Duration of Ventilations During Cardiopulmonary Resuscitation by Lay Rescuers and First Responders

Abstract

In the Netherlands, when a cardiac arrest is suspected, 2 ambulances equipped with a manual defibrillator are sent by the dispatcher. Besides the ambulance, the dispatcher sends firefighters or policemen (first Background-The 2010 guidelines for cardiopulmonary resuscitation allow 5 seconds to give 2 breaths to deliver sufficient chest compressions and to keep perfusion pressure high. This study aims to determine whether the recommended short interruption for ventilations by trained lay rescuers and first responders can be achieved and to evaluate its consequence for chest compressions and survival. Methods and Results-From a prospective data collection of out-of-hospital cardiac arrest, we used automatic external defibrillator recordings of cardiopulmonary resuscitation by rescuers who had received a standard European Resuscitation Council basic life support and automatic external defibrillator course. Ventilation periods and total compressions delivered per minute during each 2 minutes of cardiopulmonary resuscitation cycle were measured, and the chest compression fraction was calculated. Neurological intact survival to discharge was studied in relation to these factors and covariates. We included 199 automatic external defibrillator recordings. The median interruption time for 2 ventilations was 7 seconds (25th-75th percentile, 6-9 seconds). Of all rescuers, 21% took <5 seconds and 83% took <10 seconds for a ventilation period; 97%, 88%, and 63% of rescuers were able to deliver >60, >70, and >80 chest compressions per minute, respectively. The median chest compression fraction was 65% (25th-75th percentile, 59%-71%

Fully automatic rhythm analysis during chest compression pauses

“…Moreover, our testing conditions were very challenging because pauses were very short (median duration 4.7 s). Indeed, pauses for two ventilations in CPR performed by laypersons may last around 7 s (IQR, 6-9), 28 in those circumstances the accuracy and reliability of the detector would further improve.…”

“…27 Basic Life Support (BLS) guidelines recommend 30:2 CV-ratio CPR. At the standard rate of 100 compressions per minute, pauses for two ventilations occur approximately every 20 s. Furthermore, in BLS scenarios these pauses normally last longer than 5 s. 28 Recently, Ruiz et al 29 proposed doing rhythm analysis during these pauses because the ECG would not have chest compression artefacts. This would allow an accurate rhythm assessment every 20 s during CPR.…”

Part 5: Adult Basic Life Support and Cardiopulmonary Resuscitation Quality

“…79 In an investigation of first responders equipped with AEDs, the duration of pauses specific to ventilation was not associated with survival. 80 …”

Part 3: Adult Basic Life Support and Automated External Defibrillation

“…For the critical outcome of favorable neurologic outcome, we found 1 low-quality observational study (downgraded for imprecision) 147 enrolling 199 patients. This study compared survival against a reference ventilation range of 5 to 6 seconds and found no difference with longer ranges of time for 2 breaths delivered by lay rescuers, ranging over 10 to 12 seconds (adjusted OR, 1.30; 95% CI, 0.29-5.97) and 13 seconds or greater (adjusted OR, 2.38; 95% CI, 0.46-12.1).…”