithm was developed. First, the TI signal was filtered to obtain ventilation waveforms, including a least mean squares filter to remove artifacts due to CCs. Potential ventilations were then identified with a heuristic detector and characterized by a set of 16 features. These were finally fed to a random forest classifier to discriminate between true ventilations and false positives. Patients were split into 100 distinct training (70%) and test (30%) partitions. The median (interquartile range) sensitivity, PPV and F-score were 83.9 (70.2-91.2) %, 86.1 (75.0-93.3) % and 84.3 (72.1-91.4) %. Our method would allow feedback on ventilation rates as well as surrogate measures of insufflated air volume during CPR.

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Association of ventilation with outcomes from out-of-hospital cardiac arrest

Cited by 38 publications

References 27 publications

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

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

Continuous flow insufflation of oxygen compared with manual ventilation during out-of-hospital cardiac arrest: A survey of the paramedics

An Impedance-based Algorithm to Detect Ventilations During Cardiopulmonary Resuscitation

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