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Improved ventilation monitoring during CPR

      Despite the inclusion of ventilation recommendations in the cardiopulmonary resuscitation guidelines, widespread monitoring of ventilation has yet to happen. Ventilation monitoring has been performed using airway pressure measurements,
      • Maertens V.L.
      • Smedt L.E.G.D.
      • Lemoyne S.
      • et al.
      Patients with cardiac arrest are ventilated two times faster than guidelines recommend: an observational prehospital study using tracheal pressure measurement.
      • Aufderheide T.P.
      • Sigurdsson G.
      • Pirrallo R.G.
      • et al.
      Hyperventilation-induced hypotension during cardiopulmonary resuscitation.
      and algorithms have also been developed that use the capnogram signal and the thoracic impedance signal singly, or in combination, to monitor ventilation rate.
      • Edelson D.P.
      • Eilevstjønn J.
      • Weidman E.K.
      • Retzer E.
      • Hoek T.L.V.
      • Abella B.S.
      Capnography and chest-wall impedance algorithms for ventilation detection during cardiopulmonary resuscitation.
      The airway pressure measurements were more accurate, but airway pressure measurements are not commonplace in the pre-hospital and emergency department setting. Ventilation rate detected in the chest wall impedance or capnogram signal tended to underestimate the ventilation rate. The principle obstacle to ventilation rate measurement has been the removal of the chest compression artifact from the positive pressure ventilation signal.
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