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Vaillancourt C, Midzic I, Taljaard M, Chisamore B. Performer fatigue and CPR quality comparing 30:2 to 15:2 compression to ventilation ratios in older bystanders: A randomized crossover trial. Resuscitation 2011; 82:51-6. [DOI: 10.1016/j.resuscitation.2010.09.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 07/18/2010] [Accepted: 09/03/2010] [Indexed: 11/28/2022]
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Sayre MR, Koster RW, Botha M, Cave DM, Cudnik MT, Handley AJ, Hatanaka T, Hazinski MF, Jacobs I, Monsieurs K, Morley PT, Nolan JP, Travers AH. Part 5: Adult basic life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2010; 122:S298-324. [PMID: 20956253 DOI: 10.1161/circulationaha.110.970996] [Citation(s) in RCA: 132] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Koster RW, Baubin MA, Bossaert LL, Caballero A, Cassan P, Castrén M, Granja C, Handley AJ, Monsieurs KG, Perkins GD, Raffay V, Sandroni C. Basismaßnahmen zur Wiederbelebung Erwachsener und Verwendung automatisierter externer Defibrillatoren. Notf Rett Med 2010; 13:523-542. [PMID: 32214895 PMCID: PMC7087822 DOI: 10.1007/s10049-010-1368-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- R W Koster
- 1_1368Department of Cardiology, Academic Medical Center, Amsterdam, Niederlande
| | - M A Baubin
- 2_1368Department of Anaesthesiology and Critical Care Medicine, University Hospital Innsbruck, Innsbruck, Österreich
| | - L L Bossaert
- 3_1368Department of Critical Care, University of Antwerp, Antwerpen, Belgien
| | - A Caballero
- 4_1368Hospital Universitario Virgen del Rocío, Sevilla, Spanien
| | - P Cassan
- European Reference Centre for First Aid Education, French Red Cross, Paris, Frankreich
| | - M Castrén
- 6_1368Department of Clinical Science and Education, Karolinska Institute, Stockholm, Schweden
| | - C Granja
- 7_1368Emergency and Intensive Medicine Department, Hospital Pedro Hispano, Matosinhos, Porto, Portugal
| | - A J Handley
- 8_1368Colchester Hospital University NHS Foundation Trust, Colchester, Großbritannien
| | - K G Monsieurs
- 9_1368Emergency Department, Ghent University Hospital, Gent, Belgien
| | - G D Perkins
- 10_1368University of Warwick, Warwick Medical School, Warwick, Großbritannien
| | - V Raffay
- Municipal Institute for Emergency Medicine Novi Sad, Novi Sad, AP Vojvodina, Serbien
| | - C Sandroni
- 12_1368Catholic University School of Medicine, Policlinico Universitario Agostino Gemelli, Rom, Italien
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Berg MD, Schexnayder SM, Chameides L, Terry M, Donoghue A, Hickey RW, Berg RA, Sutton RM, Hazinski MF. Part 13: pediatric basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010; 122:S862-75. [PMID: 20956229 PMCID: PMC3717258 DOI: 10.1161/circulationaha.110.971085] [Citation(s) in RCA: 193] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Berg RA, Hemphill R, Abella BS, Aufderheide TP, Cave DM, Hazinski MF, Lerner EB, Rea TD, Sayre MR, Swor RA. Part 5: Adult Basic Life Support. Circulation 2010; 122:S685-705. [PMID: 20956221 DOI: 10.1161/circulationaha.110.970939] [Citation(s) in RCA: 480] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kleinman ME, de Caen AR, Chameides L, Atkins DL, Berg RA, Berg MD, Bhanji F, Biarent D, Bingham R, Coovadia AH, Hazinski MF, Hickey RW, Nadkarni VM, Reis AG, Rodriguez-Nunez A, Tibballs J, Zaritsky AL, Zideman D. Pediatric basic and advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Pediatrics 2010; 126:e1261-318. [PMID: 20956433 PMCID: PMC3784274 DOI: 10.1542/peds.2010-2972a] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Berg MD, Schexnayder SM, Chameides L, Terry M, Donoghue A, Hickey RW, Berg RA, Sutton RM, Hazinski MF. Pediatric basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics 2010; 126:e1345-60. [PMID: 20956430 PMCID: PMC3741664 DOI: 10.1542/peds.2010-2972c] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Kleinman ME, de Caen AR, Chameides L, Atkins DL, Berg RA, Berg MD, Bhanji F, Biarent D, Bingham R, Coovadia AH, Hazinski MF, Hickey RW, Nadkarni VM, Reis AG, Rodriguez-Nunez A, Tibballs J, Zaritsky AL, Zideman D. Part 10: Pediatric basic and advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2010; 122:S466-515. [PMID: 20956258 PMCID: PMC3748977 DOI: 10.1161/circulationaha.110.971093] [Citation(s) in RCA: 143] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Note From the Writing Group: Throughout this article, the reader will notice combinations of superscripted letters and numbers (eg, “Family Presence During ResuscitationPeds-003”). These callouts are hyperlinked to evidence-based worksheets, which were used in the development of this article. An appendix of worksheets, applicable to this article, is located at the end of the text. The worksheets are available in PDF format and are open access.
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Koster RW, Baubin MA, Bossaert LL, Caballero A, Cassan P, Castrén M, Granja C, Handley AJ, Monsieurs KG, Perkins GD, Raffay V, Sandroni C. European Resuscitation Council Guidelines for Resuscitation 2010 Section 2. Adult basic life support and use of automated external defibrillators. Resuscitation 2010; 81:1277-92. [PMID: 20956051 PMCID: PMC7116923 DOI: 10.1016/j.resuscitation.2010.08.009] [Citation(s) in RCA: 380] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Rudolph W Koster
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
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Iglesias JM, López-Herce J, Urbano J, Solana MJ, Mencía S, Del Castillo J. Chest compressions versus ventilation plus chest compressions in a pediatric asphyxial cardiac arrest animal model. Intensive Care Med 2010; 36:712-6. [PMID: 20148320 DOI: 10.1007/s00134-010-1777-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2009] [Accepted: 10/29/2009] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare the ventilation achieved with chest compressions (CC) or ventilation plus compressions (VC) in a pediatric animal model of cardiac arrest. DESIGN Randomized experimental study. SETTING Experimental department of a University Hospital. METHODS Twelve infant pigs with asphyxial cardiac arrest. Sequential 3-min periods of VC and CC were performed for a total duration of 9 min. Tidal volume (TV), end-tidal CO(2) (EtCO(2)), mean arterial pressure (MAP), central venous pressure (CVP), mean pulmonary arterial pressure (mPAP), and peripheral, cerebral, and renal saturations were recorded and arterial and venous blood gases were analyzed. RESULTS VC achieved a TV similar to the preset parameters on the ventilator, whilst the TV in CC was very low (P < 0.001). EtCO(2) with VC was significantly higher than with CC (14.0 vs. 3.9 mmHg, P < 0.05). Arterial pH was higher with VC than with CC (6.99 vs. 6.90 mmHg, P < 0.05). Arterial PCO(2) was lower with VC than with CC (62.1 vs. 97.0 mmHg, P < 0.05). There were no significant differences in the MAP; CVP; mPAP; peripheral, renal, and cerebral saturations; or lactate concentrations between the two techniques. CONCLUSIONS VC achieves better ventilation than CC during cardiopulmonary resuscitation and has no negative effect on the hemodynamic situation.
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Affiliation(s)
- Jose María Iglesias
- Pediatric Intensive Care Service, Hospital General Universitario Gregorio Marañón, Dr Castelo 47, 28009, Madrid, Spain
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Hogan TS. Exercise involvement at cardiac arrest and chest compression-only cardiopulmonary resuscitation. Anaesthesia 2009; 64:1268. [PMID: 19825079 DOI: 10.1111/j.1365-2044.2009.06119.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Zed PJ, Abu-Laban RB, Shuster M, Green RS, Slavik RS, Travers AH. Update on cardiopulmonary resuscitation and emergency cardiovascular care guidelines. Am J Health Syst Pharm 2009; 65:2337-46. [PMID: 19052280 DOI: 10.2146/ajhp080168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The key changes included in the 2005 cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC) guidelines are reviewed. Advances since publication of the current guidelines are also discussed. SUMMARY The 2005 CPR and ECC guidelines include several key changes from the previous version published in 2000. The new guidelines place an increased emphasis on chest compressions and recommend a compression:ventilation (C:V) ratio of 30:2. Current knowledge on defibrillation has also been incorporated by recommending that Emergency Medical Service (EMS) rescuers give two minutes of CPR before defibrillation when the response interval is greater than four to five minutes and EMS responders did not witness the arrest. Another major change is the recommendation for a single shock to be administered followed immediately by CPR with no check of the cardiac rhythm until two minutes of CPR has been performed postdefibrillation. The 2005 guidelines recommend that an automated external defibrillator should be implemented in public locations where there is a relatively high likelihood of witnessed cardiac arrest. In addition, the most recent guidelines highlight the shift from primary-rhythm-based therapies and resuscitation to a focus on neurologic outcomes. CONCLUSION Several evidence-based changes were included in the 2005 CPR and ECC guidelines, including a C:V ratio of 30:2 and mitigation of hands-off time, early defibrillation, administration of a single shock versus a three-shock sequence, use of public-access defibrillators, and a shift from primary-rhythm-based therapies to a focus on neurologic outcomes.
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Affiliation(s)
- Peter J Zed
- Department of Pharmacy, and Pharmacotherapeutic Specialist-Emergency Medicine, Queen Elizabeth II Health Sciences Centre (QEIIHSC), Halifax, NS, Canada.
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64
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Wyckoff MH, Berg RA. Optimizing chest compressions during delivery-room resuscitation. Semin Fetal Neonatal Med 2008; 13:410-5. [PMID: 18514603 DOI: 10.1016/j.siny.2008.04.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
There is a paucity of data to support the recommendations for cardiac compressions for the newly born. Techniques, compression to ventilation ratios, hand placement, and depth of compression guidelines are generally based on expert consensus, physiologic plausibility, and data from pediatric and adult models.
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Affiliation(s)
- Myra H Wyckoff
- The University of Texas Southwestern Medical Center at Dallas, Department of Pediatrics, Division of Neonatal-Perinatal Medicine, 5323 Harry Hines Boulevard, Dallas, Texas 75390-9063, USA.
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Markstaller K, Rudolph A, Karmrodt J, Gervais HW, Goetz R, Becher A, David M, Kempski OS, Kauczor HU, Dick WF, Eberle B. Effect of chest compressions only during experimental basic life support on alveolar collapse and recruitment. Resuscitation 2008; 79:125-32. [DOI: 10.1016/j.resuscitation.2008.03.228] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2007] [Revised: 02/04/2008] [Accepted: 03/24/2008] [Indexed: 10/21/2022]
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Rottenberg EM. Letter by Rottenberg regarding article "Improved neurological outcome with continuous chest compressions compared with 30:2 compressions-to-ventilations cardiopulmonary resuscitation in a realistic swine model of out-of-hospital cardiac arrest". Circulation 2008; 117:e493; author reply e494. [PMID: 18559708 DOI: 10.1161/circulationaha.107.756569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mouth-to-mouth ventilation and/or chest compression in basic life support: The debate continues. Resuscitation 2008; 77:283-5. [DOI: 10.1016/j.resuscitation.2008.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Ong MEH, Ng FSP, Anushia P, Tham LP, Leong BSH, Ong VYK, Tiah L, Lim SH, Anantharaman V. Comparison of chest compression only and standard cardiopulmonary resuscitation for out-of-hospital cardiac arrest in Singapore. Resuscitation 2008; 78:119-26. [PMID: 18502559 DOI: 10.1016/j.resuscitation.2008.03.012] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2008] [Revised: 02/22/2008] [Accepted: 03/06/2008] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Chest compression only cardiopulmonary resuscitation (CC-CPR) without ventilation has been proposed as an alternative to standard cardiopulmonary resuscitation (CPR) for bystanders. However, there has been controversy regarding the relative effectiveness of both of these techniques. We aim to compare the outcomes of cardiac arrest patients in the cardiac arrest and resuscitation epidemiology study who either received CC-CPR, standard CPR or no bystander CPR. METHODS This prospective cohort study involved all out-of-hospital cardiac arrest (OHCA) patients attended to by emergency medical service (EMS) providers in a large urban centre. The data analyses were conducted secondarily on these collected data. The technique of bystander CPR was reported by paramedics who arrived at the scene. RESULTS From 1 October 2001 to 14 October 2004, 2428 patients were enrolled into the study. Of these, 255 were EMS-witnessed arrests and were excluded. 1695 cases did not receive any bystander CPR, 287 had standard CPR and 154 CC-CPR. Patient characteristics were similar in both the standard and CC-CPR groups except for a higher incidence of residential arrests and previous heart disease sufferers in the CC-CPR group. Patients who received standard CPR (odds ratio (OR) 5.4, 95% confidence interval (CI) 2.1-14.0) or CC-CPR (OR 5.0, 95% CI 1.5-16.4) were more likely to survive to discharge than those who had no bystander CPR. There was no significant difference in survival to discharge between those who received CC-CPR and standard CPR (OR 0.9, 95% CI 0.3-3.1). CONCLUSION We found that patients were more likely to survive with any form of bystander CPR than without. This emphasises the importance of chest compressions for OHCA patients, whether with or without ventilation.
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Affiliation(s)
- Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
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Abstract
PURPOSE OF REVIEW Bystander cardiopulmonary resuscitation increases the chances of survival after out-of-hospital cardiac arrest. Existing bystander cardiopulmonary resuscitation rates are poor. There are several strategies for increasing the frequency and effectiveness of bystander cardiopulmonary resuscitation. These include simplifying the technique for basic life support, emphasizing the importance of compressions over ventilation, reducing the length of training by using video-based self-instruction and widening the range of those trained to include school children. RECENT FINDINGS A change in compression-ventilation ratio from 15: 2 to 30: 2 increases the number of compressions delivered. There is some evidence that compression-only cardiopulmonary resuscitation may increase survival rates from out-of-hospital cardiac arrest. Video-based self-instruction enables laypeople to be trained in basic life support in a fraction of the time of traditional courses. School children can be taught basic life support and can be used to help disseminate the skill. SUMMARY The optimal basic life support technique that will generate the highest survival rates from out-of-hospital cardiac arrest has not been determined, but there is increasing evidence that the existing technique needs to be simplified. Bystander cardiopulmonary resuscitation increases survival but it needs to be undertaken more frequently if overall survival rates are to be improved significantly.
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Abstract
American Heart Association advocates chest compression without ventilation
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72
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Sayre MR, Berg RA, Cave DM, Page RL, Potts J, White RD. Hands-only (compression-only) cardiopulmonary resuscitation: a call to action for bystander response to adults who experience out-of-hospital sudden cardiac arrest: a science advisory for the public from the American Heart Association Emergency Cardiovascular Care Committee. Circulation 2008; 117:2162-7. [PMID: 18378619 DOI: 10.1161/circulationaha.107.189380] [Citation(s) in RCA: 273] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Prearrest administration of low-molecular-weight heparin in porcine cardiac arrest: Hemodynamic effects and resuscitability*. Crit Care Med 2008; 36:881-6. [DOI: 10.1097/ccm.0b013e318164e781] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hwang SO, Kim SH, Kim H, Jang YS, Zhao PG, Lee KH, Choi HJ, Shin TY. Comparison of 15:1, 15:2, and 30:2 compression-to-ventilation ratios for cardiopulmonary resuscitation in a canine model of a simulated, witnessed cardiac arrest. Acad Emerg Med 2008; 15:183-9. [PMID: 18275449 DOI: 10.1111/j.1553-2712.2008.00026.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This experimental study compared the effect of compression-to-ventilation (CV) ratios of 15:1, 15:2, and 30:2 on hemodynamics and resuscitation outcome in a canine model of a simulated, witnessed ventricular fibrillation (VF) cardiac arrest. METHODS Thirty healthy dogs, irrespective of species (mean +/- SD, 19.2 +/- 2.2 kg), were used in this study. A VF arrest was induced. The dogs received cardiopulmonary resuscitation (CPR) and were divided into three groups based on the applied CV ratios of 15:1, 15:2, and 30:2. After 1 minute of untreated VF, 4 minutes of basic life support (BLS) was performed. At the end of the 4 minutes, the dogs were defibrillated with an automatic external defibrillator (AED) and advanced cardiac life support (ACLS) efforts were continued for 10 minutes or until restoration of spontaneous circulation (ROSC) was attained, whichever came first. RESULTS None of the hemodynamic parameters, and arterial oxygen profiles was significantly different between the three groups during BLS- and ACLS-CPR. Eight dogs (80%) from each group achieved ROSC during BLS and ACLS. The survival rate was not different between the three groups. In the 15:1 and 30:2 groups, the number of compressions delivered over 1 minute were significantly greater than in the 15:2 group (73.1 +/- 8.1 and 69.0 +/- 6.9 to 56.3 +/- 6.8; p < 0.01). The time for ventilation during which compressions were stopped at each minute was significantly lower in the 15:1 and 30:2 groups than in the 15:2 group (15.4 +/- 3.9 and 17.1 +/- 2.7 to 25.2 +/- 2.6 sec/min; p < 0.01). CONCLUSIONS In a canine model of witnessed VF using a simulated scenario, CPR with three CV ratios, 15:1, 15:2, and 30:2, did not result in any differences in hemodynamics, arterial oxygen profiles, and resuscitation outcome among the three groups. CPR with a CV ratio of 15:1 provided comparable chest compressions and shorter pauses for ventilation between each cycle compared to a CV ratio of 30:2.
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Affiliation(s)
- Sung Oh Hwang
- Wonju College of Medicine, Yonsei University, Wonju, Kangwondo, Republic of Korea.
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75
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Bjørshol CA, Søreide E, Torsteinbø TH, Lexow K, Nilsen OB, Sunde K. Quality of chest compressions during 10min of single-rescuer basic life support with different compression: ventilation ratios in a manikin model. Resuscitation 2008; 77:95-100. [PMID: 18207627 DOI: 10.1016/j.resuscitation.2007.11.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2007] [Revised: 10/15/2007] [Accepted: 11/05/2007] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Good quality basic life support (BLS) improves outcome during cardiac arrest. As fatigue may reduce BLS performance over time we wanted to examine the quality of chest compressions in a single-rescuer scenario during prolonged BLS with different compression:ventilation ratios (C:V ratios). MATERIAL AND METHODS Professional paramedics were asked to perform single-rescuer BLS with C:V ratios of 15:2, 30:2 and 50:2 for 10 min each in random order. A Laerdal Medical Resusci Anne Simulator with PC Skillreporting System was used for BLS quality analysis. Total number of chest compressions, compression depth and compression rate were measured and the differences between the C:V ratios were analysed with repeated measures ANOVA. For analysis of fatigue, chest compression variables for each 2-min period were analysed and compared with the first 2-min period using repeated measures ANOVA. RESULTS Altogether 50 paramedics completed the study. The mean number of chest compressions increased significantly from 604 to 770 and 862 with C:V ratios of 15:2, 30:2 and 50:2, respectively. Chest compression rate was significantly higher with C:V ratio of 15:2 compared to 30:2 and 50:2 but was above 100 per minute for all three ratios. However, the mean chest compression depth did not change significantly between the different C:V ratios. The number of chest compressions did not change significantly with time for any of the three C:V ratios. Compression depth did decline after the first 2-min period for 30:2 and 50:2 as did compression rate for all three ratios. However all were above the guideline limits for the entire test period. CONCLUSION Increasing the C:V ratio increases the number of chest compressions during 10 min of BLS. Compression depth and compression rate were within guideline recommendations for all three ratios. We found no decline in chest compression quality below guideline recommendations during 10 min of BLS with any of the three different C:V ratios.
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Affiliation(s)
- Conrad Arnfinn Bjørshol
- Department of Anaesthesia and Intensive Care, Division of Acute Care Medicine, Stavanger University Hospital, Stavanger, Norway.
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76
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Arterial blood gases during basic life support of human cardiac arrest victims. Resuscitation 2007; 77:35-8. [PMID: 18035475 DOI: 10.1016/j.resuscitation.2007.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2007] [Revised: 09/25/2007] [Accepted: 10/16/2007] [Indexed: 11/22/2022]
Abstract
BACKGROUND Ventilation with tidal volumes sufficient to raise the victim's chest is an integral part of guidelines for lay-rescuer basic life support, but optimal tidal volume, frequency and ratio to chest compressions are not known. METHODS Adults with non-traumatic, out-of-hospital cardiac arrest, who were not successfully resuscitated following advanced life support by the staff of a physician-manned ambulance, were included. Advanced life support comprised tracheal intubation and mechanical ventilation with tidal volume of 700 ml and 100% oxygen, 12 times per min. An arterial blood sample was drawn at the end of the resuscitation attempt and analysed on the scene. After the victim was declared dead, basic life support was initiated with chest compressions and mouth-to-mask or mouth-to-tracheal tube ventilation (15:2), with volumes sufficient to make the chest rise. The tracheal tube was equipped with an impedance valve to avoid passive ventilation secondary to chest compressions. Arterial blood samples were drawn after 7-8 min of basic life support and analysed on the scene. RESULTS Six men and two women, median (range) age 72 (32-86) years, were included in the study. Four of these received mouth-to-mask ventilation and four mouth-to-tracheal tube ventilation. Mean (S.D.) arterial blood carbon dioxide and oxygen tension during advanced life support were 6.4 (1.4)kPa and 22 (15)kPa, respectively. Similar values during basic life support were 9.6 (1.9)kPa and 8.5 (1.6)kPa, respectively, with no differences between the ventilation methods. CONCLUSION Ventilation during basic life support performed according to international guidelines (2000) resulted in arterial hypercapnia and hypoxia.
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77
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Reply to “use of the Impedance Threshold Device (ITD)”. Resuscitation 2007. [DOI: 10.1016/j.resuscitation.2007.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kellum MJ. Compression-only cardiopulmonary resuscitation for bystanders and first responders. Curr Opin Crit Care 2007; 13:268-72. [PMID: 17468557 DOI: 10.1097/mcc.0b013e32814b0524] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The current resuscitation guidelines consider ventilation and chest compression essential components of resuscitation and therefore only one methodology, standard cardiopulmonary resuscitation, is explicitly recommended for the treatment of both respiratory and cardiac arrests. Pathophysiological and experimental observations argue that this generalization results in suboptimal treatment for victims of cardiac arrest. RECENT FINDINGS For more than a decade animal studies have demonstrated that assisted ventilation is not essential during the initial treatment of a fibrillatory arrest; but only in the last year have these results been confirmed in humans. These new observations come from a handful of systems utilizing cardiocerebral resuscitation in their prehospital resuscitation of adult victims of presumed cardiac arrest. They have all demonstrated a dramatic increase in survival. Recent data also indicate that survival is significantly increased when laypersons perform chest-compression-only cardiopulmonary resuscitation. SUMMARY The current resuscitation guidelines regarding the prehospital treatment of victims of adult cardiac arrest should be modified to explicitly permit the use of continuous-chest-compression cardiopulmonary resuscitation.
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Affiliation(s)
- Michael J Kellum
- Rock and Walworth County Sudden Cardiac Death Project, Mercy Walworth Hospital and Clinic, Lake Geneva, Wisconsin, USA.
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79
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Sherman M. The new American Heart Association cardiopulmonary resuscitation guidelines: should children and adults have to share? Curr Opin Pediatr 2007; 19:253-7. [PMID: 17505182 DOI: 10.1097/mop.0b013e3280fb270c] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW The latest American Heart Association guidelines for pediatric cardiopulmonary resuscitation (CPR) were published in December 2005. Changes from the 2000 guidelines were directed toward simplifying CPR. Infants, children, and adults now share the same recommendation for the initial compression:ventilation ratio. This is a significant change for pediatricians trained in the importance of a respiratory etiology of pediatric cardiopulmonary arrest. The present review will focus on the rationale behind these guideline changes. RECENT FINDINGS The new guidelines for single rescuer CPR include a compression:ventilation ratio of 30: 2 for both adult and pediatric victims. The impetus for this recommendation is based on recent appreciation for the deleterious effects of hyperventilation as well as an attempt to increase bystander delivery of CPR. The physiologic results of hyperventilation are discussed. The new pediatric basic life support guideline changes are underscored. Research representing the spectrum of opinions on the optimal compression:ventilation ratio, including compression-only CPR, is presented. SUMMARY Although based primarily on adult, animal, and computational models, the new compression:ventilation ratio, recommended for both initial pediatric and adult CPR, is a reasonable recommendation. The simplified CPR guidelines released in 2005 will hopefully contribute to improved bystander delivery of CPR and improved outcome.
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Affiliation(s)
- Mindy Sherman
- Pediatric Emergency Medicine Unit, Ellison One, Massachusetts General Hospital, Fruit Street, Boston, MA 02138, USA.
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80
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Xanthos T, Tsirikos-Karapanos N, Papadimitriou D, Vlachos IS, Tsiftsi K, Ekmektzoglou KA, Papadimitriou L. Resuscitation outcomes comparing year 2000 with year 2005 ALS guidelines in a pig model of cardiac arrest. Resuscitation 2007; 73:459-66. [PMID: 17291669 DOI: 10.1016/j.resuscitation.2006.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2006] [Revised: 10/13/2006] [Accepted: 10/26/2006] [Indexed: 11/17/2022]
Abstract
BACKGROUND Ventricular fibrillation remains the leading cause of death in western societies. International organizations publish guidelines to follow in case of cardiac arrest. The aim of the present study is to assess whether the newly published guidelines record similar resuscitation success with the 2000 Advanced Life Support Guidelines on Resuscitation in a swine model of cardiac arrest. METHODS AND RESULTS Nineteen landrace/large white pigs were used. Ventricular fibrillation was induced with the use of a transvenous pacing wire inserted into the right ventricle. The animals were randomized into two groups. In Group A, 10 animals were resuscitated using the 2000 guidelines, whereas in Group B, 9 animals were resuscitated using the 2005 guidelines. Both algorithms recorded similar successful resuscitation rates, as 60% of the animals in Group A and 44.5% in Group B were successfully resuscitated. However, animals in Group A restored a rhythm, compatible with a pulse, quicker than those in Group B (p=0.002). Coronary perfusion pressure (CPP) was not adversely affected by three defibrillation attempts in Group A. CONCLUSIONS Both algorithms' resulted in comparable resuscitation success, however, guidelines 2000 resulted in faster resuscitation times. These preliminary results merit further investigation.
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Affiliation(s)
- Theodoros Xanthos
- Department of Experimental Surgery and Surgical Research N.S.Christeas, Athens School of Medicine, 15B Agiou Thoma Street, 11527 Athens, Greece.
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81
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Affiliation(s)
- Michael Shuster
- Department of Emergency Medicine, Mineral Springs Hospital, Banff, AB.
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82
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Affiliation(s)
- Jonas A Cooper
- Cardiovascular Division, Department of Internal Medicine, Washington University School of Medicine, St Louis, MO, USA
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83
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Herff H, Raedler C, Zander R, Wenzel V, Schmittinger CA, Brenner E, Rieger M, Lindner KH. Use of an inspiratory impedance threshold valve during chest compressions without assisted ventilation may result in hypoxaemia. Resuscitation 2006; 72:466-76. [PMID: 17150297 DOI: 10.1016/j.resuscitation.2006.07.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2006] [Revised: 07/14/2006] [Accepted: 07/17/2006] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Although the concept of intermittent airway occlusion with the inspiratory impedance threshold valve (ITV) is a well-recognised strategy for improving efficiency of cardiopulmonary resuscitation (CPR), little is known about possible pulmonary side effects. METHODS After a baseline chest CT-scan, 24 pigs with beating hearts undergoing apnoeic oxygenation received an injection of a contrast medium and were then assigned randomly to either active compression-decompression CPR with ITV (ACD ITV CPR), ACD CPR alone, or standard-CPR with ITV (standard-ITV CPR), or standard-CPR alone. After a maximum of 5 min of chest compressions or if oxygen saturation dropped below 70%, the experiment was stopped, haemodynamic variables and blood gas values were measured, and another CT-scan was performed; all animals underwent a 30 min recovery-period and a third subsequent CT-scan. RESULTS At baseline arterial oxygen saturation by pulse oxymetry was 99% in all four groups; in both the ACD ITV CPR and the standard-ITV CPR groups, arterial oxygen saturation dropped below 70% within 126+/-9s, whereas chest compressions in all ACD CPR and standard-CPR pigs were performed over 5 min (P<0.001). Before stopping chest compressions arterial oxygen pressure decreased in the ACD ITV CPR group from 426+/-96 to 42+/-8 mmHg while it decreased in the ACD CPR group only from 415+/-116 to 197+/-127 mmHg (P<0.001 between groups); in the standard-ITV CPR group arterial oxygen partial pressure decreased from 427+/-109 to 34+/-5 mmHg while oxygen partial pressure decreased only from 467+/-44 to 144+/-98 mmHg in the standard-CPR group (P<0.004 between groups). After the second CT scan arterial oxygen partial pressure decreased further to 19+/-2 mmHg in the ACD ITV CPR versus 210+/-41 mmHg in the ACD CPR group; to 20+/-2 mmHg in the standard-ITV CPR versus 148+/-33 mmHg in the standard-CPR group. Lung-density values (Hounsfield units) were significantly higher in the ACD ITV CPR versus ACD CPR group (-134+/-54 versus -330+/-77) and standard-ITV CPR versus standard-CPR group (-98+/-50 versus -387+/-42). After a 30 min recovery-period, there were no significant differences in arterial oxygen partial pressure (ACD ITV CPR 275+/-110 mmHg versus ACD CPR 379+/-111 mmHg and standard-ITV CPR 265+/-138 mmHg versus standard CPR 367+/-55 mmHg). Furthermore, there were no differences in lung density values between groups after 30 min of recovery. CONCLUSION In this animal model with a beating heart, intermittent airway obstruction through an ITV combined with apnoeic oxygenation and without active ventilation resulted in hypoxaemia due to transiently impaired lung function.
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Affiliation(s)
- Holger Herff
- Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria.
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84
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Pytte M, Kramer-Johansen J, Eilevstjønn J, Eriksen M, Strømme TA, Godang K, Wik L, Steen PA, Sunde K. Haemodynamic effects of adrenaline (epinephrine) depend on chest compression quality during cardiopulmonary resuscitation in pigs. Resuscitation 2006; 71:369-78. [PMID: 17023108 DOI: 10.1016/j.resuscitation.2006.05.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2006] [Revised: 05/04/2006] [Accepted: 05/10/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Adrenaline (epinephrine) is used during cardiopulmonary resuscitation (CPR) based on animal experiments without supportive clinical data. Clinically CPR was reported recently to have much poorer quality than expected from international guidelines and what is generally done in laboratory experiments. We have studied the haemodynamic effects of adrenaline during CPR with good laboratory quality and with quality simulating clinical findings and the feasibility of monitoring these effects through VF waveform analysis. METHODS AND RESULTS After 4 min of cardiac arrest, followed by 4 min of basic life support, 14 pigs were randomised to ClinicalCPR (intermittent manual chest compressions, compression-to-ventilation ratio 15:2, compression depth 30-38 mm) or LabCPR (continuous mechanical chest compressions, 12 ventilations/min, compression depth 45 mm). Adrenaline 0.02 mg/kg was administered 30 s thereafter. Plasma adrenaline concentration peaked earlier with LabCPR than with ClinicalCPR, median (range), 90 (30, 150) versus 150 (90, 270) s (p = 0.007), respectively. Coronary perfusion pressure (CPP) and cortical cerebral blood flow (CCBF) increased and femoral blood flow (FBF) decreased after adrenaline during LabCPR (mean differences (95% CI) CPP 17 (6, 29) mmHg (p = 0.01), FBF -5.0 (-8.8, -1.2) ml min(-1) (p = 0.02) and median difference CCBF 12% of baseline (p = 0.04)). There were no significant effects during ClinicalCPR (mean differences (95% CI) CPP 4.7 (-3.2, 13) mmHg (p = 0.2), FBF -0.2 (-4.6, 4.2) ml min(-1)(p = 0.9) and CCBF 3.6 (-1.8, 9.0)% of baseline (p = 0.15)). Slope VF waveform analysis reflected changes in CPP. CONCLUSION Adrenaline improved haemodynamics during laboratory quality CPR in pigs, but not with quality simulating clinically reported CPR performance.
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Affiliation(s)
- Morten Pytte
- Department of Anaesthesiology, Ulleval University Hospital, Oslo, Norway.
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85
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Dias JA, Brown TB, Saini D, Shah RC, Cofield SS, Waterbor JW, Funkhouser E, Terndrup TE. Simplified dispatch-assisted CPR instructions outperform standard protocol. Resuscitation 2006; 72:108-14. [PMID: 17123687 DOI: 10.1016/j.resuscitation.2006.04.018] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2006] [Revised: 04/19/2006] [Accepted: 04/19/2006] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Dispatch-assisted chest compressions only CPR (CC-CPR) has gained widespread acceptance, and recent research suggests that increasing the proportion of compression time during CPR may increase survival from out-of-hospital cardiac arrest. We created a simplified CC-CPR protocol to reduce time to start chest compressions and to increase the proportion of time spent delivering chest compressions. This simplified protocol was compared to a published protocol, Medical Priority Dispatch System (MPDS) Version 11.2, recommended by the National Academies of Emergency Dispatch. METHODS Subjects were randomized to the MPDS v11.2 protocol or a simplified protocol. Data was recorded from a Laerdal Resusci Anne Skillreporter manikin. A simulated emergency medical dispatcher, contacted by cell phone, delivered standardized instructions for both protocols. Outcomes included chest compression rate, depth, hand position, full release, overall proportion of compressions without error, time to start of CPR and total hands-off chest time. Proportions were analyzed by Wilcoxon's Rank Sum tests and time variables with Welch ANOVA and Wilcoxon's Rank Sum test. All tests used a two-sided alpha-level of 0.05. RESULTS One hundred and seventeen subjects were randomized prospectively, 58 to the standard protocol and 59 to the simplified protocol. The average age of subjects in both groups was 25 years old. For both groups, the compression rate was equivalent (104 simplified versus 94 MPDS, p = 0.13), as was the proportion with total release (1.0 simplified versus 1.0 MPDS, p = 0.09). The proportion to the correct depth was greater in the simplified protocol (0.31 versus 0.03, p < 0.01), as was the proportion of compressions done without error (0.05 versus 0.0, p = 0.16). Time to start of chest compressions and total hands-off chest time were better in the simplified protocol (start time 60.9s versus 78.6s, p < 0.0001; hands-off chest time 69 s versus 95 s, p < 0.0001). The proportion with correct hand position, however, was worse in the simplified protocol (0.35 versus 0.84, p < 0.01). CONCLUSIONS The simplified protocol was as good as, or better than the MPDS v11.2 protocol in every aspect studied except hand position, and the simplified protocol resulted in significant time savings. The protocol may need modification to ensure correct hand position. Time savings and improved quality of CPR achieved by the new set of instructions could be important in strengthening critical links in the cardiac chain of survival.
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Affiliation(s)
- J A Dias
- School of Public Health, University of Alabama at Birmingham, USA.
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86
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Losert H, Risdal M, Sterz F, Nysaether J, Köhler K, Eftestøl T, Wandaller C, Myklebust H, Uray T, Sodeck G, Laggner AN. Thoracic impedance changes measured via defibrillator pads can monitor ventilation in critically ill patients and during cardiopulmonary resuscitation. Crit Care Med 2006; 34:2399-405. [PMID: 16850000 DOI: 10.1097/01.ccm.0000235666.40378.60] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Monitoring of ventilation performance during cardiopulmonary resuscitation would be desirable to improve the quality of cardiopulmonary resuscitation. To investigate the potential for measuring ventilation rate and inspiration time, we calculated the correlation in waveform between transthoracic impedance measured via defibrillator pads and tidal volume given by a ventilator. DESIGN Clinical study. SETTING Emergency department of a tertiary care university hospital. PATIENTS A convenience sample of mechanical ventilated patients (n = 32), cardiac arrest patients (n = 20), and patients after restoration of spontaneous circulation (n = 31) older than 18 were eligible. INTERVENTIONS The Heartstart 4000SP defibrillator (Laerdal Medical Cooperation, Stavanger, Norway) with additional capabilities of recording thoracic impedance changes was used. MEASUREMENTS AND MAIN RESULTS The relationship between impedance change and tidal volume (impedance coefficient) was calculated. The mean (sd) correlations between the impedance waveform and the tidal volume waveform in the patient groups studied were .971 (.027), .969 (.032), and .967 (.035), respectively. The mean (sd) impedance coefficient for all patients in the study was .00194 (.0078) Omega/mL, and the mean (sd) specific (weight-corrected) impedance coefficient was .152 (.048) Omega/kg/mL. The measured thorax impedance change for different tidal volumes (400-1000 mL) was approximately linear. CONCLUSIONS The impedance sensor of a defibrillator is accurate in identifying tidal volumes, when chest compressions are interrupted. This also allows quantifying ventilation rates and inspiration times. However this technology, at its present state, provides only limited practical means for exact tidal volume estimation.
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Affiliation(s)
- Heidrun Losert
- Department of Emergency Medicine, Medical University of Vienna, Austria
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87
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Rottenberg EM. The need for head rotation and abdominal compressions during bystander cardiopulmonary resuscitation. Am J Emerg Med 2006; 24:573-6. [PMID: 16938596 DOI: 10.1016/j.ajem.2006.01.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2005] [Revised: 01/17/2006] [Accepted: 01/20/2006] [Indexed: 11/25/2022] Open
Abstract
The current AHA-ECC guidelines for basic life support focus on the provision of good chest compressions with minimal interruptions for patients with presumed out-of-hospital cardiac arrest. Moreover, international consensus guidelines now support the use of chest compression-only cardiopulmonary resuscitation (CPR) instructions for dispatcher-assisted CPR given over the phone to untrained bystanders. However, evidence that strongly challenge these recommendations have been overlooked. A review of this evidence argues for the need for head rotation (a hands-free method of airway control) and abdominal compressions during bystander CPR.
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Affiliation(s)
- Eric M Rottenberg
- Department of Perioperative Services, The Ohio State University Medical Center, Columbus, OH 43210-1228, USA.
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88
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Cavus E, Bein B, Dörges V, Stadlbauer KH, Wenzel V, Steinfath M, Hanss R, Scholz J. Brain tissue oxygen pressure and cerebral metabolism in an animal model of cardiac arrest and cardiopulmonary resuscitation. Resuscitation 2006; 71:97-106. [PMID: 16942830 DOI: 10.1016/j.resuscitation.2006.03.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2005] [Revised: 02/28/2006] [Accepted: 03/09/2006] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Direct measurement of brain tissue oxygenation (PbtO2) is established during spontaneous circulation, but values of PbtO2 during and after cardiopulmonary resuscitation (CPR) are unknown. The purpose of this study was to investigate: (1) the time-course of PbtO2 in an established model of CPR, and (2) the changes of cerebral venous lactate and S-100B. METHODS In 12 pigs (12-16 weeks, 35-45 kg), ventricular fibrillation (VF) was induced electrically during general anaesthesia. After 4 min of untreated VF, all animals were subjected to CPR (chest compression rate 100/min, FiO2 1.0) with vasopressor therapy after 7, 12, and 17 min (vasopressin 0.4, 0.4, and 0.8 U/kg, respectively). Defibrillation was performed after 22 min of cardiac arrest. After return of spontaneous circulation (ROSC), the pigs were observed for 1h. RESULTS After initiation of VF, PbtO2 decreased compared to baseline (mean +/- SEM; 22 +/- 6 versus 2 +/- 1 mmHg after 4 min of VF; P < 0.05). During CPR, PbtO2 increased, and reached maximum values 8 min after start of CPR (25 +/- 7 mmHg; P < 0.05 versus no-flow). No further changes were seen until ROSC. Lactate, and S-100B increased during CPR compared to baseline (16 +/- 2 versus 85 +/- 8 mg/dl, and 0.46 +/- 0.05 versus 2.12 +/- 0.40 microg/l after 13 min of CPR, respectively; P < 0.001); lactate remained elevated, while S-100B returned to baseline after ROSC. CONCLUSIONS Though PbtO2 returned to pre-arrest values during CPR, PbtO2 and cerebral lactate were lower than during post-arrest reperfusion with 100% oxygen, which reflected the cerebral low-flow state during CPR. The transient increase of S-100B may indicate a disturbance of the blood-brain-barrier.
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Affiliation(s)
- Erol Cavus
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 21, 24105 Kiel, Germany.
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Aufderheide TP. The problem with and benefit of ventilations: should our approach be the same in cardiac and respiratory arrest? Curr Opin Crit Care 2006; 12:207-12. [PMID: 16672778 DOI: 10.1097/01.ccx.0000224863.55711.56] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Recent advances in cardiopulmonary resuscitation have led to greater understanding of cardio-cerebral-pulmonary interactions during the process. The purpose of this discussion is to update the physiologic understanding of these interactions during cardiopulmonary resuscitation, review the detrimental and beneficial effects of ventilation, and identify implications for clinical practice. RECENT FINDINGS There is an inversely proportional relationship between mean intrathoracic pressure, coronary perfusion pressure, and survival from cardiac arrest. Increased ventilation rates and increased ventilation duration impede venous blood return to the heart, decreasing hemodynamics and coronary perfusion pressure during cardiopulmonary resuscitation. It has also been shown that there is a direct and immediate transfer of the increase in intrathoracic pressure to the cranial cavity with each positive pressure ventilation, also reducing cerebral perfusion pressure. The reduced amount of blood flowing through the pulmonary bed during cardiopulmonary resuscitation tends to be overventilated, compromising hemodynamics to both the heart and brain and resulting in ventilation/perfusion mismatch. SUMMARY The fundamental hemodynamic principle of intrathoracic pressure defines cardio-cerebral-pulmonary interactions during cardiopulmonary resuscitation. Further research is essential to optimize these interactions during treatment of profound shock.
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Affiliation(s)
- Tom P Aufderheide
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
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90
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Yannopoulos D, Aufderheide TP, Gabrielli A, Beiser DG, McKnite SH, Pirrallo RG, Wigginton J, Becker L, Vanden Hoek T, Tang W, Nadkarni VM, Klein JP, Idris AH, Lurie KG. Clinical and hemodynamic comparison of 15:2 and 30:2 compression-to-ventilation ratios for cardiopulmonary resuscitation*. Crit Care Med 2006; 34:1444-9. [PMID: 16557155 DOI: 10.1097/01.ccm.0000216705.83305.99] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare cardiopulmonary resuscitation (CPR) with a compression to ventilation (C:V) ratio of 15:2 vs. 30:2, with and without use of an impedance threshold device (ITD). DESIGN Prospective randomized animal and manikin study. SETTING Animal laboratory and emergency medical technician training facilities. SUBJECTS Twenty female pigs and 20 Basic Life Support (BLS)-certified rescuers. INTERVENTIONS, MEASUREMENTS, AND MAIN RESULTS ANIMALS Acid-base status, cerebral, and cardiovascular hemodynamics were evaluated in 18 pigs in cardiac arrest randomized to a C:V ratio of 15:2 or 30:2. After 6 mins of cardiac arrest and 6 mins of CPR, an ITD was added. Compared to 15:2, 30:2 significantly increased diastolic blood pressure (20 +/- 1 to 26 +/- 1; p < .01); coronary perfusion pressure (18 +/- 1 to 25 +/- 2; p = .04); cerebral perfusion pressure (16 +/- 3 to 18 +/- 3; p = .07); common carotid blood flow (48 +/- 5 to 82 +/- 5 mL/min; p < .001); end-tidal CO2 (7.7 +/- 0.9 to 15.7 +/- 2.4; p < .0001); and mixed venous oxygen saturation (26 +/- 5 to 36 +/- 5, p < .05). Hemodynamics improved further with the ITD. Oxygenation and arterial pH were similar. Only one of nine pigs had return of spontaneous circulation with 15:2, vs. six of nine with 30:2 (p < 0.03). HUMANS: Fatigue and quality of CPR performance were evaluated in 20 BLS-certified rescuers randomized to perform CPR for 5 mins at 15:2 or 30:2 on a recording CPR manikin. There were no significant differences in the quality of CPR performance or measurement of fatigue. Significantly more compressions per minute were delivered with 30:2 in both the animal and human studies. CONCLUSIONS These data strongly support the contention that a ratio of 30:2 is superior to 15:2 during manual CPR and that the ITD further enhances circulation with both C:V ratios.
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Handley AJ, Koster R, Monsieurs K, Perkins GD, Davies S, Bossaert L. European Resuscitation Council guidelines for resuscitation 2005. Section 2. Adult basic life support and use of automated external defibrillators. Resuscitation 2006; 67 Suppl 1:S7-23. [PMID: 16321717 DOI: 10.1016/j.resuscitation.2005.10.007] [Citation(s) in RCA: 378] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Handley AJ, Koster R, Monsieurs K, Perkins GD, Davies S, Bossaert L, Bahr J. Lebensrettende Basismaßnahmen für Erwachsene und Verwendung automatisierter externer Defibrillatoren. Notf Rett Med 2006. [DOI: 10.1007/s10049-006-0792-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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2005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Part 2: Adult basic life support. Resuscitation 2005; 67:187-201. [PMID: 16324988 PMCID: PMC7144408 DOI: 10.1016/j.resuscitation.2005.09.016] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Fenici P, Idris AH, Lurie KG, Ursella S, Gabrielli A. What is the optimal chest compression-ventilation ratio? Curr Opin Crit Care 2005; 11:204-11. [PMID: 15928467 DOI: 10.1097/01.ccx.0000163651.57730.73] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Despite a more widespread knowledge of basic cardiopulmonary resuscitation maneuvers in the community, the survival rate for patients with cardiac arrest has remained essentially unchanged in the past 30 years. Over the past few decades, many different compression-ventilation ratios have been studied in terms of best coronary and cerebral oxygen delivery, restoration of spontaneous circulation, and neurologic outcome. This article summarizes the recent evidence presented at the International Consensus on Resuscitation Science in January 2005. RECENT FINDINGS Recent data from animal and mathematical models suggest a move to a higher compression-ventilation ratio to maximize coronary and cerebral oxygen delivery during cardiac arrest and long-term neurologic outcome. Prospective randomized human data on alternative compression-ventilation ratios are missing and new evidence seems to indicate the inadequacy of both lay and professional rescuers in providing chest compression and ventilating the victim in cardiac arrest. Finally, observational and animal studies highlight the hidden danger of inadvertent hyperventilation during advanced cardiac life support as a reduction of both coronary and perfusion pressure secondary to increased intrathoracic pressure and decreased venous return. SUMMARY The optimal compression-ventilation ratio is still unknown and the best tradeoff between oxygenation and organ perfusion during cardiopulmonary resuscitation is probably different for each patient and scenario. A discrepancy between what is recommended by the current guidelines and the 'real world' of cardiopulmonary resuscitation has resulted in a near flat survival rate from cardiac arrest in the past few years.
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Affiliation(s)
- Peter Fenici
- Department of Emergency Medicine, Catholic University Hospital of Rome, Italy
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Affiliation(s)
- P A Steen
- Department of Anesthesiology, Ulleval University Hospital, Oslo, Norway.
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97
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Hüpfl M, Duma A, Uray T, Maier C, Fiegl N, Bogner N, Nagele P. Over-the-head cardiopulmonary resuscitation improves efficacy in basic life support performed by professional medical personnel with a single rescuer: a simulation study. Anesth Analg 2005; 101:200-5, table of contents. [PMID: 15976232 DOI: 10.1213/01.ane.0000154305.70984.6b] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Two-rescuer cardiopulmonary resuscitation (CPR) is considered the best method for professional basic life support (BLS). However, in many prehospital cardiac arrest situations, one rescuer has to begin CPR alone while the other performs additional tasks. In theory, over-the-head CPR is a suitable alternative in this situation, with the added benefit of allowing the single rescuer to use a self-inflating bag for ventilation. In this trial, we compared standard single-rescuer CPR with over-the-head CPR in manikins. We planned this study using a crossover study design where each participant administered both CPR techniques in a randomized order. Ventilation and chest compression data were collected with analysis software during a 2-min CPR test for each technique. Sixty-seven emergency medical technician students participated in this trial. Over-the-head CPR allowed for superior ventilation compared to standard CPR (number of correct ventilations: 330 of 760 versus 279 of 779; P = 0.002). The quality of delivered chest compressions did not differ between the two groups (correct chest compressions: 4293 of 6304 versus 4313 of 6395; P = 0.44). In conclusion, our study has shown that over-the-head CPR may be an effective alternative BLS technique when a single professional rescuer has to perform CPR, likely offering superior ventilation and comparable chest compression quality compared with standard BLS.
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Affiliation(s)
- Michael Hüpfl
- Department of Anesthesia and General Intensive Care, Medical University Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
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Hostler D, Guimond G, Callaway C. A comparison of CPR delivery with various compression-to-ventilation ratios during two-rescuer CPR. Resuscitation 2005; 65:325-8. [PMID: 15919570 DOI: 10.1016/j.resuscitation.2004.11.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2004] [Revised: 11/16/2004] [Accepted: 11/16/2004] [Indexed: 11/19/2022]
Abstract
BACKGROUND The number of chest compressions required for optimal generation of coronary perfusion pressure remains unknown although studies examining compression-to-ventilation ratios higher than 15:2 (C:V) in animals have reported higher C:V to be superior for return of spontaneous circulation and neurologic outcome. We examined human performance of two-rescuer CPR using various C:V. METHODS Thirty six EMT-Basic students in their final week of training performed two-rescuer CPR using C:V of 15:2, 30:2, 40:2, 50:2, and 60:2 on a recording resuscitation manikin. Compression and ventilation variables were recorded by computer while the number of pauses for ventilations and the hands-off time (time not spent performing chest compressions) were abstracted by hand. Data were analyzed by ANOVA and significant differences from the standard treatment of C:V = 15:2 were assessed by Tukey's HSD post hoc test. FINDINGS The number of compressions delivered per minute increased with increasing C:V while the hands-off time and pauses for ventilations decreased. All comparisons were significantly different from C:V = 15:2 (P < 0.001). The ventilation numbers decreased with increasing C:V although mean minute volume exceeded 1l for all C:V. INTERPRETATION A 15:2 compression-to-ventilation ratio when performed during two-rescuer CPR results in 26s of hands off time each minute while only delivering 60 compressions. Alternative C:V ratios of 30:2, 40:2, 50:2, and 60:2 all exceed the AHA recommended 80 compressions/min while still delivering a minute volume in excess of 1l.
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Affiliation(s)
- David Hostler
- University of Pittsburgh, Department of Emergency Medicine and the Affiliated Emergency Medicine Residency, 230 McKee Place, Suite 500, Pittsburgh, PA 15213, USA.
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Roppolo LP, Pepe PE, Cimon N, Gay M, Patterson B, Yancey A, Clawson JJ. Modified cardiopulmonary resuscitation (CPR) instruction protocols for emergency medical dispatchers: rationale and recommendations. Resuscitation 2005; 65:203-10. [PMID: 15866402 DOI: 10.1016/j.resuscitation.2004.11.025] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2004] [Revised: 11/01/2004] [Accepted: 11/01/2004] [Indexed: 12/12/2022]
Abstract
BACKGROUND International consensus guidelines now support the use of "chest compressions-only" cardiopulmonary resuscitation (CPR) instructions (CCOIs) by emergency medical dispatch (EMD) personnel providing telephone assistance to untrained bystanders at a cardiac arrest scene. These guidelines are based largely on evolving experimental data and a clinical trial conducted in one venue with distinct emergency medical services (EMS) system features. Accordingly, the Council of Standards for the National Academies of Emergency Dispatch was asked to adapt a modified telephone CPR protocol, and specifically one that could be applied more broadly to the spectrum of EMS systems. METHODS A group of international EMD specialists, researchers and professional association representatives analyzed available scientific data and considered variations in EMS systems, particularly those in Europe and North America. RESULTS AND CONCLUSIONS Several recommendations were established: (1) to avoid confusion, bystanders already providing CPR should continue those previously learned methods; (2) following a sudden collapse unlikely to be of respiratory etiology, CCOIs should be provided when the bystander is not CPR-trained, declining to perform mouth-to-mouth ventilation or unsure of actions to take; (3) following 4 min of CCOIs, ventilations can be provided, but, for now, only at a compression-ventilation ratio of 100:2 until EMS arrives; (4) until more data become available, dispatchers should follow existing compression-ventilation protocols for children and adult cases involving probable respiratory/trauma etiologies; (5) EMD CPR protocols should account for EMS system features and receive quality oversight and expert medical direction.
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Affiliation(s)
- Lynn P Roppolo
- Chair, Emergency Medicine, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Mail Code 8579, Dallas, TX 75390-8579, USA
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Markstaller K, Eberle B, Dick WF. ["Topless" cardiopulmonary resuscitation. Fashion or science?]. Anaesthesist 2004; 53:927-36. [PMID: 15340728 DOI: 10.1007/s00101-004-0749-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A decade after the onset of a discussion whether ventilation could be omitted from bystander basic life support (BLS) algorithms, the state of the evidence is reevaluated. Initial animal studies and a prospective randomized patient trial had suggested that omission of ventilation during the first minutes of lay cardiopulmonary resuscitation (CPR) did not impair patient outcomes. More recent studies demonstrate, however, that this may hold true only in very specific scenarios, and that the chest compression-only technique was never superior to standard BLS. Instead of calling basics of BLS training and practice into question, more and better training of lay persons and professionals appears mandatory, and targeted use of dispatcher-guided telephone CPR should be evaluated and, if it improves outcome, it should be encouraged. Future studies should focus much less on the omission but on the optimization of ventilation under the specific conditions of CPR.
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Affiliation(s)
- K Markstaller
- Klinik und Poliklinik für Anästhesiologie, Inselspital, Universität Bern, Bern, Schweiz.
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