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Benoit JL, Hogan AN, Connelly KM, McMullan JT. Intra-arrest blood-based biomarkers for out-of-hospital cardiac arrest: A scoping review. J Am Coll Emerg Physicians Open 2024; 5:e13131. [PMID: 38500598 PMCID: PMC10945310 DOI: 10.1002/emp2.13131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/29/2024] [Accepted: 02/02/2024] [Indexed: 03/20/2024] Open
Abstract
Objective Blood-based biomarkers play a central role in the diagnosis and treatment of critically ill patients, yet none are routinely measured during the intra-arrest phase of out-of-hospital cardiac arrest (OHCA). Our objective was to describe methodological aspects, sources of evidence, and gaps in research surrounding intra-arrest blood-based biomarkers for OHCA. Methods We used scoping review methodology to summarize existing literature. The protocol was designed a priori following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews. Inclusion criteria were peer-reviewed scientific studies on OHCA patients with at least one blood draw intra-arrest. We excluded in-hospital cardiac arrest and animal studies. There were no language, date, or study design exclusions. We conducted an electronic literature search using PubMed and Embase and hand-searched secondary literature. Data charting/synthesis were performed in duplicate using standardized data extraction templates. Results The search strategy identified 11,834 records, with 118 studies evaluating 105 blood-based biomarkers included. Only eight studies (7%) had complete reporting. The median number of studies per biomarker was 2 (interquartile range 1-4). Most studies were conducted in Asia (63 studies, 53%). Only 22 studies (19%) had blood samples collected in the prehospital setting, and only six studies (5%) had samples collected by paramedics. Pediatric patients were included in only three studies (3%). Out of eight predefined biomarker categories of use, only two were routinely assessed: prognostic (97/105, 92%) and diagnostic (61/105, 58%). Conclusions Despite a large body of literature on intra-arrest blood-based biomarkers for OHCA, gaps in methodology and knowledge are widespread.
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Affiliation(s)
- Justin L. Benoit
- Department of Emergency MedicineUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Andrew N. Hogan
- Department of Emergency MedicineUT Southwestern Medical CenterDallasTexasUSA
| | | | - Jason T. McMullan
- Department of Emergency MedicineUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
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Morton S, Avery P, Payne J, OMeara M. Arterial Blood Gases and Arterial Lines in the Prehospital Setting: A Systematic Literature Review and Survey of Current United Kingdom Helicopter Emergency Medical Services. Air Med J 2022; 41:201-208. [PMID: 35307144 DOI: 10.1016/j.amj.2021.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/21/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Prehospital guidelines state that monitoring should match in-hospital standards, but consensus on the use of arterial blood gases (ABGs) and arterial lines remains unclear. The aim was to perform a systematic literature review and survey of UK helicopter emergency medical services (HEMS) use and perceptions of ABGs and arterial lines. METHODS A systematic literature review was conducted for arterial lines and ABGs and prehospital care. Additionally, two questionnaires were distributed to all UK HEMS (questionnaire 1: current clinical practice and questionnaire 2: clinicians' opinions). RESULTS From 1,028 results, 13 studies (10 ABGs and 3 arterial lines) were included, demonstrating it is feasible to obtain ABGs and place arterial lines in the prehospital setting. There were concerns about practical difficulties for ABGs and the time taken for arterial lines. Survey responses were obtained from all UK HEMS (N = 22). Six services carry equipment for performing ABGs and nine services for arterial lines. Clinicians expressed concerns relating to the time taken to perform both procedures, but most believed it would allow better monitoring and more targeted treatment. CONCLUSION The evidence of benefit for both procedures remains poor. Overall, there may be clinical benefits, but these are likely to be patient specific and require further investigation.
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Affiliation(s)
- Sarah Morton
- Essex and Herts Air Ambulance, Earls Colne, Colchester, Essex, United Kingdom.
| | - Pascale Avery
- Emergency Department, Aneurin Bevan University Health Board, Newport, United Kingdom
| | - Jessie Payne
- Essex and Herts Air Ambulance, Earls Colne, Colchester, Essex, United Kingdom
| | - Matthew OMeara
- Essex and Herts Air Ambulance, Earls Colne, Colchester, Essex, United Kingdom; Anaesthetic Department, University Hospitals North Midlands, Stoke-on-Trent, United Kingdom
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3
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Orlob S, Wittig J, Hobisch C, Auinger D, Honnef G, Fellinger T, Ristl R, Schindler O, Metnitz P, Feigl G, Prause G. Reliability of mechanical ventilation during continuous chest compressions: a crossover study of transport ventilators in a human cadaver model of CPR. Scand J Trauma Resusc Emerg Med 2021; 29:102. [PMID: 34321068 PMCID: PMC8316711 DOI: 10.1186/s13049-021-00921-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/14/2021] [Indexed: 11/22/2022] Open
Abstract
Background Previous studies have stated that hyperventilation often occurs in cardiopulmonary resuscitation (CPR) mainly due to excessive ventilation frequencies, especially when a manual valve bag is used. Transport ventilators may provide mandatory ventilation with predetermined tidal volumes and without the risk of hyperventilation. Nonetheless, interactions between chest compressions and ventilations are likely to occur. We investigated whether transport ventilators can provide adequate alveolar ventilation during continuous chest compression in adult CPR. Methods A three-period crossover study with three common transport ventilators in a cadaver model of CPR was carried out. The three ventilators ‘MEDUMAT Standard²’, ‘Oxylog 3000 plus’, and ‘Monnal T60’ represent three different interventions, providing volume-controlled continuous mandatory ventilation (VC-CMV) via an endotracheal tube with a tidal volume of 6 mL/kg predicted body weight. Proximal airflow was measured, and the net tidal volume was derived for each respiratory cycle. The deviation from the predetermined tidal volume was calculated and analysed. Several mixed linear models were calculated with the cadaver as a random factor and ventilator, height, sex, crossover period and incremental number of each ventilation within the period as covariates to evaluate differences between ventilators. Results Overall median deviation of net tidal volume from predetermined tidal volume was − 21.2 % (IQR: 19.6, range: [− 87.9 %; 25.8 %]) corresponding to a tidal volume of 4.75 mL/kg predicted body weight (IQR: 1.2, range: [0.7; 7.6]). In a mixed linear model, the ventilator model, the crossover period, and the cadaver’s height were significant factors for decreased tidal volume. The estimated effects of tidal volume deviation for each ventilator were − 14.5 % [95 %-CI: −22.5; −6.5] (p = 0.0004) for ‘Monnal T60’, − 30.6 % [95 %-CI: −38.6; −22.6] (p < 0.0001) for ‘Oxylog 3000 plus’ and − 31.0 % [95 %-CI: −38.9; −23.0] (p < 0.0001) for ‘MEDUMAT Standard²’. Conclusions All investigated transport ventilators were able to provide alveolar ventilation even though chest compressions considerably decreased tidal volumes. Our results support the concept of using ventilators to avoid excessive ventilatory rates in CPR. This experimental study suggests that healthcare professionals should carefully monitor actual tidal volumes to recognise the occurrence of hypoventilation during continuous chest compressions. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00921-2.
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Affiliation(s)
- Simon Orlob
- Division of Anaesthesiology for Cardiovascular Surgery and Intensive Care Medicine, Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria. .,Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany.
| | - Johannes Wittig
- Medical University of Graz, Auenbruggerplatz 2, 8036, Graz, Austria
| | - Christoph Hobisch
- Division of General Anaesthesiology, Emergency- and Intensive Care Medicine, Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria
| | - Daniel Auinger
- Division of General Anaesthesiology, Emergency- and Intensive Care Medicine, Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria
| | - Gabriel Honnef
- Division of General Anaesthesiology, Emergency- and Intensive Care Medicine, Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria
| | - Tobias Fellinger
- Centre for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Robin Ristl
- Centre for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Otmar Schindler
- Department of Internal and Respiratory Medicine, Intensive Care Unit Enzenbach, State Hospital Graz II, Hörgas 30, 8112, Gratwein, Austria
| | - Philipp Metnitz
- Division of General Anaesthesiology, Emergency- and Intensive Care Medicine, Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria
| | - Georg Feigl
- Division of Macroscopic and Clinical Anatomy, Medical University of Graz, Harrachgasse 21, 8010, Graz, Austria.,Institute of Morphology and Clinical Anatomy, Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Gerhard Prause
- Division of General Anaesthesiology, Emergency- and Intensive Care Medicine, Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria
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Fitz-Clarke JR. Effect of tidal volume on gas exchange during rescue ventilation. Respir Physiol Neurobiol 2019; 273:103335. [PMID: 31707007 DOI: 10.1016/j.resp.2019.103335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 10/24/2019] [Indexed: 11/25/2022]
Abstract
Tidal volume VT required for mouth-to-mouth (MTM) and bag-valve-mask (BVM) rescue ventilation remains debatable owing to differences in physiology and end-point objectives. Analysis of gas transport may clarify minimum necessary VT and its determinants. Alveolar and arterial O2 and CO2 responses to MTM and air BVM ventilation for VT between 0.4 and 1.2 liters were computed using a model of gas exchange that incorporates inspired gas concentrations, airway dead space, cardiac output, pulmonary shunt, blood gas dissociation curves, tissue compartments, and metabolic rate. Parameters were adjusted to match published human data. Steady state arterial oxygen saturation reached plateaus at VT above 0.7 liters with MTM and 0.6 liters with air ventilation at 12 breaths per minute. Increasing shunt shifted oxygenation plateaus downward, but larger tidal volumes did not improve oxygen saturation. Carbon dioxide retention occurred at VT below 2.3 liters for MTM ventilation and 0.6 liters for air ventilation. Results establish a physiological foundation for tidal volume requirements during resuscitation.
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Affiliation(s)
- John R Fitz-Clarke
- Department of Emergency Medicine, Dalhousie University, Suite 355 - 1796 Summer Street, Halifax, N.S, B3H 3A7, Canada.
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Annathurai A, Fook-Chong S, Lee S, Cheng S, Lee C, Shahidah N, Koh Z, Ong M. Use of a Load Distributing Band Device (with Ventilation Prompts) during Cardiopulmonary Resuscitation. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791502200306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Over-ventilation can compromise coronary perfusion pressures during cardiopulmonary resuscitation (CPR) and should be minimised. We compared ventilations during manual and mechanical (load-distributing band - LDB) CPR, which gives ventilation prompts. Our primary objective was to compare the ventilation rate between manual CPR and LDB-CPR. Method This was a phased, non-randomised study at a tertiary hospital emergency department. All out-of-hospital, non-traumatic cardiac arrest adult patients during the study period from February 2007 till July 2008 were eligible. Pregnant females and patients aged less than 18 years of age were excluded. Ventilation rates in the first and second 5 minutes segments were recorded. Over-ventilation was defined as ventilation rate above 12 breaths per minute. All data analyses were performed with SPSS, version 17.0. Mean differences with 95% confidence interval (CI) were compared between the 2 treatment groups. Results From February 2007 till August 2007, there were 29 patients with manual CPR; and from September 2007 till July 2008, there were 62 with LDB-CPR. In the first 5 minutes of CPR, the proportion of patients that were over-ventilated, was 27.6% (manual) and 4.8% (LDB) (difference = 22.7%; 95% CI: 3.5-46.4%). In the next 5 minutes, the proportion of patients that were over-ventilated was 37.9% and 1.6% for manual and mechanical CPR respectively (difference = 36.3%; 95% CI: 16.5-58.9%). Conclusion Over-ventilation is reduced significantly in LDB-CPR compared to manual CPR during the first and second 5 minutes of resuscitation.
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Affiliation(s)
- A Annathurai
- Singapore General Hospital, Department of Emergency Medicine, Singapore
| | | | - Sh Lee
- Seoul National University, Seoul, Korea
| | - Sy Cheng
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore
| | - C Lee
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore
| | - N Shahidah
- Singapore General Hospital, Department of Emergency Medicine, Singapore
| | - Zx Koh
- Singapore General Hospital, Department of Emergency Medicine, Singapore
| | - Meh Ong
- Singapore General Hospital, Department of Emergency Medicine, Singapore
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Perkins G, Handley A, Koster R, Castrén M, Smyth M, Olasveengen T, Monsieurs K, Raffay V, Gräsner JT, Wenzel V, Ristagno G, Soar J. [Adult basic life support and automated external defibrillation.]. Notf Rett Med 2017; 20:3-24. [PMID: 32214897 PMCID: PMC7087749 DOI: 10.1007/s10049-017-0328-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- G.D. Perkins
- Warwick Medical School, University of Warwick, Coventry, UK
- Critical Care Unit, Heart of England NHS Foundation Trust, Birmingham, UK
| | | | - R.W. Koster
- Department of Cardiology, Academic Medical Center, Amsterdam, Niederlande
| | - M. Castrén
- Department of Emergency Medicine and Services, Helsinki University Hospital and Helsinki University, Helsinki, Finnland
| | - M.A. Smyth
- Warwick Medical School, University of Warwick, Coventry, UK
- West Midlands Ambulance Service NHS Foundation Trust, Dudley, UK
| | - T. Olasveengen
- Norwegian National Advisory Unit on Prehospital Emergency Medicine and Department of Anesthesiology, Oslo University Hospital, Oslo, Norwegen
| | - K.G. Monsieurs
- Emergency Medicine, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgien
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgien
| | - V. Raffay
- Municipal Institute for Emergency Medicine Novi Sad, Novi Sad, Serbien
| | - J.-T. Gräsner
- Department of Anaesthesia and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Kiel, Deutschland
| | - V. Wenzel
- Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Österreich
| | - G. Ristagno
- Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche „Mario Negri“, Milan, Italien
| | - J. Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
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Perkins G, Handley A, Koster R, Castrén M, Smyth M, Olasveengen T, Monsieurs K, Raffay V, Gräsner JT, Wenzel V, Ristagno G, Soar J. [Adult basic life support and automated external defibrillation.]. Notf Rett Med 2015; 18:748-769. [PMID: 32214896 PMCID: PMC7088113 DOI: 10.1007/s10049-015-0081-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- G.D. Perkins
- Warwick Medical School, University of Warwick, Coventry, UK
- Critical Care Unit, Heart of England NHS Foundation Trust, Birmingham, UK
| | | | - R.W. Koster
- Department of Cardiology, Academic Medical Center, Amsterdam, Niederlande
| | - M. Castrén
- Department of Emergency Medicine and Services, Helsinki University Hospital and Helsinki University, Helsinki, Finnland
| | - M.A. Smyth
- Warwick Medical School, University of Warwick, Coventry, UK
- West Midlands Ambulance Service NHS Foundation Trust, Dudley, UK
| | - T. Olasveengen
- Norwegian National Advisory Unit on Prehospital Emergency Medicine and Department of Anesthesiology, Oslo University Hospital, Oslo, Norwegen
| | - K.G. Monsieurs
- Emergency Medicine, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgien
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgien
| | - V. Raffay
- Municipal Institute for Emergency Medicine Novi Sad, Novi Sad, Serbien
| | - J.-T. Gräsner
- Department of Anaesthesia and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Kiel, Deutschland
| | - V. Wenzel
- Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Österreich
| | - G. Ristagno
- Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche „Mario Negri“, Milan, Italien
| | - J. Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
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8
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European Resuscitation Council Guidelines for Resuscitation 2015: Section 2. Adult basic life support and automated external defibrillation. Resuscitation 2015; 95:81-99. [PMID: 26477420 DOI: 10.1016/j.resuscitation.2015.07.015] [Citation(s) in RCA: 722] [Impact Index Per Article: 80.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Ahn HJ, Kim KD, Jeong WJ, Lee JW, Yoo IS, Ryu S. The Adequacy of a Conventional Mechanical Ventilator as a Ventilation Method during Cardiopulmonary Resuscitation: A Manikin Study. Korean J Crit Care Med 2015. [DOI: 10.4266/kjccm.2015.30.2.89] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Kill C, Galbas M, Neuhaus C, Hahn O, Wallot P, Kesper K, Wulf H, Dersch W. Chest Compression Synchronized Ventilation versus Intermitted Positive Pressure Ventilation during Cardiopulmonary Resuscitation in a Pig Model. PLoS One 2015; 10:e0127759. [PMID: 26011525 PMCID: PMC4444197 DOI: 10.1371/journal.pone.0127759] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 04/19/2015] [Indexed: 12/02/2022] Open
Abstract
Background Guidelines recommend mechanical ventilation with Intermitted Positive Pressure Ventilation (IPPV) during resuscitation. The influence of the novel ventilator mode Chest Compression Synchronized Ventilation (CCSV) on gas exchange and arterial blood pressure compared with IPPV was investigated in a pig model. Methods In 12 pigs (general anaesthesia/intubation) ventricular fibrillation was induced and continuous chest compressions were started after 3min. Pigs were mechanically ventilated in a cross-over setting with 5 ventilation periods of 4min each: Ventilation modes were during the first and last period IPPV (100% O2, tidalvolumes = 7ml/kgKG, respiratoryrate = 10/min), during the 2nd, 3rd and 4th period CCSV (100% O2), a pressure-controlled and with each chest compression synchronized breathing pattern with three different presets in randomized order. Presets: CCSVA: Pinsp = 60mbar, inspiratorytime = 205ms; CCSVB: Pinsp = 60mbar, inspiratorytime = 265ms; CCSVC: Pinsp = 45mbar, inspiratorytime = 265ms. Blood gas samples were drawn for each period, mean arterial (MAP) and centralvenous (CVP) blood pressures were continuously recorded. Results as median (25%/75%percentiles). Results Ventilation with each CCSV mode resulted in higher PaO2 than IPPV: PaO2: IPPVfirst: 19.6(13.9/36.2)kPa, IPPVlast: 22.7(5.4/36.9)kPa (p = 0.77 vs IPPVfirst), CCSVA: 48.9(29.0/58.2)kPa (p = 0.028 vs IPPVfirst, p = 0.0001 vs IPPVlast), CCSVB: 54.0 (43.8/64.1) (p = 0.001 vs IPPVfirst, p = 0.0001 vs IPPVlast), CCSVC: 46.0 (20.2/58.4) (p = 0.006 vs IPPVfirst, p = 0.0001 vs IPPVlast). Both the MAP and the difference MAP-CVP did not decrease during twelve minutes CPR with all three presets of CCSV and were higher than the pressures of the last IPPV period. Conclusions All patterns of CCSV lead to a higher PaO2 and avoid an arterial blood pressure drop during resuscitation compared to IPPV in this pig model of cardiac arrest.
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Affiliation(s)
- Clemens Kill
- Department of Anesthesiology and Critical Care, Philipps-University, Marburg, Germany
- Department of Emergency Medicine, Philipps-University, Marburg, Germany
- * E-mail:
| | - Monika Galbas
- Department of Anesthesiology and Critical Care, Philipps-University, Marburg, Germany
| | | | - Oliver Hahn
- Department of Anesthesiology and Critical Care, Philipps-University, Marburg, Germany
| | - Pascal Wallot
- Department of Anesthesiology and Critical Care, Philipps-University, Marburg, Germany
| | - Karl Kesper
- Department of Internal Medicine, Section Respiratory Diseases, Philipps-University, Marburg, Germany
| | - Hinnerk Wulf
- Department of Anesthesiology and Critical Care, Philipps-University, Marburg, Germany
| | - Wolfgang Dersch
- Department of Anesthesiology and Critical Care, Philipps-University, Marburg, Germany
- Department of Emergency Medicine, Philipps-University, Marburg, Germany
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Mechanical ventilation during cardiopulmonary resuscitation with intermittent positive-pressure ventilation, bilevel ventilation, or chest compression synchronized ventilation in a pig model. Crit Care Med 2014; 42:e89-95. [PMID: 24158168 DOI: 10.1097/ccm.0b013e3182a63fa0] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Mechanical ventilation with an automated ventilator is recommended during cardiopulmonary resuscitation with a secured airway. We investigated the influence of intermittent positive-pressure ventilation, bilevel ventilation, and the novel ventilator mode chest compression synchronized ventilation, a pressure-controlled ventilation triggered by each chest compression, on gas exchange, hemodynamics, and return of spontaneous circulation in a pig model. DESIGN Animal study. SETTING University laboratory. SUBJECTS Twenty-four three-month-old female domestic pigs. INTERVENTIONS The study was performed on pigs under general anesthesia with endotracheal intubation. Arterial and central venous catheters were inserted and IV rocuronium (1 mg/kg) was injected. After 3 minutes of cardiac arrest (ventricular fibrillation at t = 0 min), animals were randomized into intermittent positive-pressure ventilation (control group), bilevel, or chest compression synchronized ventilation group. Following 10 minute uninterrupted chest compressions and mechanical ventilation, advanced life support was performed (100% O2, up to six defibrillations, vasopressors). MEASUREMENTS AND MAIN RESULTS Blood gas samples were drawn at 0, 4 and 13 minutes. At 13 minutes, hemodynamics was analyzed beat-to-beat in the end-inspiratory and end-expiratory cycle comparing the IPPV with the bilevel group and the CCSV group. Data were analyzed with the Mann-Whitney U test. Return of spontaneous circulation was achieved in five of eight (intermittent positive-pressure ventilation), six of eight (bilevel), and four of seven (chest compression synchronized ventilation) pigs. The results of arterial blood gas analyses at t = 4 minutes and t = 13 minutes (torr) were as follows: PaO2 intermittent positive-pressure ventilation, 143 (76/256) and 262 (81/340); bilevel, 261 (109/386) (p = 0.195 vs intermittent positive-pressure ventilation) and 236 (86/364) (p = 0.878 vs intermittent positive-pressure ventilation); and chest compression synchronized ventilation, 598 (471/650) (p < 0.001 vs intermittent positive-pressure ventilation) and 634 (115/693) (p = 0.054 vs intermittent positive-pressure ventilation); PaCO2 intermittent positive-pressure ventilation, 40 (38/43) and 45 (36/52); bilevel, 39 (35/41) (p = 0.574 vs intermittent positive-pressure ventilation) and 46 (42/49) (p = 0.798); and chest compression synchronized ventilation, 28 (27/32) (p = 0.001 vs intermittent positive-pressure ventilation) and 26 (18/29) (p = 0.004); mixed venous pH intermittent positive-pressure ventilation, 7.34 (7.31/7.35) and 7.26 (7.25/7.31); bilevel, 7.35 (7.29/7.37) (p = 0.645 vs intermittent positive-pressure ventilation) and 7.27 (7.17/7.31) (p = 0.645 vs intermittent positive-pressure ventilation); and chest compression synchronized ventilation, 7.34 (7.33/7.39) (p = 0.189 vs intermittent positive-pressure ventilation) and 7.35 (7.34/7.36) (p = 0.006 vs intermittent positive-pressure ventilation). Mean end-inspiratory and end-expiratory arterial pressures at t = 13 minutes (mm Hg) were as follows: intermittent positive-pressure ventilation, 28.0 (25.0/29.6) and 27.9 (24.4/30.0); bilevel, 29.1 (25.6/37.1) (p = 0.574 vs intermittent positive-pressure ventilation) and 28.7 (24.2/36.5) (p = 0.721 vs intermittent positive-pressure ventilation); and chest compression synchronized ventilation, 32.7 (30.4/33.4) (p = 0.021 vs intermittent positive-pressure ventilation) and 27.0 (24.5/27.7) (p = 0.779 vs intermittent positive-pressure ventilation). CONCLUSIONS Both intermittent positive-pressure ventilation and bilevel provided similar oxygenation and ventilation during cardiopulmonary resuscitation. Chest compression synchronized ventilation elicited the highest mean arterial pressure, best oxygenation, and a normal mixed venous pH during cardiopulmonary resuscitation.
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Smyth M, Perkins GD. How do we integrate man with machine in our resuscitation efforts? Resuscitation 2013; 84:1159-60. [PMID: 23968679 DOI: 10.1016/j.resuscitation.2013.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hopper K, Epstein SE, Fletcher DJ, Boller M. RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 3: Basic life support. J Vet Emerg Crit Care (San Antonio) 2012; 22 Suppl 1:S26-43. [DOI: 10.1111/j.1476-4431.2012.00753.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Kate Hopper
- School of Veterinary Medicine; Department of Veterinary Surgical and Radiological Sciences; University of California at Davis; Davis; CA
| | - Steven E. Epstein
- School of Veterinary Medicine; Department of Veterinary Surgical and Radiological Sciences; University of California at Davis; Davis; CA
| | - Daniel J. Fletcher
- College of Veterinary Medicine; Department of Clinical Sciences; Cornell University; Ithaca; NY
| | - Manuel Boller
- Department of Clinical Studies; School of Veterinary Medicine; and the Department of Emergency Medicine; School of Medicine; Center for Resuscitation Science University of Pennsylvania; Philadelphia; PA
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Comparison of manually triggered ventilation and bag-valve-mask ventilation during cardiopulmonary resuscitation in a manikin model. Resuscitation 2011; 83:488-93. [PMID: 21958929 DOI: 10.1016/j.resuscitation.2011.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Revised: 09/06/2011] [Accepted: 09/08/2011] [Indexed: 01/22/2023]
Abstract
BACKGROUND To compare a novel, pressure-limited, flow adaptive ventilator that enables manual triggering of ventilations (MEDUMAT Easy CPR, Weinmann, Germany) with a bag-valve-mask (BVM) device during simulated cardiac arrest. METHODS Overall 74 third-year medical students received brief video instructions (BVM: 57s, ventilator: 126s), standardised theoretical instructions and practical training for both devices. Four days later, the students were randomised into 37 two-rescuer teams and were asked to perform 8min of cardiopulmonary resuscitation (CPR) on a manikin using either the ventilator or the BVM (randomisation list). Applied tidal volumes (V(T)), inspiratory times and hands-off times were recorded. Maximum airway pressures (P(max)) were measured with a sensor connected to the artificial lung. Questionnaires concerning levels of fatigue, stress and handling were evaluated. V(T), pressures and hands-off times were compared using t-tests, questionnaire data were analysed using the Wilcoxon test. RESULTS BVM vs. ventilator (mean±SD): the mean V(T) (408±164ml vs. 315±165ml, p=0.10) and the maximum V(T) did not differ, but the number of recorded V(T)<200ml differed (8.1±11.3 vs. 17.0±14.4 ventilations, p=0.04). P(max) did not differ, but inspiratory times (0.80±0.23s vs. 1.39±0.31s, p<0.001) and total hands-off times (133.5±17.8s vs. 162.0±11.1s, p<0.001) did. The estimated levels of fatigue and stress were comparable; however, the BVM was rated to be easier to use (p=0.03). CONCLUSION For the user group investigated here, this ventilator exhibits no advantages in the setting of simulated CPR and carries a risk of prolonged no-flow time.
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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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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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Odendaal CL. Cardiopulmonary-cerebral resuscitation. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2010. [DOI: 10.1080/22201173.2010.10872665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Yeh ST, Cawley RJ, Aune SE, Angelos MG. Oxygen requirement during cardiopulmonary resuscitation (CPR) to effect return of spontaneous circulation. Resuscitation 2009; 80:951-5. [DOI: 10.1016/j.resuscitation.2009.05.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Revised: 04/21/2009] [Accepted: 05/04/2009] [Indexed: 10/20/2022]
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SOS-KANTO study group. Comparison of Arterial Blood Gases of Laryngeal Mask Airway and Bag-Valve-Mask Ventilation in Out-of-Hospital Cardiac Arrests. Circ J 2009; 73:490-6. [DOI: 10.1253/circj.cj-08-0874] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- SOS-KANTO study group
- Members and investigaters who participated in the SOS-KANTO are listed in Appendix 1
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Berlac P, Hyldmo PK, Kongstad P, Kurola J, Nakstad AR, Sandberg M. Pre-hospital airway management: guidelines from a task force from the Scandinavian Society for Anaesthesiology and Intensive Care Medicine. Acta Anaesthesiol Scand 2008; 52:897-907. [PMID: 18702752 DOI: 10.1111/j.1399-6576.2008.01673.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This article is intended as a generic guide to evidence-based airway management for all categories of pre-hospital personnel. It is based on a review of relevant literature but the majority of the studies have not been performed under realistic, pre-hospital conditions and the recommendations are therefore based on a low level of evidence (D). The advice given depends on the qualifications of the personnel available in a given emergency medical service (EMS). Anaesthetic training and routine in anaesthesia and neuromuscular blockade is necessary for the use of most techniques in the treatment of patients with airway reflexes. For anaesthesiologists, the Task Force commissioned by the Scandinavian Society of Anaesthesia and Intensive Care Medicine recommends endotracheal intubation (ETI) following rapid sequence induction when securing the pre-hospital airway, although repeated unsuccessful intubation attempts should be avoided independent of formal qualifications. Other physicians, as well as paramedics and other EMS personnel, are recommended the lateral trauma recovery position as a basic intervention combined with assisted mask-ventilation in trauma patients. When performing advanced cardiopulmonary resuscitation, we recommend that non-anaesthesiologists primarily use a supraglottic airway device. A supraglottic device such as the laryngeal tube or the intubation laryngeal mask should also be available as a backup device for anaesthesiologists in failed ETI.
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Affiliation(s)
- P Berlac
- Copenhagen Mobile Intensive Care Unit, Rigshospitalet, Capital Region of Denmark, Copenhagen, Denmark
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21
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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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Yannopoulos D, Aufderheide T. Acute management of sudden cardiac death in adults based upon the new CPR guidelines. ACTA ACUST UNITED AC 2007; 9:2-9. [PMID: 17224415 DOI: 10.1093/europace/eul126] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
PURPOSE OF THE REVIEW The aim of this article is to provide a comprehensive description of interventions that can improve outcomes in adults with sudden cardiac death. The new American Heart Association 2005 Guidelines introduced a number of changes for the initial management of cardiorespiratory arrest based on new data that accumulated over the last 5 years. ACUTE MANAGEMENT OF SUDDEN CARDIAC DEATH Appropriate interventions targeting the three phases of cardiopulmonary resuscitation (CPR) (electrical, circulatory, and metabolic) should be implemented. Early defibrillation in early witnessed arrest with one shock is very effective and can improve survival outcomes. When resuscitation efforts are delayed and CPR is performed by paramedics, 2 min of CPR before shock is recommended. Emphasis has been placed on fast and forceful continuous compressions with minimal interruptions, adequate decompression, and decrease in the rate of ventilations to 8-10/min for intubated patients with two rescuers and a universal increase in compression to ventilation ratio to 30:2 for lone rescuers. Mechanical adjuncts to improve circulation have been adapted in the recommendations. The inspiratory impedance threshold device that enhances negative intrathoracic pressure and improves venous preload has been recommended for application in intubated and bag-mask ventilated patients. Owing to the difficulty of endotracheal intubation, airway management devices (Combitube and Laryngeal Mask Airway) can be used as alternatives with minimal extra training. CONCLUSION The new guidelines for CPR have focused on early defibrillation, uninterrupted compressions, complete decompression, fewer ventilations, and simplification and uniformity of the process.
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Affiliation(s)
- Demetris Yannopoulos
- Department of Medicine, Division of Cardiology, University of Minnesota, 2800 Hamline Avenue North No. 211, Roseville, MN 55113, USA.
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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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Ibrahim W, Gehani AA. Insight into the New Changes in European Resuscitation Council Guidelines for Adult Resuscitation (2005). Qatar Med J 2005. [DOI: 10.5339/qmj.2005.2.6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
It is five years now since the last European resuscitation guidelines were published(1). The science of resuscitation has been enriched with further significant scientific evidence that has led to new evidence-based guidelines. These guidelines were released in November 2005 and published in the international Journal of Resuscitation, November 2005(2).
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Affiliation(s)
- W. Ibrahim
- *Pulmonary Medicine Section, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - A. A. Gehani
- **Cardiology and Cardiovascular Surgery Department, Hamad Medical Corporation, Doha, Qatar
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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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Affiliation(s)
- Gordon A Ewy
- University of Arizona Sarver Heart Center, University of Arizona, Tucson, Ariz 85724, USA.
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