Abstract
Aims
Ventilation at high respiratory rates is considered detrimental during CPR because
it may increase intrathoracic pressure limiting venous return and forward blood flow
generation. We examined whether ventilation at high, yet clinically plausible, tidal
volumes could also be detrimental, and further examined effects on end-tidal pCO2 (PETCO2).
Methods
Sixteen domestic pigs were randomized to one of four ventilatory patterns representing
two levels of respiratory rate (min−1) and two levels of tidal volume (ml/kg); i.e., 10/6, 10/18, 33/6, and 33/18 during
chest compression after 8 min of untreated VF.
Results
Data (mmHg, mean ± SD) are presented in the order listed above. Ventilation at 33/18 prompted higher
airway pressures (p < 0.05) and persistent expiratory airway flow (p < 0.05) before breath delivery demonstrating air trapping. The right atrial pressure
during chest decompression showed a statistically insignificant increase with increasing
minute-volume (7 ± 4, 10 ± 3, 12 ± 1, and 13 ± 3; p = 0.055); however, neither the coronary perfusion pressure (23 ± 1, 17 ± 6, 18 ± 6, and 21 ± 2; NS) nor the cerebral perfusion pressure (32 ± 3, 23 ± 8, 30 ± 12, and 31 ± 3; NS) was statistically different. Yet, increasing minute-volume reduced the PETCO2 demonstrating a high dependency on tidal volumes delivered at currently recommended
respiratory rates.
Conclusions
Increasing respiratory rate and tidal volume up to a minute-volume 10-fold higher
than currently recommended had no adverse hemodynamic effects during CPR but reduced
PETCO2 suggesting that ventilation at controlled rate and volume could enhance the precision
with which PETCO2 reflects CPR quality, predicts return of circulation, and serve to guide optimization
of resuscitation interventions.
Keywords
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References
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Article info
Publication history
Published online: August 19, 2011
Accepted:
July 20,
2011
Received in revised form:
July 13,
2011
Received:
May 9,
2011
Footnotes
☆A Spanish translated version of the summary of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2011.07.034.
Identification
Copyright
© 2011 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
