Mechanical Ventilation Management During Mechanical Chest Compressions

Orso, Daniele; Vetrugno, Luigi; Federici, Nicola; Borselli, Matteo; Spadaro, Savino; Cammarota, Gianmaria; Bove, Tiziana

doi:10.4187/respcare.07775

Cited by 25 publications

(17 citation statements)

References 74 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In recent years the role of ventilation has been comprehensively discussed [ 5 , 6 ]. A major caveat in this debate has been the risk of hyperventilation in CPR [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

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.

show abstract

“…In recent years the role of ventilation has been comprehensively discussed [ 5 , 6 ]. A major caveat in this debate has been the risk of hyperventilation in CPR [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…Usage of mechanical ventilation in CPR might be a valid strategy to limit the respiratory rate and prevent tachy-ventilation during continuous chest compressions [ 6 ]. Whether common portable ventilators can provide relevant alveolar ventilation during continuous chest compressions is unknown.…”

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

View full text Add to dashboard Cite

show abstract

“…CPR techniques have evolved in the last decade in terms of implementing high-quality measures, early intervention in defibrillable rhythms for the impact of the electrical phase of arrest [62]. Still, it continues to Although there is still a lack of conclusive scientific evidence on the ventilatory mode and the parameters to be programmed in the ventilator during compressions in resuscitation, it is imperative further studies to determine the effects that mechanical ventilation has on ultrasound findings during cardiopulmonary resuscitation [63].…”

Section: Evidence Of Ultrasound In Arrest As a Prognostic Toolmentioning

confidence: 99%

“…Mechanical ventilation has physiological effects on the patient in cardiac arrest, and thus clinical challenges are posed on the mechanical ventilation strategy to be implemented during the arrest. Although there is still a lack of conclusive scientific evidence on the ventilatory mode and the parameters to be programmed in the ventilator during compressions in resuscitation, it is imperative further studies to determine the effects that mechanical ventilation has on ultrasound findings during cardiopulmonary resuscitation [ 63 ].…”

Section: Practical Approach Use Of the Pocusmentioning

confidence: 99%

Point-of-care ultrasound in cardiorespiratory arrest (POCUS-CA): narrative review article

et al. 2021

View full text Add to dashboard Cite

The POCUS-CA (Point-of-care ultrasound in cardiac arrest) is a diagnostic tool in the Intensive Care Unit and Emergency Department setting. The literature indicates that in the patient in a cardiorespiratory arrest it can provide information of the etiology of the arrest in patients with non-defibrillable rhythms, assess the quality of compressions during cardiopulmonary resuscitation (CPR), and define prognosis of survival according to specific findings and, thus, assist the clinician in decision-making during resuscitation. This narrative review of the literature aims to expose the usefulness of ultrasound in the setting of cardiorespiratory arrest as a tool that allows making a rapid diagnosis and making decisions about reversible causes of this entity. More studies are needed to support the evidence to make ultrasound part of the resuscitation algorithms. Teamwork during cardiopulmonary resuscitation and the inclusion of ultrasound in a multidisciplinary approach is important to achieve a favorable clinical outcome.

show abstract

“…We read with great interest the paper "Mechanical Ventilation Management During Mechanical Chest Compressions" by Orso et al, 1 in which they identified available knowledge on mechanical ventilation strategies during cardiopulmonary resuscitation (CPR).…”

mentioning

confidence: 99%

Ventilation During Cardiac Arrest and After Return of Spontaneous Circulation: Like Father, Like Son?

2021

View full text Add to dashboard Cite

Mechanical Ventilation Management During Mechanical Chest Compressions

Cited by 25 publications

References 74 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

Point-of-care ultrasound in cardiorespiratory arrest (POCUS-CA): narrative review article

Ventilation During Cardiac Arrest and After Return of Spontaneous Circulation: Like Father, Like Son?

Contact Info

Product

Resources

About