Mechanical ventilation may not be essential for initial cardiopulmonary resuscitation

Noč, Marko; Mh, Weil; Tang, W; Turner, Todd; Fukui, Michihiko

doi:10.1016/0300-9572(96)83774-9

Cited by 20 publications

(25 citation statements)

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“…121,122 Most of the evidence supporting the chest compression alone approach comes from animal data. [123][124][125][126] Contrary to animal anatomy, the human upper airway does not stay open spontaneously thus preventing the free flow of air during chest compressions. 127,128 Among 885 observed cardiac arrest cases receiving bystander CPR, 16% of people survived with conventional CPR, compared with 10% who received chest compressions alone.…”

Section: Ii-3 Inform Trainees About What To Expect During Resuscitatimentioning

confidence: 99%

Understanding and improving low bystander CPR rates: a systematic review of the literature

Vaillancourt

Stiell

Wells

2008

CJEM

139

110

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Objectives: Cardiopulmonary resuscitation (CPR) is a crucial yet weak link in the chain of survival for out-of-hospital cardiac arrest. We sought to understand the determinants of bystander CPR and the factors associated with successful training. Methods: For this systematic review, we searched 11 electronic databases, 1 trial registry and 9 scientific websites. We performed hand searches and contacted 6 content experts. We reviewed without restriction all communications pertaining to who should learn CPR, what should be taught, when to repeat training, where to give CPR instructions and why people lack the motivation to learn and perform CPR. We used standardized forms to review papers for inclusion, quality and data extraction. We grouped publications by category and classified recommendations using a standardized classification system that was based on level of evidence. Results: We reviewed 2409 articles and selected 411 for complete evaluation. We included 252 of the 411 papers in this systematic review. Differences in their study design precluded a meta-analysis. We classified 22 recommendations; those with the highest scores were 1) 9-1-1 dispatchassisted CPR instructions, 2) teaching CPR to family members of cardiac patients, 3) Braslow's selftraining video, 4) maximizing time spent using manikins and 5) teaching the concepts of ambiguity and diffusion of responsibility. Recommendations not supported by evidence include mass training events, pulse taking prior to CPR by laymen and CPR using chest compressions alone. Conclusion:We evaluated and classified the potential impact of interventions that have been proposed to improve bystander CPR rates. Our results may help communities design interventions to improve their bystander CPR rates. RÉSUMÉ Objectifs : La réanimation cardio-respiratoire (RCR) est un maillon essentiel, quoique faible, de la chaîne de survie lors de la survenue d'un arrêt cardiaque hors de l'hôpital. Nous avons cherché à comprendre les déterminants du taux de passants pouvant administrer la RCR et les facteurs liés à une formation efficace. Méthodes : Dans le cadre de cette revue systématique, nous avons analysé 11 bases de données électroniques, un registre d'essais cliniques et neuf sites Web scientifiques. Nous avons réalisé des recherches manuelles et communiqué avec six experts du contenu. Nous avons examiné sans restriction toutes les communications portant sur les questions suivantes : qui devrait apprendre la RCR, ce qu'on devrait enseigner, QUAND la formation devrait être renouvelée, où les cours de

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Section: Ii-3 Inform Trainees About What To Expect During Resuscitatimentioning

confidence: 99%

Understanding and improving low bystander CPR rates: a systematic review of the literature

Vaillancourt

Stiell

Wells

2008

CJEM

139

110

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“…12,13 The CPC evaluation uses a 5-point scale to assess neurological function (1ϭnormal: no difficulty with standing, walking, eating, or drinking, being alert and fully responsive to environmental stimuli; 2ϭmild disability: able to stand but exhibiting an unsteady gait, drinking but not eating normally, and showing a slower response to environmental stimuli; 3ϭsevere disability: unable to stand or walk without assistance, not drinking or eating, awake but failing to respond normally to noxious stimuli; 4ϭcoma; and 5ϭdeath). All surviving animals were then killed with intravenous barbiturates.…”

Section: Outcome and Neurological Evaluationmentioning

confidence: 99%

Importance of Continuous Chest Compressions During Cardiopulmonary Resuscitation

et al. 2002

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Background — Interruptions to chest compression–generated blood flow during cardiopulmonary resuscitation (CPR) are detrimental. Data show that such interruptions for mouth-to-mouth ventilation require a period of “rebuilding” of coronary perfusion pressure to obtain the level achieved before the interruption. Whether such hemodynamic compromise from pausing to ventilate is enough to affect outcome is unknown. Methods and Results — Thirty swine (weight 35±2 kg) underwent 3 minutes of untreated ventricular fibrillation before 12 minutes of basic life support CPR. Animals were randomized to receive either standard airway (A), breathing (B), and compression (C) CPR with expired-gas ventilation in a 15:2 compression-to-ventilation ratio or continuous chest compression CPR. Those randomized to the standard 15:2 group had no chest compressions for a period of 16 seconds each time the 2 ventilations were delivered. Defibrillation was attempted at 15 minutes of cardiac arrest. All resuscitated animals were supported in an intensive care environment for 1 hour, then in a maintenance facility for 24 hours. The primary end point of neurologically normal 24-hour survival was significantly better in the experimental group receiving continuous chest compression CPR (12 of 15 versus 2 of 15; P <0.0001). Conclusions — Mouth-to-mouth ventilation performed by single layperson rescuers produces substantial interruptions in chest compression–supported circulation. Continuous chest compression CPR produces greater neurologically normal 24-hour survival than standard ABC CPR when performed in a clinically realistic fashion. Any technique that minimizes lengthy interruptions of chest compressions during the first 10 to 15 minutes of basic life support should be given serious consideration in future efforts to improve outcome results from cardiac arrest.

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“…It is a common mammalian pattern of breathing based on the simple brain stem reflex expressed in the setting of cerebral hypoxia 10 . The beneficial effect of gasping on circulation and gas exchange during cardiac arrest has been described [11][12][13][14] . It has been formerly hypothesized that gasping is a protective mechanism for anoxia during delivery of immature animals 10 .…”

Section: Discussionmentioning

confidence: 99%

The presence of gasping predicts long-term survival in out-of-hospital cardiac arrest patients

Knor¹,

Šeblová²,

Škulec³

et al. 2018

BIOMED PAP

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Background. The presence of gasping in out-of-hospital cardiac arrest (OHCA) patients predicts short-term prognosis. We performed a retrospective study to evaluate whether the presence of gasping at the time of Emergency Medical Service (EMS) arrival in the case OHCA patients of presumed cardian origin has any impact on six-month survival and/ or sustained return of spontaneous circulation (ROSC). Methods. We collected and analyzed Utstein Style data for all patients resuscitated for OHCA of presumed cardiac origin by the EMS of the Central Bohemian Region from Results. During the data collection period, 565 cases of OHCA of presumed cardiac origin were reported. Gasping at the time of EMS arrival was identified in 23.9%. The presence of gasping was associated with a significantly increased frequency of sustained ROSC (48.1 versus 20.7%, P<0.001) and six-month survival (40.7 versus 16.7%, P<0.001) than in non-breathing patients. Presence of gasping upon EMS arrival has been found to be an independent positive predictor of sustained ROSC (OR 2.51, CI 95% 1. 59-3.98, P<0.001). The occurrence of gasping at the time of EMS arrival at the scene was significantly related to response time from EMS activation to arrival. Conclusion. The presence of gasping upon arrival of the EMS for the patient with OHCA of presumed cardiac origin predicts both improves short-term and long-term prognoses.

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Mechanical ventilation may not be essential for initial cardiopulmonary resuscitation

Cited by 20 publications

References 0 publications

Understanding and improving low bystander CPR rates: a systematic review of the literature

Understanding and improving low bystander CPR rates: a systematic review of the literature

Importance of Continuous Chest Compressions During Cardiopulmonary Resuscitation

The presence of gasping predicts long-term survival in out-of-hospital cardiac arrest patients

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