A review of ventilation in adult out‐of‐hospital cardiac arrest

Abstract

Out‐of‐hospital cardiac arrest continues to be a devastating condition despite advances in resuscitation care. Ensuring effective gas exchange must be weighed against the negative impact hyperventilation can have on cardiac physiology and survival. The goals of this narrative review are to evaluate the available evidence regarding the role of ventilation in out‐of‐hospital cardiac arrest resuscitation and to provide recommendations for future directions. Ensuring successful airway patency is fundamental for effective ventilation. The airway management approach should be based on professional skill level and the situation faced by rescuers. Evidence has explored the influence of different ventilation rates, tidal volumes, and strategies during out‐of‐hospital cardiac arrest; however, other modifiable factors affecting out‐of‐hospital cardiac arrest ventilation have limited supporting data. Researchers have begun to explore the impact of ventilation in adult out‐of‐hospital cardiac arrest outcomes, further stressing its importance in cardiac arrest resuscitation management. Capnography and thoracic impedance signals are used to measure ventilation rate, although these strategies have limitations. Existing technology fails to reliably measure real‐time clinical ventilation data, thereby limiting the ability to investigate optimal ventilation management. An essential step in advancing cardiac arrest care will be to develop techniques to accurately and reliably measure ventilation parameters. These devices should allow for immediate feedback for out‐of‐hospital practitioners, in a similar way to chest compression feedback. Once developed, new strategies can be established to guide out‐of‐hospital personnel on optimal ventilation practices.

The impact of a ventilation timing light on CPR Quality: A randomized crossover study

“…Although it does not appear to be a large improvement, given that neither group provided an excessive VR (i.e., > 12), improving consistency and adherence to standards helps to validate the tool, potentially increasing its use in the industry as VR is considered a CPR quality performance metric. 14 …”

Contribution of chest compressions to end-tidal carbon dioxide levels generated during out-of-hospital cardiopulmonary resuscitation

“…[6][7][8][9][10][11] The optimal values to objectively guide CPR based on ETCO 2 remain unknown. Quantifying interactions among CPR components and ETCO 2 levels and trends may help to better understand CPR quality in terms of patients' responses, 12,13 avoid hyperventilation 14 and optimize chest compressions during resuscitation. [15][16][17] Linear regression models for describing the relationship between ETCO 2 and ventilation rate, chest compression depth and chest compression rate have been proposed, under the assumption of additive effects and similar dependency between ETCO 2 and the variables under study.…”

A pilot evaluation of respiratory mechanics during prehospital manual ventilation

“…Knowledge about manual ventilation has been derived largely from animal, cadaver, and simulation studies, or examined through indirect measurement of respiratory parameters, such as end-tidal carbon dioxide and thoracic impedance. [11][12] We aimed to address this gap by measuring real-time respiratory mechanics during manual ventilation provided by EMS personnel following endotracheal intubation.…”