Efficacy of Several Modes of Continuous-Flow Insufflation for Resuscitation of a Canine Model of Acute Respiratory Arrest

Barnas, G. M.; Smalley, Arthur J.; Miller, Janice; Park, Sun Gu; Delaney, Paul; Mackenzie, Colin F.

doi:10.1016/s0196-0644(96)70166-x

Cited by 4 publications

(1 citation statement)

References 10 publications

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“…In transtracheal insufflation, oxygen or room air is delivered via cannula at a steady flow of approximately 2 liters/minute directly into the trachea with a separate transtracheal port or an open airway providing the exhaust port . Its key utility has been as a continuous source of oxygen as an adjunct to surgical procedures involving the upper airway, an adjunct to mechanical ventilation, or as an alternate method to achieve oxygenation during cardiopulmonary resuscitation.…”

Section: Discussionmentioning

confidence: 99%

A Resuscitation Option for Upper Airway Occlusion Based on Bolus Transtracheal Lung Inflation

Villiere

Nakase

Kollmar

et al. 2018

Laryngoscope Investig Oto

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BackgroundAcute laryngospasm sufficient to cause obstructive apnea is a medical emergency that can be difficult to manage within the very short time available for establishing an airway. We have presented substantial evidence that laryngospasm‐based obstructive apnea is the cause of sudden death in epilepsy, and airway management is particularly challenging during seizure activity.ObjectiveWe sought to determine if the transtracheal delivery of a bolus of oxygen or room air below the level of an obstruction to inflate the lungs could be an effective method to prolong the time available for responders seeking to establish a stable airway, and, if so, what could be learned about optimization of delivery parameters from a rat model.MethodsRats were fitted with a t‐shaped tracheal tube for controlling access to air and for measuring airway pressures. After respiratory arrest from simulated laryngospasm, bolus transtracheal lung inflation with a volume of gas equivalent to half the vital capacity was delivered to the closed respiratory system as the only resuscitation step.ResultsBolus lung inflation was sufficient for resuscitation, improving cardiac function and re‐establishing adequate oxygen status to support life. Inflation steps could be repeated and survival times were approximately 3 times that of non‐inflated lungs.ConclusionThe properties and consequences of bolus lung inflation are described as a foundation for procedures or devices that can be useful in cases of severe laryngospasm and other cases of upper airway obstruction.Level of Evidence3

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Section: Discussionmentioning

confidence: 99%

A Resuscitation Option for Upper Airway Occlusion Based on Bolus Transtracheal Lung Inflation

Villiere

Nakase

Kollmar

et al. 2018

Laryngoscope Investig Oto

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Kardiopulmonale Reanimation „oben ohne”? Soll die Herz-Lungenwiederbelebung künftig ohne Beatmung erfolgen?

1999

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A paper published in various US journals on Emergency Medicine in 1997, has raised considerable concerns. The authors question if it is justified to continue to recommend initial ventilation as part of basic CPR when performed by lay-bystanders. A few aspects need to be discussed and some questions have to be answered before any changes in the current recommendations may even be considered: e.g. 1. How convincing does the available evidence support the following hypotheses: 1.1. Lay CPR without mouth-to-mouth-ventilation provides better outcome after cardiac arrest than lay CPR with mouth-to-mouth-ventilation. 1.2. Endotracheal intubation may be detrimental in patients suffering from hemodynamic compromises, particularly from VF. 2. Is it scientifically and ethically acceptable to design and perform prospective randomized controlled trials (RCTs) to evaluate the efficacy of those components of BCLS and ACLS which have in accordance with AHA-, ERC Guidelines and ILCOR Statements in the past been applied in millions of cardiac arrest victims and have obviously enabled the patients to lead a meaningful life after survival; under conditions of the proposed study design patients of the study group would be left without the treatment option ventilation, thus diminishing their chances of survival. Ad 1: The arguments presented by the authors are hardly convincing. The authors themselves state elsewhere that reluctance to perform mouth-to-mouth-ventilation should not represent a major problem because most cardiac arrests of cardiac etiology occur at home and in the presence of a relative or friend. Moreover, unreliable recommendations for mouth-to-mouth-ventilation (AHA), lack of training, retention of skills and knowledge, and a deficit in motivation include the main causes of the disappointingly low figures of bystander CPR worldwide. This situation cannot be improved simply by eliminating a lifesaving component of CPR-ventilation. Instead, the proposal to abandon the administration of unreasonably high ventilation volumes (800-1200 ml/breath) from the present guidelines and to recommend volumes ranging from 400-500 ml/breath recently made by the ERC should be given serious consideration. Furthermore, equipment and training manikins need to be adapted to these more reasonable volumes. Independently of the mechanisms of slow decreases in SaO2 after cardiac arrest (provided no compressions are performed) independently of gasping, ventilatory effects of standard compression or ACD-HCPR in the absence of mouth-to-mouth-ventilation, it is essential to realise that the patient's airways need to be maintained open at all times (this is unlike animal experiments where the airways are primarily kept open by the respective tissue structures): The minimum requirement of First Responder CPR is the guarantee that open airways are maintained. It may possibly be discussed if the present sequence of ABC might be changed to CAB, a practice adopted in the Netherlands many years ago, however, outcome trials an CAB have not been published...

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New Thoughts on Cardiopulmonary Resuscitation

Evans

1999

Veterinary Clinics of North America: Small Animal Practice

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Efficacy of Several Modes of Continuous-Flow Insufflation for Resuscitation of a Canine Model of Acute Respiratory Arrest

Cited by 4 publications

References 10 publications

A Resuscitation Option for Upper Airway Occlusion Based on Bolus Transtracheal Lung Inflation

A Resuscitation Option for Upper Airway Occlusion Based on Bolus Transtracheal Lung Inflation

Kardiopulmonale Reanimation „oben ohne”? Soll die Herz-Lungenwiederbelebung künftig ohne Beatmung erfolgen?

New Thoughts on Cardiopulmonary Resuscitation

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