Mechanical Ventilation During Resuscitation: How Manual Chest Compressions Affect a Ventilator’s Function

Speer, Tillmann; Dersch, Wolfgang; Kleine, Björn; Neuhaus, Christian; Kill, Clemens

doi:10.1007/s12325-017-0615-7

Cited by 10 publications

(4 citation statements)

References 28 publications

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“…While we found the turbine-driven ventilator to perform best, both pneumatic ventilators missed the preset tidal volume by almost a third. This compares to the results of a manikin study [ 16 ] and corresponds to the suspicion of hypoventilation in our previous clinical studies of blood gases in OHCA [ 26 , 27 ]. These found that contrary to the common perception of hyperventilation in CPR, hypocapnia leading to alkalosis was not observed at all.…”

Section: Discussionsupporting

confidence: 86%

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Reliability of mechanical ventilation during continuous chest compressions: a crossover study of transport ventilators in a human cadaver model of CPR

Orlob

Wittig

Hobisch

et al. 2021

Scand J Trauma Resusc Emerg Med

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Background Previous studies have stated that hyperventilation often occurs in cardiopulmonary resuscitation (CPR) mainly due to excessive ventilation frequencies, especially when a manual valve bag is used. Transport ventilators may provide mandatory ventilation with predetermined tidal volumes and without the risk of hyperventilation. Nonetheless, interactions between chest compressions and ventilations are likely to occur. We investigated whether transport ventilators can provide adequate alveolar ventilation during continuous chest compression in adult CPR. Methods A three-period crossover study with three common transport ventilators in a cadaver model of CPR was carried out. The three ventilators ‘MEDUMAT Standard²’, ‘Oxylog 3000 plus’, and ‘Monnal T60’ represent three different interventions, providing volume-controlled continuous mandatory ventilation (VC-CMV) via an endotracheal tube with a tidal volume of 6 mL/kg predicted body weight. Proximal airflow was measured, and the net tidal volume was derived for each respiratory cycle. The deviation from the predetermined tidal volume was calculated and analysed. Several mixed linear models were calculated with the cadaver as a random factor and ventilator, height, sex, crossover period and incremental number of each ventilation within the period as covariates to evaluate differences between ventilators. Results Overall median deviation of net tidal volume from predetermined tidal volume was − 21.2 % (IQR: 19.6, range: [− 87.9 %; 25.8 %]) corresponding to a tidal volume of 4.75 mL/kg predicted body weight (IQR: 1.2, range: [0.7; 7.6]). In a mixed linear model, the ventilator model, the crossover period, and the cadaver’s height were significant factors for decreased tidal volume. The estimated effects of tidal volume deviation for each ventilator were − 14.5 % [95 %-CI: −22.5; −6.5] (p = 0.0004) for ‘Monnal T60’, − 30.6 % [95 %-CI: −38.6; −22.6] (p < 0.0001) for ‘Oxylog 3000 plus’ and − 31.0 % [95 %-CI: −38.9; −23.0] (p < 0.0001) for ‘MEDUMAT Standard²’. Conclusions All investigated transport ventilators were able to provide alveolar ventilation even though chest compressions considerably decreased tidal volumes. Our results support the concept of using ventilators to avoid excessive ventilatory rates in CPR. This experimental study suggests that healthcare professionals should carefully monitor actual tidal volumes to recognise the occurrence of hypoventilation during continuous chest compressions.

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Section: Discussionsupporting

confidence: 86%

“…Nevertheless, chest compressions are a counteracting force to positive pressure ventilation and may limit inspiratory volumes [ 16 ]. The risk of hypoventilation in CPR has been recently illustrated by Duchatelet et al [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Reliability of mechanical ventilation during continuous chest compressions: a crossover study of transport ventilators in a human cadaver model of CPR

Orlob

Wittig

Hobisch

et al. 2021

Scand J Trauma Resusc Emerg Med

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“…They also demonstrated that CCSV significantly improved arterial oxygenation and better maintained arterial blood pressure during CPR when compared with the IPPV mode ( 8 ). Recently, Speer et al ( 21 ) demonstrated that CCSV delivered a significantly higher frequency of correct ventilation parameters without exceeding the upper pressure preset when compared with the IPPV mode during manual chest compression in a simulation model. In the present study, the same parameters of CCSV and IPPV were set based on the above-mentioned two studies, and the similar results were observed: CCSV significantly increased blood oxygenation, and partly improved blood circulation during CPR compared with the IPPV group.…”

Section: Discussionmentioning

confidence: 99%

The combination of chest compression synchronized ventilation and aortic balloon occlusion improve the outcomes of cardiopulmonary resuscitation in swine

Khan

Zhang

et al. 2022

Front. Med.

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AimThe primary mission of cardiopulmonary resuscitation (CPR) is to provide adequate blood flow and oxygen delivery for restoring spontaneous circulation from cardiac arrest (CA) events. Previously, studies demonstrated that chest compression synchronized ventilation (CCSV) improved systemic oxygen supply during CPR, and aortic balloon occlusion (ABO) augments the efficacy of external CPR by increasing blood perfusion to vital organs. However, both them failed to make a significant improvement in return of spontaneous circulation (ROSC). In this study, we investigated the effects of combined CCSV and ABO on the outcomes of CPR in swine.MethodsThirty-one male domestic swine were subjected to 8 min of electrically induced and untreated CA followed by 8 min of CPR. CPR was performed by continuous chest compressions and mechanical ventilation. At the beginning of CPR, the animals were randomized to receive intermittent positive pressure ventilation (IPPV, n = 10), CCSV (n = 7), IPPV + ABO (n = 7), or CCSV + ABO (n = 7). During CPR, gas exchange and systemic hemodynamics were measured, and ROSC was recorded. After resuscitation, the function and injury biomarkers of vital organs including heart, brain, kidney, and intestine were evaluated.ResultsDuring CPR, PaO2 was significantly higher accompanied by significantly greater regional cerebral oxygen saturation in the CCSV and CCSV + ABO groups than the IPPV group. Coronary perfusion pressure, end-tidal carbon dioxide, and carotid blood flow were significantly increased in the IPPV + ABO and CCSV + ABO groups compared with the IPPV group. ROSC was achieved in five of ten (IPPV), five of seven (CCSV), six of seven (IPPV + ABO), and seven of seven (CCSV + ABO) swine, with the rate of resuscitation success being significantly higher in the CCSV + ABO group than the IPPV group (P = 0.044). After resuscitation, significantly improved myocardial and neurological function, and markedly less cardiac, cerebral, renal, and intestinal injuries were observed in the CCSV + ABO group compared with the IPPV group.ConclusionThe combination of CCSV and ABO improved both ventilatory and hemodynamic efficacy during CPR, promoted ROSC, and alleviated post-resuscitation multiple organ injury in swine.

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“…The use of bi-level ventilation itself can be seen as controversial, since this is primarily described as a non-invasive ventilation mode, often used to support infants or patients suffering from respiratory failure (22) . Additionally, this mode has been shown to produce increased inspiratory pressures, when applied during CPR (23) . Although we could not observe these pressure peaks in our study and have no indication of resulting pulmonary damage, a specific pressure profile analysis might be warranted in future studies.…”

Section: Mmims-miget Measurements Showed Significantly Less Shunt Volmentioning

confidence: 99%

Peer Review #1 of "Bi-Level ventilation decreases pulmonary shunt and modulates neuroinflammation in a cardiopulmonary resuscitation model (v0.1)"

Kohlhauer¹

2020

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Background: Optimal ventilation strategies during cardiopulmonary resuscitation are still heavily debated and poorly understood. So far, no convincing evidence could be presented in favour of outcome relevance and necessity of specific ventilation patterns. In recent years, alternative models to the guideline-based intermittent positive pressure ventilation (IPPV) have been proposed. In this randomized controlled trial, we evaluated a bi-level ventilation approach in a porcine model to assess possible physiological advantages for the pulmonary system as well as resulting changes in neuroinflammation compared to standard measures. Methods: 16 male German landrace pigs were anesthetized and instrumented with arterial and venous catheters. Ventricular fibrillation was induced and the animals were left untreated and without ventilation for 4 minutes. After randomization, the animals were assigned to either the guideline-based group (IPPV, tidal volume 8-10ml/kg, respiratory rate 10/min, F i O 2 1.0) or the bi-level group (inspiratory pressure levels 15-17cmH 2 O/5cmH 2 O, respiratory rate 10/min, F i O 2 1.0). Mechanical chest compressions and interventional ventilation were initiated and after 5 minutes, blood samples, including ventilation/perfusion measurements via multiple inert gas elimination technique, were taken. After 8 minutes, advanced life support including adrenaline administration and defibrillations were started for up to 4 cycles. Animals achieving ROSC were monitored for 6 hours and lungs and brain tissue were harvested for further analyses. Results: 5 of the IPPV and 4 of the bi-level animals achieved ROSC. While there were no significant differences in gas exchange or hemodynamic values, bi-level treated animals showed less pulmonary shunt directly after ROSC and a tendency to lower inspiratory pressures during CPR. Additionally, cytokine expression of Tumour-necrosis factor alpha was significantly reduced in hippocampal tissue compared to IPPV animals. Conclusion: Bi-level ventilation with a constant positive end expiratory pressure and pressure-controlled ventilation is not inferior in terms of oxygenation and decarboxylation when compared to guideline-based IPPV ventilation. Additionally, bi-level ventilation showed signs for a potentially ameliorated neurological outcome as well as less pulmonary shunt following experimental resuscitation. Given the restrictions of the animal model, these advantages should be further examined.

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Mechanical Ventilation During Resuscitation: How Manual Chest Compressions Affect a Ventilator’s Function

Abstract: Parts of this study were supported by Weinmann Emergency Medical Technology GmbH + Co.KG.

Cited by 10 publications

References 28 publications

Reliability of mechanical ventilation during continuous chest compressions: a crossover study of transport ventilators in a human cadaver model of CPR

Reliability of mechanical ventilation during continuous chest compressions: a crossover study of transport ventilators in a human cadaver model of CPR

The combination of chest compression synchronized ventilation and aortic balloon occlusion improve the outcomes of cardiopulmonary resuscitation in swine

Peer Review #1 of "Bi-Level ventilation decreases pulmonary shunt and modulates neuroinflammation in a cardiopulmonary resuscitation model (v0.1)"

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