Comparison of 15:1, 15:2, and 30:2 Compression‐to‐Ventilation Ratios for Cardiopulmonary Resuscitation in a Canine Model of a Simulated, Witnessed Cardiac Arrest

Hwang, Sung Oh; Kim, Sun Hyu; Kim, Hyun; Jang, Yong Soo; Zhao, Pei; Lee, Kang Hyun; Choi, Heeseung; Shin, Tae Yong

doi:10.1111/j.1553-2712.2008.00026.x

Cited by 19 publications

(20 citation statements)

References 17 publications

(16 reference statements)

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“…CV ratios emphasizing chest compression rate were associated with arterial desaturation, while those favoring frequent ventilation aggravated tissue hypoperfusion. 4,[6][7][8]14 We hypothesized that if one ventilation would be sufficient to maintain arterial oxygenation during CPR, the hands-off time for ventilation would be reduced. For the experiment, we set a 4-second pause for two ventilations or a 2-second pause for a single ventilation.…”

Section: Discussionmentioning

confidence: 99%

“…11,13 The two consecutive ventilations currently recommended in CPR guidelines might adversely affect resuscitation of the cardiac arrest patient. When two ventilations in a CPR cycle are performed, the rescuer needs to wait for exhalation after the first ventilation, which results in over 4 seconds prolongation of hands-off time 14 and associated risk of decreased chest compression fraction (CCF), which in turn affects the rate of return of spontaneous circulation (ROSC). 15 In contrast to CPR with two consecutive ventilations, a single ventilation minimizes chest compression interruption because the rescuer does not have to wait for exhalation and in fact promotes it by chest compression.…”

mentioning

confidence: 99%

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Comparison Between 30:1 and 30:2 Compression‐to‐ventilation Ratios for Cardiopulmonary Resuscitation: Are Two Ventilations Necessary?

Cha

Kim

et al. 2015

Academic Emergency Medicine

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Objectives: Controversy is continuing over the need for ventilation and the optimal compressionventilation (CV) ratio during cardiopulmonary resuscitation (CPR). The aim of this study was to comparatively elucidate the effect on hemodynamics and arterial oxygen saturation of a single ventilation relative to two consecutive ventilations during CPR in a dog model of cardiac arrest.Methods: Twenty mongrel dogs were divided into two groups. After 3 minutes of ventricular fibrillation (VF), the single-ventilation group received CPR with a 30:1 CV ratio, and the two-ventilation group received CPR with a 30:2 CV ratio, all with room air for 7 minutes. Thereafter, continuous chest compressions and intermittent ventilation at rate of 10 per minute were followed for both groups for 10 minutes. Hemodynamic parameters, arterial blood gas profiles, and variables from CPR were compared at baseline and at 5, 10, 15, and 20 minutes after induction of VF.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Comparison Between 30:1 and 30:2 Compression‐to‐ventilation Ratios for Cardiopulmonary Resuscitation: Are Two Ventilations Necessary?

Cha

Kim

et al. 2015

Academic Emergency Medicine

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“…We identified very-low-quality evidence (downgraded for very serious risk of bias and indirectness, and serious inconsistency and imprecision) from 10 animal studies [54][55][56][57][58][59][60][61][62][63] and 1 human observational study 64 that does not enable us to estimate with confidence the effect of a ventilation rate of 10/ min compared with any other rate for the important outcome of ROSC.…”

Section: Consensus On Sciencementioning

confidence: 99%

Part 4: Advanced Life Support

Nolan¹,

Hazinski²,

Aickin³

et al. 2015

Circulation

554

125

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Questions to be addressed (using the PICO [population, intervention, comparator, outcome] format) 3 were prioritized by ALS Task Force members (by voting). Prioritization criteria included awareness of significant new data and new controversies or questions about practice. Questions about topics no longer relevant to contemporary practice or where little new research has occurred were given lower priority. The ALS Task Force prioritized 42 PICO questions for review. With the assistance of information specialists, a detailed search for relevant articles was performed in each of 3 online databases (PubMed, Embase, and the Cochrane Library).By using detailed inclusion and exclusion criteria, articles were screened for further evaluation. The reviewers for each question created a reconciled risk of bias assessment for each of the included studies, using state-of-the-art tools: Cochrane for randomized controlled trials (RCTs), 4 Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 for studies of diagnostic accuracy, 5 and GRADE for observational studies that inform both therapy and prognosis questions. 6 GRADE evidence profile tables 7 were then created to facilitate an evaluation of the evidence in support of each of the critical and important outcomes. The quality of the evidence (or confidence in the estimate of the effect) was categorized as high, moderate, low, or very low, 8 based on the study methodologies and the 5 core GRADE domains of risk of bias, inconsistency, indirectness, imprecision, and other considerations (including publication bias). 9 These evidence profile tables were then used to create a written summary of evidence for each outcome (the consensus on science statements). Whenever possible, consensus-based treatment recommendations were then created. These recommendations (designated as strong or weak) were accompanied by an overall assessment of the evidence and a statement from the task force about the values, preferences, and task force insights that underlie the recommendations. Further details of the methodology that underpinned the evidence evaluation process are found in "Part 2: Evidence Evaluation and Management of Conflicts of Interest."The task force preselected and ranked outcome measures that were used as consistently as possible for all PICO questions. Longer-term, patient-centered outcomes were considered more important than process variables and shorter-term outcomes. For most questions, we used the following hierarchy starting with the most important: long-term survival with neurologically favorable survival, long-term survival, short-term survival, and process variable. In general, longterm was defined as from hospital discharge to 180 days or longer, and short-term was defined as shorter than to hospital discharge. For certain questions (eg, related to defibrillation or confirmation of tracheal tube position), process variables such as termination of fibrillation and correct tube placement were important. A few questions (eg, organ donation) required unique outcomes....

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“…One method to achieve sufficient tidal volumes may be to stop chest compressions for a short, but undisturbed ventilation pause. This strategy would mean changing the current CPR guidelines [8] and it could reduce blood flow due to discontinued chest compressions [7]. Apart from stopping chest compressions for ventilation or high ventilation pressures, another strategy to achieve adequate tidal volumes may be to slowly inflate the lungs of CPR patients and maintain positive pressure for more than 1 s. This may allow air to perfuse into the lungs for two or three consecutive decompression pauses, resulting in sufficient tidal volumes.…”

Section: Schlüsselwörtermentioning

confidence: 99%

“…A current controversial discussion is on the impact of positive pressure ventilation on blood flow during cardiopulmonary resuscitation (CPR) and to find the "right dose" of ventilation for future CPR strategies [7]. Whereas any ventilation has an impact on blood flow, vice versa any pressure on the chest in ventilated patients has the potential to reduce tidal volumes.…”

Section: Introductionmentioning

confidence: 99%