What is the optimal chest compression-ventilation ratio?

Abstract

The optimal compression-ventilation ratio is still unknown and the best tradeoff between oxygenation and organ perfusion during cardiopulmonary resuscitation is probably different for each patient and scenario. A discrepancy between what is recommended by the current guidelines and the 'real world' of cardiopulmonary resuscitation has resulted in a near flat survival rate from cardiac arrest in the past few years.

Qualität der Herz-Lungen-Wiederbelebung unter dem universellen Algorithmus 2005

“…Changes to the procedure included the process for locating the pressure point for chest compressions and also a change in the ratio of chest compressions to mouth-to-mouth ventilations to 30:2 [4,5] in order to decrease interruptions in chest compressions and thereby provide more continuous coronary blood flow [4,6,7].…”

The problem with and benefit of ventilations: should our approach be the same in cardiac and respiratory arrest?

“…Studied interpretation of the available evidence [26,[38][39][40][41][42][43][44][45] supports the contention that at least some ventilations should occur during resuscitative efforts from cardiac arrest. Acid-base balance and oxygenation are important factors in survival from states of profound shock [46][47][48].…”

“…Several well established laboratories have previously demonstrated that chest compression only CPR can be as effective as chest compressions and rescue breathing during the first 6-12 min of cardiac arrest in animal models [38][39][40][41][42][43]. The persistence of an open airway in these models, allowing for ventilation produced by chest compressions alone or in conjunction with spontaneous gasping, may not reflect physiology in human resuscitation [26,[38][39][40][41][42][43].…”

“…The optimal compression : ventilation ratio has not been defined, but is likely to be considerably greater compressions and fewer breaths than has been clinically practiced [26]. The need for pulmonary gas exchange during states of profound shock is reduced.…”

Towards optimum chest compression performance during constant peak displacement cardiopulmonary resuscitation

“…While many studies have been performed by different researchers to investigate various hemodynamic and mechanical aspects of the application of chest compressions during CPR [2,7,10,11,14,15,17,[19][20][21][22]25], as of now comparatively few studies have investigated the conditions required to achieve optimum CC performance during CPR [4,5,8,12,24,26]. Most of the previous work in this area has focused on determining the best CC to ventilation ratio during CPR in infants [5,26] and adults [4,12,24]. The optimal CC depth for children was also studied experimentally by Braga et al [8] using computer tomography.…”