The first quantitative report of ventilation rate during in-hospital resuscitation of older children and adolescents

Abstract

Aim During adult cardiac arrest, rescuers frequently provide ventilations at rates exceeding those recommended by the American Heart Association (AHA). Excessive ventilation is associated with worse clinical outcome after adult cardiac arrest. This study is the first to characterize ventilation rate adherence to AHA guidelines during in-hospital pediatric cardiac arrest resuscitation. Patients and methods We prospectively enrolled children and adolescents (≥8 years of age) who suffered a cardiac arrest in a pediatric intensive care unit (PICU) or emergency department (ED) of a tertiary-care pediatric hospital. Ventilation rate (breaths per minute [bpm]) was monitored via changes in chest wall impedance (CWI) recorded by defibrillator electrode pads during cardiopulmonary resuscitation (CPR). Results Twenty-four CPR events were enrolled yielding 588 thirty-second CPR epochs. The proportion of CPR epochs with ventilation rates exceeding AHA guidelines (>10 bpm) was 63% (CI95 59–67%), significantly higher than our a priori hypothesis of 30% (p < 0.01). The proportion of CPR epochs with ventilation rates exceeding 20 bpm was 20% (CI95 17–23). After controlling for location of arrest and initial event rhythm, resuscitations that occurred on nights/weekends were 3.6 times (CI95: 1.6–7.9, p < 0.01) more likely to have a ventilation rate exceeding AHA guidelines. Conclusions During in-hospital pediatric cardiac arrest, rescuers frequently provide artificial ventilations at rates in excess of AHA guidelines, with twenty percent of CPR time having ventilation rates double that recommended. Excessive ventilation was particularly common during CPR events that occurred on nights/weekends.

Cardiopulmonary Resuscitation Quality: Improving Cardiac Resuscitation Outcomes Both Inside and Outside the Hospital

“…Excessive ventilation, either by rate or tidal volume, is common in resuscitation environments. 38,[57][58][59][60] Although chest compression−only CPR by bystanders has yielded similar survival outcomes from out-of-hospital arrest as standard CPR, 38,51,52 there is presently not enough evidence to define when or if ventilation should be withheld by experienced providers, and more data will be required.…”

Cardiopulmonary resuscitation quality and patient survival outcome in cardiac arrest: A systematic review and meta-analysis

“…1. 34 This diagram also documents the reasons for exclusion of articles; the majority (39 of 68) were excluded because they did not directly document the relationship between at least one CPR quality parameter and at least one survival outcome or allow the direct calculation of such a relationship.…”

Comparative Analysis of Tidal Volume and Airway Pressure with a Bag-valve Mask using RespiTrainer

“…(2) . 그러나 과호흡의 제공을 피 하는 것을 강조함에도 불구하고 발표된 여러 문헌에서는 성인 혹은 소아환자에서의 실제 심폐소생술에서는 여전히 잦은 과호흡 제공이 일어나고 있다고 보고하고 있다 (7,8) .…”