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Editorial| Volume 184, 109696, March 2023

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

Published:January 18, 2023DOI:https://doi.org/10.1016/j.resuscitation.2023.109696
Measuring ventilation during out-of-hospital cardiac arrest: PART of the equation
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      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.
      Crit Care Med. 2004; 32: S345-S351
      , 
      • Aufderheide T.P.
      • Sigurdsson G.
      • Pirrallo R.G.
      • et al.
      Hyperventilation-Induced Hypotension During Cardiopulmonary Resuscitation.
      Circulation. 2004; 109: 1960-1965
      , 
      • Bhandari S.
      • Coult J.
      • Counts C.R.
      • et al.
      Investigating the Airway Opening Index during cardiopulmonary resuscitation.
      Resuscitation. 2022; 178: 96-101
      , 
      • Lesimple A.
      • Fritz C.
      • Hutin A.
      • et al.
      A novel capnogram analysis to guide ventilation during cardiopulmonary resuscitation: clinical and experimental observations.
      Crit Care Lond Engl. 2022; 26: 287
      , 
      • Van Den Daele C.
      • Vanwulpen M.
      • Hachimi-Idrissi S.
      Chest compressions during ventilation in out-of-hospital cardiopulmonary resuscitation cause fragmentation of the airflow.
      Am J Emerg Med. 2021; 50: 455-458
      , 
      • Chang M.P.
      • Lu Y.
      • Leroux B.
      • et al.
      Association of ventilation with outcomes from out-of-hospital cardiac arrest.
      Resuscitation. 2019; 141: 174-181
      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.
      Crit Care Med. 2004; 32: S345-S351
      , 
      • Aufderheide T.P.
      • Sigurdsson G.
      • Pirrallo R.G.
      • et al.
      Hyperventilation-Induced Hypotension During Cardiopulmonary Resuscitation.
      Circulation. 2004; 109: 1960-1965
      , 
      • Chang M.P.
      • Lu Y.
      • Leroux B.
      • et al.
      Association of ventilation with outcomes from out-of-hospital cardiac arrest.
      Resuscitation. 2019; 141: 174-181
      , 
      • Wang H.E.
      • Jaureguibeitia X.
      • Aramendi E.
      • et al.
      Airway strategy and ventilation rates in the pragmatic airway resuscitation trial.
      Resuscitation. 2022; 176: 80-87
      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.
      Resuscitation. 2019; 135: 37-44
      , 

      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.
      Resuscitation. 2022; 177: 78-84
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      References

        • Aufderheide T.P.
        • Lurie K.G.
        Death by hyperventilation: a common and life-threatening problem during cardiopulmonary resuscitation.
        Crit Care Med. 2004; 32: S345-S351
        View in Article
        • Aufderheide T.P.
        • Sigurdsson G.
        • Pirrallo R.G.
        • et al.
        Hyperventilation-Induced Hypotension During Cardiopulmonary Resuscitation.
        Circulation. 2004; 109: 1960-1965
        View in Article
        • Bhandari S.
        • Coult J.
        • Counts C.R.
        • et al.
        Investigating the Airway Opening Index during cardiopulmonary resuscitation.
        Resuscitation. 2022; 178: 96-101
        View in Article
        • Lesimple A.
        • Fritz C.
        • Hutin A.
        • et al.
        A novel capnogram analysis to guide ventilation during cardiopulmonary resuscitation: clinical and experimental observations.
        Crit Care Lond Engl. 2022; 26: 287
        View in Article
        • Van Den Daele C.
        • Vanwulpen M.
        • Hachimi-Idrissi S.
        Chest compressions during ventilation in out-of-hospital cardiopulmonary resuscitation cause fragmentation of the airflow.
        Am J Emerg Med. 2021; 50: 455-458
        View in Article
        • Chang M.P.
        • Lu Y.
        • Leroux B.
        • et al.
        Association of ventilation with outcomes from out-of-hospital cardiac arrest.
        Resuscitation. 2019; 141: 174-181
        View in Article
        • Wang H.E.
        • Jaureguibeitia X.
        • Aramendi E.
        • et al.
        Airway strategy and ventilation rates in the pragmatic airway resuscitation trial.
        Resuscitation. 2022; 176: 80-87
        View in Article
        • 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.
        Resuscitation. 2019; 135: 37-44
        View in Article

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

        View in Article
        • Shih J.A.
        • Robertson H.K.
        • Issa M.S.
        • et al.
        Acute respiratory distress syndrome after in-hospital cardiac arrest.
        Resuscitation. 2022; 177: 78-84
        View in Article
        • Nassal M.M.J.
        • Jaureguibeitia X.
        • Aramendi E.
        • et al.
        Novel application of thoracic impedance to characterize ventilations during cardiopulmonary resuscitation in the pragmatic airway resuscitation trial.
        Resuscitation. 2021; 168: 58-64
        View in Article
        • Yang B.Y.
        • Blackwood J.E.
        • Shin J.
        • et al.
        A pilot evaluation of respiratory mechanics during prehospital manual ventilation.
        Resuscitation. 2022; 177: 55-62
        View in Article
        • Grieco D.L.
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        • Drouet A.
        • et al.
        Intrathoracic Airway Closure Impacts CO2 Signal and Delivered Ventilation during Cardiopulmonary Resuscitation.
        Am J Respir Crit Care Med. 2019; 199: 728-737
        View in Article
        • Abrahamowicz A.A.
        • Counts C.R.
        • Danielson K.R.
        • et al.
        The association between arterial-end-tidal carbon dioxide difference and outcomes after out-of-hospital cardiac arrest.
        Resuscitation. 2022; 181: 3-9
        View in Article
        • Wang H.
        • Jaureguibeitia X.
        • Aramendi E.
        • et al.
        Methods for calculating ventilation rates during resuscitation from out-of-hospital cardiac arrest.
        Resuscitation. 2022; 109679
        View in Article

      Article info

      Publication history

      Published online: January 18, 2023
      Accepted: January 10, 2023
      Received: January 9, 2023

      Identification

      DOI: https://doi.org/10.1016/j.resuscitation.2023.109696

      Copyright

      © 2023 Elsevier B.V. All rights reserved.

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