Advertisement

Gastric insufflation during cardiopulmonary resuscitation: A study in human cadavers

      Abstract

      Introduction

      Bag-valve-mask ventilation is the first-line ventilation method during cardiopulmonary resuscitation (CPR). Risks include excessive volume delivery and gastric insufflation, the latter increasing the risk of pneumonia. The efficacy of ventilation can also be reduced by airway closure. We hypothesized that continuous chest compression (CC) could limit the risk of gastric insufflation compared to the recommended 30:2 interrupted CC strategy. This experimental study was performed in human “Thiel” cadavers to assess the respective impact of discontinuous vs. continuous chest compressions on gastric insufflation and ventilation during CPR.

      Methods

      The 30:2 interrupted CC technique was compared to continuous CC in 5 non-intubated cadavers over a 6 min-period. Flow and Airway Pressure were measured at the mask. A percutaneous gastrostomy allowed measuring the cumulative gastric insufflated volume. Two additional cadavers were equipped with esophageal and gastric catheters instead of the gastrostomy.

      Results

      For the 7 cadavers studied (4 women) median age of death was 79 [74–84] years.
      After 6 min of CPR, the cumulative gastric insufflation measured in 5 cadavers was markedly reduced during continuous CC compared to the interrupted CC strategy: (1.0 [0.8–4.1] vs. 5.9 [4.0–5.6] L; p < 0.05) while expired minute ventilation was slightly higher during continuous than interrupted CC (1.9 [1.4–2.8] vs. 1.6 [1.1–2.7] L/min; P < 0.05).
      In 2 additional cadavers, the progressive rise in baseline gastric pressure was lower during continuous CC than interrupted CC (1 and 2 cmH2O vs. 12 and 5.8 cmH2O).

      Conclusion

      Continuous CC significantly reduces the volume of gas insufflated in the stomach compared to the recommended 30:2 interrupted CC strategy. Ventilation actually delivered to the lung is also slightly increased by the strategy.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Resuscitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Valenzuela T.D.
        • Roe D.J.
        • Cretin S.
        • Spaite D.W.
        • Larsen M.P.
        Estimating effectiveness of cardiac arrest interventions: a logistic regression survival model.
        Circulation. 1997; 96: 3308-3313
        • Perkins G.D.
        • Handley A.J.
        • Koster R.W.
        • et al.
        European resuscitation council guidelines for resuscitation 2015: section 2. Adult basic life support and automated external defibrillation.
        Resuscitation. 2015; 95: 81-99
        • Nichol G.
        • Leroux B.
        • Wang H.
        • et al.
        Trial of continuous or interrupted chest compressions during CPR.
        N Engl J Med. 2015; 373: 2203-2214
        • Brown S.P.
        • Wang H.
        • Aufderheide T.P.
        • et al.
        A randomized trial of continuous versus interrupted chest compressions in out-of-hospital cardiac arrest: rationale for and design of the resuscitation outcomes consortium continuous chest compressions trial.
        Am Heart J. 2015; 169: 334-341.e5
        • Idris A.H.
        Reassessing the need for ventilation during CPR.
        Ann Emerg Med. 1996; 27: 569-575
        • Ruben H.
        • Knudsen E.J.
        • Carugati G.
        Gastric inflation in relation to airway pressure.
        Acta Anaesthesiol Scand. 1961; 5: 107-114
        • Wenzel V.
        • Idris A.H.
        • Banner M.J.
        • et al.
        Respiratory system compliance decreases after cardiopulmonary resuscitation and stomach inflation: impact of large and small tidal volumes on calculated peak airway pressure.
        Resuscitation. 1998; 38: 113-118
        • Cordioli R.L.
        • Grieco D.L.
        • Charbonney E.
        • Richard J.-C.
        • Savary D.
        New physiological insights in ventilation during cardiopulmonary resuscitation.
        Curr Opin Crit Care. 2019; 25: 37-44
        • Charbonney E.
        • Delisle S.
        • Savary D.
        • et al.
        A new physiological model for studying the effect of chest compression and ventilation during cardiopulmonary resuscitation: the Thiel cadaver.
        Resuscitation. 2018; 125: 135-142
        • Lawes E.G.
        • Campbell I.
        • Mercer D.
        Inflation pressure, gastric insufflation and rapid sequence induction.
        Br J Anaesth. 1987; 59: 315-318
        • Maruyama D.
        • Chaki T.
        • Omote M.
        • Hirata N.
        • Yamauchi M.
        • Yamakage M.
        Movements of the double-lumen endotracheal tube due to lateral position with head rotation and tube fixation: a Thiel-embalmed cadaver study.
        Surg Radiol Anat SRA. 2015; 37: 841-844
        • László C.J.
        • Szűcs Z.
        • Nemeskéri Á
        • et al.
        Human cadavers preserved using Thiel’s method for the teaching of fibreoptically-guided intubation of the trachea: a laboratory investigation.
        Anaesthesia. 2018; 73: 65-70
        • Akoumianaki E.
        • Maggiore S.M.
        • Valenza F.
        • et al.
        The application of esophageal pressure measurement in patients with respiratory failure.
        Am J Respir Crit Care Med. 2014; 189: 520-531
        • Aufderheide T.P.
        • Lurie K.G.
        Death by hyperventilation: a common and life-threatening problem during cardiopulmonary resuscitation.
        Crit Care Med. 2004; 32: S345-51
        • Aufderheide T.P.
        • Sigurdsson G.
        • Pirrallo R.G.
        • et al.
        Hyperventilation-induced hypotension during cardiopulmonary resuscitation.
        Circulation. 2004; 109: 1960-1965
        • Wenzel V.
        • Keller C.
        • Idris A.H.
        • Dörges V.
        • Lindner K.H.
        • Brimacombe J.R.
        Effects of smaller tidal volumes during basic life support ventilation in patients with respiratory arrest: good ventilation, less risk?.
        Resuscitation. 1999; 43: 25-29
        • Baskett P.
        • Nolan J.
        • Parr M.
        Tidal volumes which are perceived to be adequate for resuscitation.
        Resuscitation. 1996; 31: 231-234
        • Paal P.
        • Neurauter A.
        • Loedl M.
        • et al.
        Effects of stomach inflation on haemodynamic and pulmonary function during cardiopulmonary resuscitation in pigs.
        Resuscitation. 2009; 80: 365-371
        • Berg M.D.
        • Idris A.H.
        • Berg R.A.
        Severe ventilatory compromise due to gastric distention during pediatric cardiopulmonary resuscitation.
        Resuscitation. 1998; 36: 71-73
        • Jabre P.
        • Penaloza A.
        • Pinero D.
        • et al.
        Effect of bag-mask ventilation vs endotracheal intubation during cardiopulmonary resuscitation on neurological outcome after out-of-hospital cardiorespiratory arrest: a randomized clinical trial.
        JAMA. 2018; 319: 779-787
        • Fitz-Clarke J.R.
        Fast or slow rescue ventilations: a predictive model of gastric inflation.
        Respir Care. 2018; 63: 502-509
        • Rabus F.C.
        • Luebbers H.-T.
        • Graetz K.W.
        • Mutzbauer T.S.
        Comparison of different flow-reducing bag-valve ventilation devices regarding respiratory mechanics and gastric inflation in an unprotected airway model.
        Resuscitation. 2008; 78: 224-229
        • Zecha-Stallinger A.
        • Wenzel V.
        • Wagner-Berger H.G.
        • von Goedecke A.
        • Lindner K.H.
        • Hörmann C.
        A strategy to optimise the performance of the mouth-to-bag resuscitator using small tidal volumes: effects on lung and gastric ventilation in a bench model of an unprotected airway.
        Resuscitation. 2004; 61: 69-74
        • Segal N.
        • Voiglio E.J.
        • Rerbal D.
        • et al.
        Effect of continuous oxygen insufflation on induced-gastric air volume during cardiopulmonary resuscitation in a cadaveric model.
        Resuscitation. 2015; 86: 62-66
        • Bowman F.P.
        • Menegazzi J.J.
        • Check B.D.
        • Duckett T.M.
        Lower esophageal sphincter pressure during prolonged cardiac arrest and resuscitation.
        Ann Emerg Med. 1995; 26: 216-219
        • Gabrielli A.
        • Wenzel V.
        • Layon A.J.
        • von Goedecke A.
        • Verne N.G.
        • Idris A.H.
        Lower esophageal sphincter pressure measurement during cardiac arrest in humans: potential implications for ventilation of the unprotected airway.
        Anesthesiology. 2005; 103: 897-899
        • Grieco D.L.
        • Brochard J.
        • Drouet L.
        • et al.
        Intrathoracic airway closure impacts CO 2 signal and delivered ventilation during cardiopulmonary resuscitation.
        Am J Respir Crit Care Med. 2019; 199: 728-737
        • Cordioli R.L.
        • Grieco D.L.
        • Charbonney E.
        • Richard J.-C.
        • Savary D.
        New physiological insights in ventilation during cardiopulmonary resuscitation.
        Curr Opin Crit Care. 2019; 25: 37-44
        • Xanthos T.
        • Karatzas T.
        • Stroumpoulis K.
        • et al.
        Continuous chest compressions improve survival and neurologic outcome in a swine model of prolonged ventricular fibrillation.
        Am J Emerg Med. 2012; 30: 1389-1394
        • Zhan L.
        • Yang L.J.
        • Huang Y.
        • He Q.
        • Liu G.J.
        Continuous chest compression versus interrupted chest compression for cardiopulmonary resuscitation of non-asphyxial out-of-hospital cardiac arrest.
        Cochrane Emergency and Critical Care Group, 2019
        • Nichol G.
        • Leroux B.
        • Wang H.
        • et al.
        Trial of continuous or interrupted chest compressions during CPR.
        N Engl J Med. 2015; 373: 2203-2214