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Measuring ventilation during out-of-hospital cardiac arrest: PART of the equation

      The optimal approach to ventilation during out-of-hospital cardiac arrest has long been debated. Early studies documented adverse hemodynamic consequences with high minute ventilation, while more recent ones highlight potentially ineffective ventilation in a substantial proportion of patients.
      • Aufderheide T.P.
      • Lurie K.G.
      Death by hyperventilation: a common and life-threatening problem during cardiopulmonary resuscitation.
      • Aufderheide T.P.
      • Sigurdsson G.
      • Pirrallo R.G.
      • et al.
      Hyperventilation-Induced Hypotension During Cardiopulmonary Resuscitation.
      • Bhandari S.
      • Coult J.
      • Counts C.R.
      • et al.
      Investigating the Airway Opening Index during cardiopulmonary resuscitation.
      • Lesimple A.
      • Fritz C.
      • Hutin A.
      • et al.
      A novel capnogram analysis to guide ventilation during cardiopulmonary resuscitation: clinical and experimental observations.
      • Van Den Daele C.
      • Vanwulpen M.
      • Hachimi-Idrissi S.
      Chest compressions during ventilation in out-of-hospital cardiopulmonary resuscitation cause fragmentation of the airflow.
      • Chang M.P.
      • Lu Y.
      • Leroux B.
      • et al.
      Association of ventilation with outcomes from out-of-hospital cardiac arrest.
      Both hypo- and hyperventilation may be associated with worse outcome, though studies are mixed.
      • Aufderheide T.P.
      • Lurie K.G.
      Death by hyperventilation: a common and life-threatening problem during cardiopulmonary resuscitation.
      • Aufderheide T.P.
      • Sigurdsson G.
      • Pirrallo R.G.
      • et al.
      Hyperventilation-Induced Hypotension During Cardiopulmonary Resuscitation.
      • Chang M.P.
      • Lu Y.
      • Leroux B.
      • et al.
      Association of ventilation with outcomes from out-of-hospital cardiac arrest.
      • Wang H.E.
      • Jaureguibeitia X.
      • Aramendi E.
      • et al.
      Airway strategy and ventilation rates in the pragmatic airway resuscitation trial.
      While a growing recognition of post-arrest pulmonary complications highlights a need to refine ventilation practices, a persistent challenge has been accurate measurement of ventilation parameters, including rate, volume, and pressures.
      • Johnson N.J.
      • Caldwell E.
      • Carlbom D.J.
      • et al.
      The acute respiratory distress syndrome after out-of-hospital cardiac arrest: Incidence, risk factors, and outcomes.

      Johnson NJ, Carlbom DJ, Gaieski DF. Ventilator management and respiratory care after cardiac arrest: oxygenation, ventilation, infection, and injury. 2018.

      • Shih J.A.
      • Robertson H.K.
      • Issa M.S.
      • et al.
      Acute respiratory distress syndrome after in-hospital cardiac arrest.
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