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Fritz C, Jaeger D, Luo Y, Lardenois E, Badat B, Roquet FE, Rigollot M, Kimmoun A, Tran N'G, Richard JCM, Chouihed T, Levy B. IMPACT OF DIFFERENT VENTILATION STRATEGIES ON GAS EXCHANGES AND CIRCULATION DURING PROLONGED MECHANICAL CARDIO-PULMONARY RESUSCITATION IN A PORCINE MODEL. Shock 2022; 58:119-127. [PMID: 34710880 DOI: 10.1097/shk.0000000000001880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Background: Optimal ventilation during cardio-pulmonary resuscitation (CPR) is still controversial. Ventilation is expected to provide sufficient arterial oxygen content and adequate carbon dioxide removal, while minimizing the risk of circulatory impairment. The objective of the present study was to compare three ventilation strategies in a porcine model during mechanical continuous chest compressions (CCC) according to arterial oxygenation and hemodynamic impact. Method: Ventricular fibrillation was induced and followed by five no-flow minutes and thirty low-flow minutes resuscitation with mechanical-CCC without vasopressive drugs administration. Three groups of eight Landras pig were randomized according to the ventilation strategy: 1. Standard nonsynchronized volume-control mode (SD-group); 2. synchronized bilevel pressure-controlled ventilation (CPV-group); 3. continuous insufflation with Boussignac Cardiac-Arrest Device (BC-group). We assessed 1. arterial blood gases, 2. macro hemodynamics, 3. tissular cerebral macro and micro-circulation and 4. airway pressure, minute ventilation at baseline and every 5 minutes during the protocol. Results: Arterial PaO2 level was higher at each measurement time in SD-group (>200 mm Hg) compare to CPV-group and BC-group ( P < 0.01). In BC-group, arterial PaCO2 level was significantly higher (>90mm Hg) than in SD and CPV groups ( P < 0.01). There was no difference between groups concerning hemodynamic parameters, cerebral perfusion and microcirculation. Conclusion: Ventilation modalities in this porcine model of prolonged CPR influence oxygenation and decarboxylation without impairing circulation and cerebral perfusion. Synchronized bi-level pressure-controlled ventilation' use avoid hyperoxia and was as efficient as asynchronized volume ventilation to maintain alveolar ventilation and systemic perfusion during prolonged CPR.
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Groulx M, Emond M, Boudreau-Drouin F, Cournoyer A, Nadeau A, Blanchard PG, Mercier E. Continuous flow insufflation of oxygen for cardiac arrest: Systematic review of human and animal model studies. Resuscitation 2021; 162:292-303. [PMID: 33766663 DOI: 10.1016/j.resuscitation.2021.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/26/2021] [Accepted: 03/10/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To synthetize the evidence regarding the effect of constant flow insufflation of oxygen (CFIO) on the rate of return of spontaneous circulation (ROSC) and other clinical outcomes during cardiac arrest (CA). METHODS A systematic review was performed using four databases (PROSPERO: CRD42020071960). Studies reporting on adult CA patients or on animal models simulating CA and assessing the effect of CFIO on ROSC or other clinical outcomes were considered. RESULTS A total of 3540 citations were identified, of which 16 studies were included. Four studies (two randomized controlled trials (RCT), two cohort studies), reported on humans while 12 studies used animal models. No meta-analysis was performed due to clinical heterogeneity. There were no differences in the ROSC (18.9% vs 20.8%, p = 0.99; 27.1% vs 21.3%, p = 0.51) and sustained ROSC rates (16.1% vs 17.3%, p = 0.81; 12.5% vs 14.9%, p = 0.73) with CFIO compared to intermitant positive pressure ventilation (IPPV) in the two human RCTs. Survival to ICU discharge was similar between CFIO (2.3%) and IPPV (2.3%) in the largest RCT (p = 0.96). Human studies were at serious or high risk of bias. In animal models' studies, ROSC rates were presented in seven RCTs. CFIO was superior to IPPV in one trial, but was associated with similar ROSC rates using different ventilation strategies in the remaining six studies. CONCLUSIONS No definitive association between CFIO and ROSC, sustained ROSC or survival compared to other ventilation strategies could be demonstrated. Future studies should assess CFIO effect on post-survival neurological functions and patient-important CA outcomes.
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Affiliation(s)
- Mathieu Groulx
- Faculté de Médecine, Université Laval, Québec, Canada; Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
| | - Marcel Emond
- Faculté de Médecine, Université Laval, Québec, Canada; Centre de recherche du CHU de Québec-Université Laval, Québec, Canada; VITAM - Centre de recherche en santé durable de l'Université Laval, Québec, Canada
| | - Felix Boudreau-Drouin
- Faculté de Médecine, Université Laval, Québec, Canada; VITAM - Centre de recherche en santé durable de l'Université Laval, Québec, Canada
| | - Alexis Cournoyer
- Faculté de médecine, Université de Montréal, Québec, Canada; Département de médecine d'urgence, Hôpital du Sacré-Cœur, Montréal, Québec, Canada; Département de médecine d'urgence, Hôpital Maisonneuve-Rosemont, Montréal, Canada
| | - Alexandra Nadeau
- VITAM - Centre de recherche en santé durable de l'Université Laval, Québec, Canada
| | - Pierre-Gilles Blanchard
- Faculté de Médecine, Université Laval, Québec, Canada; VITAM - Centre de recherche en santé durable de l'Université Laval, Québec, Canada
| | - Eric Mercier
- Faculté de Médecine, Université Laval, Québec, Canada; Centre de recherche du CHU de Québec-Université Laval, Québec, Canada; VITAM - Centre de recherche en santé durable de l'Université Laval, Québec, Canada.
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The Effect of a Modified Constant Flow Insufflation of Oxygen during Cardiopulmonary Resuscitation in a Rat Model of Respiratory Cardiac Arrest on Arterial Oxygenation, Alveolar Barotrauma, and Brain Tissue Injury. Emerg Med Int 2020; 2020:8913571. [PMID: 32318293 PMCID: PMC7150730 DOI: 10.1155/2020/8913571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/12/2019] [Accepted: 02/14/2020] [Indexed: 11/28/2022] Open
Abstract
Aim Intermittent positive pressure ventilation (IPPV) can adversely affect cardiopulmonary resuscitation outcomes by increasing the intrathoracic pressure. Continuous flow insufflation of oxygen (CFIO) has been investigated as a potential alternative, but evidence supporting its superiority over intermittent positive pressure ventilation in cases of cardiac arrest is scant. The aim of the current study was to compare the effects of continuous flow insufflation of oxygen using a one-way valve during cardiopulmonary-resuscitation with intermittent positive pressure ventilation in a rat model of respiratory arrest. Methods Male Sprague-Dawley rats weighing 400∼450 g (from minimum to maximum) were randomly assigned to either a sham, IPPV, or CFIO group (n = 10 per group). Respiratory arrest was induced by blocking the endotracheal tube. Arterial blood gas analysis was performed during cardiopulmonary resuscitation to compare the oxygenation levels. Tissues were then harvested to compare the degrees of pulmonary barotrauma and ischemic brain injury. Results Return of spontaneous circulation was observed in 6/10 rats in the IPPV group and 5/10 in the CFIO group. During cardiopulmonary resuscitation, the mean PaO2 was significantly higher in the CFIO group (83.10 mmHg) than in the IPPV group (56.10 mmHg). Lung biopsy revealed more inflammatory cells and marked thickening of the alveolar wall in the IPPV group; the group also exhibited a higher frequency of neuroglial cells and apoptotic bodies of pyramidal cells, resulting from ischemic injury. Conclusion In a rat model of respiratory arrest, CFIO using a one-way valve resulted in a greater level of oxygenation and less lung and brain injuries than with IPPV.
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Cordioli RL, Grieco DL, Charbonney E, Richard JC, Savary D. New physiological insights in ventilation during cardiopulmonary resuscitation. Curr Opin Crit Care 2020; 25:37-44. [PMID: 30531537 DOI: 10.1097/mcc.0000000000000573] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW In the setting of cardiopulmonary resuscitation (CPR), classical physiological concept about ventilation become challenging. Ventilation may exert detrimental hemodynamic effects that must be balanced with its expected benefits. The risks of hyperventilation have been thoroughly addressed, even questioning the need for ventilation, emphasizing the need to prioritize chest compression quality. However, ventilation is mandatory for adequate gas exchange as soon as CPR is prolonged. Factors affecting the capability of chest compressions to produce alveolar ventilation are poorly understood. In this review, we discuss the conventional interpretation of interactions between ventilation and circulation, from the perspective of novel physiological observations. RECENT FINDINGS Many patients with cardiac arrest exhibit 'intrathoracic airway closure.' This phenomenon is associated with lung volume reduction, impedes chest compressions to generate ventilation and overall limits the delivered ventilation. This phenomenon can be reversed by the application of small levels of positive end-expiratory pressure. Also, a novel interpretation of the capnogram can rate the magnitude of this phenomenon, contributing to clarify the physiological meaning of exhaled CO2 and may help assess the real amount of delivered ventilation. SUMMARY Recent advances in the understanding of ventilatory physiology during CPR shows that capnogram analysis not only provides information on the quality of resuscitation but also on the amount of ventilation produced by chest compressions and on the total amount of ventilation.
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Affiliation(s)
- Ricardo L Cordioli
- Department of Critical Care, Intensive Care Unit, Israelita Hospital Albert Einstein.,Department of Critical Care, Intensive Care Unit, Alemao Hospital Oswaldo Cruz Sao Paulo, Sao Paulo, Brazil
| | - Domenico L Grieco
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Emmanuel Charbonney
- Université de Montréal, Montreal, Canada.,Laboratoire d'anatomie, Université du Québec à Trois-Rivières (UQTR)
| | - Jean-Christophe Richard
- SAMU74, Emergency Department, General Hospital of Annecy, Annecy.,INSERM UMR 1066, Creteil, France
| | - Dominique Savary
- SAMU74, Emergency Department, General Hospital of Annecy, Annecy
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Okuma Y, Shinozaki K, Yagi T, Saeki K, Yin T, Kim J, Becker LB. Combination of cardiac and thoracic pump theories in rodent cardiopulmonary resuscitation: a new method of three-side chest compression. Intensive Care Med Exp 2019; 7:62. [PMID: 31792731 PMCID: PMC6889262 DOI: 10.1186/s40635-019-0275-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 10/15/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND High-quality cardiopulmonary resuscitation (HQ-CPR) is of paramount importance to improve neurological outcomes of cardiac arrest (CA). The purpose of this study was to evaluate chest compression methods by combining two theories: cardiac and thoracic pumps. METHODS Male Sprague-Dawley rats were used. Three types of chest compression methods were studied. The 1-side method was performed vertically with 2 fingers over the sternum. The 2-side method was performed horizontally with 2 fingers, bilaterally squeezing the chest wall. The 3-side method combined the 1-side and the 2-side methods. Rats underwent 10 min of asphyxial CA. We examined ROSC rates, the left ventricular functions, several arterial pressures, intrathoracic pressure, and brain tissue oxygen. RESULTS The 3-side group achieved 100% return of spontaneous circulation (ROSC) from asphyxial CA, while the 1-side group and 2-side group achieved 80% and 60% ROSC, respectively. Three-side chest compression significantly shortened the time for ROSC among the groups (1-side, 105 ± 36.0; 2-side, 141 ± 21.7; 3-side, 57.8 ± 12.3 s, respectively, P < 0.05). Three-side significantly increased the intrathoracic pressure (esophagus, 7.6 ± 1.9, 7.3 ± 2.8, vs. 12.7 ± 2.2; mmHg, P < 0.01), the cardiac stroke volume (the ratio of the baseline 1.2 ± 0.6, 1.3 ± 0.1, vs. 2.1 ± 0.6, P < 0.05), and the common carotid arterial pressure (subtracted by femoral arterial pressure 4.0 ± 2.5, 0.3 ± 1.6, vs. 8.4 ± 2.6; mmHg, P < 0.01). Three-side significantly increased the brain tissue oxygen (the ratio of baseline 1.4±0.1, 1.3±0.2, vs. 1.6 ± 0.04, P < 0.05). CONCLUSIONS These results suggest that increased intrathoracic pressure by 3-side CPR improves the cardiac output, which may in turn help brain oxygenation during CPR.
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Affiliation(s)
- Yu Okuma
- The Feinstein Institute for Medical Research, Northwell Health System, 350 Community Dr. Manhasset, Manhasset, NY, 11030, USA
| | - Koichiro Shinozaki
- The Feinstein Institute for Medical Research, Northwell Health System, 350 Community Dr. Manhasset, Manhasset, NY, 11030, USA. .,Department of Emergency Medicine, North Shore University Hospital/Long Island Jewish Medical Center, Northwell Health System, Manhasset, NY, USA.
| | - Tsukasa Yagi
- The Feinstein Institute for Medical Research, Northwell Health System, 350 Community Dr. Manhasset, Manhasset, NY, 11030, USA
| | - Kota Saeki
- Nihon Kohden Innovation Center, Cambridge, MA, USA
| | - Tai Yin
- The Feinstein Institute for Medical Research, Northwell Health System, 350 Community Dr. Manhasset, Manhasset, NY, 11030, USA
| | - Junhwan Kim
- The Feinstein Institute for Medical Research, Northwell Health System, 350 Community Dr. Manhasset, Manhasset, NY, 11030, USA
| | - Lance B Becker
- The Feinstein Institute for Medical Research, Northwell Health System, 350 Community Dr. Manhasset, Manhasset, NY, 11030, USA.,Department of Emergency Medicine, North Shore University Hospital/Long Island Jewish Medical Center, Northwell Health System, Manhasset, NY, USA
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Lyons C, Callaghan M. Uses and mechanisms of apnoeic oxygenation: a narrative review. Anaesthesia 2019; 74:497-507. [DOI: 10.1111/anae.14565] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2018] [Indexed: 12/31/2022]
Affiliation(s)
- C. Lyons
- Department of Anaesthesia; Mater Misericordiae University Hospital; Dublin Ireland
| | - M. Callaghan
- Department of Anaesthesia; Galway University Hospitals; Galway Ireland
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Moore JC, Holley J, Segal N, Lick MC, Labarère J, Frascone RJ, Dodd KW, Robinson AE, Lick C, Klein L, Ashton A, McArthur A, Tsangaris A, Makaretz A, Makaretz M, Debaty G, Pepe PE, Lurie KG. Consistent head up cardiopulmonary resuscitation haemodynamics are observed across porcine and human cadaver translational models. Resuscitation 2018; 132:133-139. [DOI: 10.1016/j.resuscitation.2018.04.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/16/2018] [Accepted: 04/09/2018] [Indexed: 10/17/2022]
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9
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Charbonney E, Delisle S, Savary D, Bronchti G, Rigollot M, Drouet A, Badat B, Ouellet P, Gosselin P, Mercat A, Brochard L, Richard JCM. A new physiological model for studying the effect of chest compression and ventilation during cardiopulmonary resuscitation: The Thiel cadaver. Resuscitation 2018; 125:135-142. [PMID: 29317351 DOI: 10.1016/j.resuscitation.2018.01.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 12/03/2017] [Accepted: 01/05/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Studying ventilation and intrathoracic pressure (ITP) induced by chest compressions (CC) during Cardio Pulmonary Resuscitation is challenging and important aspects such as airway closure have been mostly ignored. We hypothesized that Thiel Embalmed Cadavers could constitute an appropriate model. METHODS We assessed respiratory mechanics and ITP during CC in 11 cadavers, and we compared it to measurements obtained in 9 out-of-hospital cardiac arrest patients and to predicted values from a bench model. An oesophageal catheter was inserted to assess chest wall compliance, and ITP variation (ΔITP). Airway pressure variation (ΔPaw) at airway opening and ΔITP generated by CC were measured at decremental positive end expiratory pressure (PEEP) to test its impact on flow and ΔPaw. The patient's data were derived from flow and airway pressure captured via the ventilator during resuscitation. RESULTS Resistance and Compliance of the respiratory system were comparable to those of the out-of-hospital cardiac arrest patients (CRSTEC 42 ± 12 vs CRSPAT 37.3 ± 10.9 mL/cmH2O and ResTEC 17.5 ± 7.5 vs ResPAT 20.2 ± 5.3 cmH2O/L/sec), and remained stable over time. During CC, ΔITP varied from 32 ± 12 cmH2O to 69 ± 14 cmH2O with manual and automatic CC respectively. Transmission of ΔITP at the airway opening was significantly affected by PEEP, suggesting dynamic small airway closure at low lung volumes. This phenomenon was similarly observed in patients. CONCLUSION Respiratory mechanics and dynamic pressures during CC of cadavers behave as predicted by a theoretical model and similarly to patients. The Thiel model is a suitable to assess ITP variations induced by ventilation during CC.
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Affiliation(s)
- Emmanuel Charbonney
- Centre de Recherche de l 'Hôpital du Sacré-cœur de Montréal, Montreal, Canada; Département de médecine, Faculté de Médecine Université de Montréal, Montreal, Canada; Laboratoire d'anatomie, Université du Québec à Trois-Rivières (UQTR) et CIUSSS MCQ, Trois-Rivières, Canada.
| | - Stéphane Delisle
- Centre de Recherche du Centre Hospitalier Universitaire de Montréal (CHUM), Montreal, Canada
| | - Dominique Savary
- SAMU74, Emergency Department, General Hospital of Annecy, Annecy, France
| | - Gilles Bronchti
- Laboratoire d'anatomie, Université du Québec à Trois-Rivières (UQTR) et CIUSSS MCQ, Trois-Rivières, Canada
| | | | - Adrien Drouet
- SAMU74, Emergency Department, General Hospital of Annecy, Annecy, France
| | | | - Paul Ouellet
- Vitalité Health Network, North West Zone, Edmundston and Department of surgery, Université de Sherbrooke, Sherbrooke, Canada
| | | | - Alain Mercat
- Critical Care Department, Angers University Hospital, Angers, France
| | - Laurent Brochard
- Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute,St. Michael's Hospital, Toronto, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Jean-Christophe M Richard
- SAMU74, Emergency Department, General Hospital of Annecy, Annecy, France; INSERM UMR 955, Créteil, France
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Peschanski N, Gillis M, Oudet J, Depil-Duval A, Chouihed T. Don't kill passive oxygenation with continuous oxygen insufflation too fast in cardiac arrest ventilation. Resuscitation 2017; 121:e3-e4. [DOI: 10.1016/j.resuscitation.2017.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
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Moore JC, Lamhaut L, Debaty G, Segal N. Reply to: Don't kill passive oxygenation with continuous oxygen insufflation too fast in cardiac arrest ventilation. Resuscitation 2017; 121:e5-e6. [PMID: 28986180 DOI: 10.1016/j.resuscitation.2017.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 10/01/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Johanna C Moore
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA; Department of Emergency Medicine, University of Minnesota, Minneapolis, MN, USA.
| | - Lionel Lamhaut
- Emergency Medical Services, SAMU 75, Necker Hospital, APHP, Université Paris Descartes, INSERM U970 Sudden Death Expertise Center, Paris, France
| | - Guillaume Debaty
- University Grenoble Alps/CNRS/CHU de Grenoble Alpes/TIMC-IMAG UMR 5525, Grenoble, France
| | - Nicolas Segal
- Department of Emergency Medicine, University of Minnesota, Minneapolis, MN, USA.
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