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Azcarate I, Urigüen JA, Leturiondo M, Sandoval CL, Redondo K, Gutiérrez JJ, Russell JK, Wallmüller P, Sterz F, Daya MR, Ruiz de Gauna S. The Role of Chest Compressions on Ventilation during Advanced Cardiopulmonary Resuscitation. J Clin Med 2023; 12:6918. [PMID: 37959385 PMCID: PMC10647836 DOI: 10.3390/jcm12216918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/25/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
Background: There is growing interest in the quality of manual ventilation during cardiopulmonary resuscitation (CPR), but accurate assessment of ventilation parameters remains a challenge. Waveform capnography is currently the reference for monitoring ventilation rate in intubated patients, but fails to provide information on tidal volumes and inspiration-expiration timing. Moreover, the capnogram is often distorted when chest compressions (CCs) are performed during ventilation compromising its reliability during CPR. Our main purpose was to characterize manual ventilation during CPR and to assess how CCs may impact on ventilation quality. Methods: Retrospective analysis were performed of CPR recordings fromtwo databases of adult patients in cardiac arrest including capnogram, compression depth, and airway flow, pressure and volume signals. Using automated signal processing techniques followed by manual revision, individual ventilations were identified and ventilation parameters were measured. Oscillations on the capnogram plateau during CCs were characterized, and its correlation with compression depth and airway volume was assessed. Finally, we identified events of reversed airflow caused by CCs and their effect on volume and capnogram waveform. Results: Ventilation rates were higher than the recommended 10 breaths/min in 66.7% of the cases. Variability in ventilation rates correlated with the variability in tidal volumes and other ventilatory parameters. Oscillations caused by CCs on capnograms were of high amplitude (median above 74%) and were associated with low pseudo-volumes (median 26 mL). Correlation between the amplitude of those oscillations with either the CCs depth or the generated passive volumes was low, with correlation coefficients of -0.24 and 0.40, respectively. During inspiration and expiration, reversed airflow events caused opposed movement of gases in 80% of ventilations. Conclusions: Our study confirmed lack of adherence between measured ventilation rates and the guideline recommendations, and a substantial dispersion in manual ventilation parameters during CPR. Oscillations on the capnogram plateau caused by CCs did not correlate with compression depth or associated small tidal volumes. CCs caused reversed flow during inspiration, expiration and in the interval between ventilations, sufficient to generate volume changes and causing oscillations on capnogram. Further research is warranted to assess the impact of these findings on ventilation quality during CPR.
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Affiliation(s)
- Izaskun Azcarate
- Group of Signal and Communications, Bilbao School of Engineering, University of the Basque Country UPV/EHU, Plaza Torres Quevedo 1, 48013 Bilbao, Spain; (J.A.U.); (M.L.); (K.R.); (J.J.G.); (S.R.d.G.)
- Department of Applied Mathematics, Bilbao School of Engineering, University of the Basque Country UPV/EHU, Plaza Torres Quevedo 1, 48013 Bilbao, Spain
| | - Jose Antonio Urigüen
- Group of Signal and Communications, Bilbao School of Engineering, University of the Basque Country UPV/EHU, Plaza Torres Quevedo 1, 48013 Bilbao, Spain; (J.A.U.); (M.L.); (K.R.); (J.J.G.); (S.R.d.G.)
- Department of Applied Mathematics, Bilbao School of Engineering, University of the Basque Country UPV/EHU, Plaza Torres Quevedo 1, 48013 Bilbao, Spain
| | - Mikel Leturiondo
- Group of Signal and Communications, Bilbao School of Engineering, University of the Basque Country UPV/EHU, Plaza Torres Quevedo 1, 48013 Bilbao, Spain; (J.A.U.); (M.L.); (K.R.); (J.J.G.); (S.R.d.G.)
| | | | - Koldo Redondo
- Group of Signal and Communications, Bilbao School of Engineering, University of the Basque Country UPV/EHU, Plaza Torres Quevedo 1, 48013 Bilbao, Spain; (J.A.U.); (M.L.); (K.R.); (J.J.G.); (S.R.d.G.)
| | - José Julio Gutiérrez
- Group of Signal and Communications, Bilbao School of Engineering, University of the Basque Country UPV/EHU, Plaza Torres Quevedo 1, 48013 Bilbao, Spain; (J.A.U.); (M.L.); (K.R.); (J.J.G.); (S.R.d.G.)
| | - James Knox Russell
- Center for Policy and Research in Emergency Medicine (CPR-EM), Department of Emergency Medicine, Oregon Health & Science University, Portland, OR 97239, USA; (J.K.R.); (M.R.D.)
| | - Pia Wallmüller
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (P.W.); (F.S.)
| | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (P.W.); (F.S.)
| | - Mohamud Ramzan Daya
- Center for Policy and Research in Emergency Medicine (CPR-EM), Department of Emergency Medicine, Oregon Health & Science University, Portland, OR 97239, USA; (J.K.R.); (M.R.D.)
| | - Sofía Ruiz de Gauna
- Group of Signal and Communications, Bilbao School of Engineering, University of the Basque Country UPV/EHU, Plaza Torres Quevedo 1, 48013 Bilbao, Spain; (J.A.U.); (M.L.); (K.R.); (J.J.G.); (S.R.d.G.)
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Zhang J, Bai C, Wang Z, Liu X, Li X, Cui X. Low-Grade Thermal Energy Harvesting and Self-Powered Sensing Based on Thermogalvanic Hydrogels. MICROMACHINES 2023; 14:mi14010155. [PMID: 36677217 PMCID: PMC9863090 DOI: 10.3390/mi14010155] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 06/07/2023]
Abstract
Thermoelectric cells (TEC) directly convert heat into electricity via the Seebeck effect. Known as one TEC, thermogalvanic hydrogels are promising for harvesting low-grade thermal energy for sustainable energy production. In recent years, research on thermogalvanic hydrogels has increased dramatically due to their capacity to continuously convert heat into electricity with or without consuming the material. Until recently, the commercial viability of thermogalvanic hydrogels was limited by their low power output and the difficulty of packaging. In this review, we summarize the advances in electrode materials, redox pairs, polymer network integration approaches, and applications of thermogalvanic hydrogels. Then, we highlight the key challenges, that is, low-cost preparation, high thermoelectric power, long-time stable operation of thermogalvanic hydrogels, and broader applications in heat harvesting and thermoelectric sensing.
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Affiliation(s)
- Jiedong Zhang
- Qiushi College, Taiyuan University of Technology, Taiyuan 030024, China
| | - Chenhui Bai
- College of Information and Computer, Taiyuan University of Technology, Taiyuan 030024, China
| | - Zhaosu Wang
- College of Information and Computer, Taiyuan University of Technology, Taiyuan 030024, China
| | - Xiao Liu
- Shanxi Transport Information Communication Company Limited, Taiyuan 030006, China
| | - Xiangyu Li
- College of Civil Engineering, Taiyuan University of Technology, Taiyuan 030024, China
| | - Xiaojing Cui
- Shanxi Transport Information Communication Company Limited, Taiyuan 030006, China
- College of Civil Engineering, Taiyuan University of Technology, Taiyuan 030024, China
- College of Physics and Information Engineering, Shanxi Normal University, Taiyuan 030031, China
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3
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Geoghegan P, Clarke J, Hogan G, Keogh A, Marsh H, Donnelly K, McEvoy N, Doolan A, Madden SF, Martin-Loeches I, Power M, Laffey JG, Curley GF. Use of a novel "Split" ventilation system in bench and porcine modeling of acute respiratory distress syndrome. Physiol Rep 2022; 10:e15452. [PMID: 36082971 PMCID: PMC9461348 DOI: 10.14814/phy2.15452] [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: 05/19/2022] [Revised: 08/10/2022] [Accepted: 08/13/2022] [Indexed: 11/28/2022] Open
Abstract
Split ventilation (using a single ventilator to ventilate multiple patients) is technically feasible. However, connecting two patients with acute respiratory distress syndrome (ARDS) and differing lung mechanics to a single ventilator is concerning. This study aimed to: (1) determine functionality of a split ventilation system in benchtop tests, (2) determine whether standard ventilation would be superior to split ventilation in a porcine model of ARDS and (3) assess usability of a split ventilation system with minimal specific training. The functionality of a split ventilation system was assessed using test lungs. The usability of the system was assessed in simulated clinical scenarios. The feasibility of the system to provide modified lung protective ventilation was assessed in a porcine model of ARDS (n = 30). In bench testing a split ventilation system independently ventilated two test lungs under conditions of varying compliance and resistance. In usability tests, a high proportion of naïve operators could assemble and use the system. In the porcine model, modified lung protective ventilation was feasible with split ventilation and produced similar respiratory mechanics, gas exchange and biomarkers of lung injury when compared to standard ventilation. Split ventilation can provide some elements of lung protective ventilation and is feasible in bench testing and an in vivo model of ARDS.
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Affiliation(s)
- Pierce Geoghegan
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jennifer Clarke
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Grace Hogan
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Aoife Keogh
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Karen Donnelly
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Natalie McEvoy
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Stephen F Madden
- Data Science Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | - John G Laffey
- Department of Anaesthesia and Critical Care, Galway University Hospital, Galway, Ireland
| | - Gerard F Curley
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland, Dublin, Ireland
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Althunayyan SM, Mubarak AM, Alotaibi RN, Alharthi MZ, Aljanoubi MA, Alshabanat S, Mobrad AM. Using gel for difficult mask ventilation on the bearded patients: a simulation-based study. Intern Emerg Med 2021; 16:1043-1049. [PMID: 33159283 PMCID: PMC7646717 DOI: 10.1007/s11739-020-02547-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/21/2020] [Indexed: 11/01/2022]
Abstract
The beard is a well-known cause of difficult mask ventilation due to excessive air leaks. Various techniques have been proposed to overcome this difficulty, such as applying a gel on the mask edge. Our objective was to determine whether the gel technique will improve ventilation and to assess the comfort of the provider. A randomized crossover design was conducted to assess the efficacy of gel in a bearded simulation model. Respiratory therapists (RT) were recruited by convenience sampling to hold the mask using a two-handed technique for a two-minute ventilation session. During the session, the ventilator provided a fixed Tidal Volume (TV) of 550 mL and a respiratory rate of 12 per minute, and the simulated model measured the received volumes. We compared the median TV and number of failed ventilation attempts with or without the gel. The comfort level while using the gel was assessed with constructed questions. We recruited 74 respiratory therapists working in Riyadh city. More than half of the participants had more than 5 years experience. The median tidal volume for standard mask ventilation without the gel was 283 mL [interquartile range (IQR) 224, 327], whereas that with the gel was 467 mL [451, 478], respectively (p < 0.01). The number of successful ventilations was recorded out of 24 breaths during the 2-min ventilation period for each technique; the proportion of successful ventilations increased significantly by 65% (95% CI 51-75%, p < 0.01) with the gel. In addition, only nine participants believed the technique was not comfortable, while the remaining individuals found it comfortable or natural. In our bearded simulation model, applying the gel significantly improved ventilation without negatively affecting comfort. Further studies and education are encouraged in the field of basic airway management.
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Affiliation(s)
- Saqer M Althunayyan
- Department of Accident and Trauma, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Kingdom of Saudi Arabia.
| | - Abdullah M Mubarak
- Department of Basic Science, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Raied N Alotaibi
- Department of Basic Science, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Musab Z Alharthi
- Department of Accident and Trauma, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed A Aljanoubi
- Department of Aviation and Marines, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Sulaiman Alshabanat
- Respiratory Care Services, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Abdulmajeed M Mobrad
- Department of Emergency Medical Services, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Kingdom of Saudi Arabia
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Abrons RO, Ten Eyck P, Sheffield ID. The Articulated Oral Airway as an aid to mask ventilation: a prospective, randomized, interventional, non-inferiority study. BMC Anesthesiol 2021; 21:94. [PMID: 33781212 PMCID: PMC8006343 DOI: 10.1186/s12871-021-01315-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 02/26/2021] [Indexed: 11/17/2022] Open
Abstract
Background Oropharyngeal airways are used both to facilitate airway patency during mask ventilation as well as conduits for flexible scope intubation, though none excel at both. A novel device, the Articulated Oral Airway (AOA), is designed to facilitate flexible scope intubation by active displacement of the tongue. Whether this active tongue displacement also facilitates mask ventilation, thus adding dual functionality, is unknown. This study compared the AOA to the Guedel Oral Airway (GOA) in regards to efficacy of mask ventilation of patients with factors predictive of difficult mask ventilation. The hypothesis was that the AOA would be non-inferior to the GOA in terms of expiratory tidal volumes by a margin of 1 ml/kg, thus demonstrating dual functionality. Methods In this randomized controlled clinical trial, fifty-eight patients with factors predictive of difficult mask ventilation were mask ventilated with both the GOA and the AOA. Video of the anesthetic monitors were evaluated by a blinded member of the research team, noting inspiratory and expiratory tidal volumes and expiratory CO2 waveforms. Results The AOA was found to be non-inferior to the GOA at a margin of 1 ml/kg with a mean weight-standardized expiratory tidal measurement 0.45 ml/kg lower (CI: 0.34–0.57) and inspiratory tidal measurement 0.109 lower (CI: − 0.26-0.04). There was no significant difference in expiratory waveforms (p = 0.2639). Conclusions The AOA was non-inferior to the GOA for mask ventilation of patients with predictors of difficult mask ventilation and there was no significant difference in EtCO2 waveforms between the groups. These results were consistent in the subset of patients who were initially difficult to mask ventilate. Trial registration ClinicalTrials.gov, NCT03144089, May 2017.
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Affiliation(s)
- Ron O Abrons
- Associate Professor, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
| | - Patrick Ten Eyck
- Assistant Director for Biostatistics and Research Design, Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA, USA
| | - Isaac D Sheffield
- Resident in Anesthesiology, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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Gavish L, Rittblat M, Gertz SD, Shaylor R, Weissman C, Eisenkraft A. Ventilating the Bearded: A Randomized Crossover Trial Comparing a Novel Bag-Valve-Guedel Adaptor to a Standard Mask. Mil Med 2021; 185:e1300-e1308. [PMID: 33444455 DOI: 10.1093/milmed/usz378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 09/08/2019] [Accepted: 09/10/2019] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Emergency field ventilation using bag-valve face mask devices can be difficult to perform, especially in bearded individuals. In view of the increasing numbers of servicemen and civilians sporting a beard or moustache, the issue of finding a technical solution for ventilation in this population has gained importance. We therefore developed a novel adaptor that enables the direct connection of a bag-valve device to a Guedel-type oropharyngeal airway device thereby directly connecting the oral airway to the bag valve, eliminating the need for a face mask. The objective of this study was to compare the efficacy of the bag-valve-Guedel adaptor (BVGA) to the common face mask in healthy bearded volunteers. METHODS This study was a randomized-by-sequence, crossover-controlled trial (NCT02768246) approved by the local IRB (0051-16-HMO). All subjects signed an informed consent before participation. Twenty-five healthy bearded men (age 28 ± 7) were recruited. After randomization, the first group (mask then BVGA, n = 12) began breathing room air through the face mask, followed by 100% O2. After washout in room air, the procedure was repeated with the BVGA. The second group (BVGA then mask, n = 13) began with the BVGA followed by the face mask. Subjects were awake and breathed spontaneously throughout the experiment. Therefore, a Guedel was not used. Physiological and respiratory parameters were monitored continuously. The primary endpoint was the presence of suspected leak as determined by end-tidal-CO2 (EtCO2 < 20 mmHg). Secondary endpoints included tidal volume and safety. RESULTS The order of device use did not affect the results significantly (p > 0.05 by Mann-Whitney-U test); therefore, the data were pooled. There were no cases of suspected leak while breathing through the BVGA. By contrast, while breathing through a face mask, there were 8 of 25 (32%) and 5 of 25 (20%) cases of suspected leak in air and 100% O2, respectively (air: p = 0.002; 100% O2: p = 0.014 by McNemar test). No adverse events were observed. CONCLUSIONS In bearded individuals, the BVGA provides significantly more efficient (less leak) ventilation compared to a face mask. This is also of particular importance in view of the increasing number of bearded individuals serving in the armed forces. Moreover, since effective ventilation with a mask requires experience, the relatively easy-to-apply BVGA will enable less experienced first responders to achieve higher success rates in this critical phase of treatment. Further studies are planned to evaluate the efficacy of the BVGA in the prehospital setting.
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Affiliation(s)
- Lilach Gavish
- Institute for Research in Military Medicine (IRMM) of the Faculty of Medicine, The Hebrew University of Jerusalem, Israel and the Israel Defense Forces Medical Corps, Israel.,Institute for Medical Research (IMRIC), Faculty of Medicine, The Hebrew University of Jerusalem, Israel
| | - Mor Rittblat
- Institute for Research in Military Medicine (IRMM) of the Faculty of Medicine, The Hebrew University of Jerusalem, Israel and the Israel Defense Forces Medical Corps, Israel
| | - S David Gertz
- Institute for Research in Military Medicine (IRMM) of the Faculty of Medicine, The Hebrew University of Jerusalem, Israel and the Israel Defense Forces Medical Corps, Israel.,Institute for Medical Research (IMRIC), Faculty of Medicine, The Hebrew University of Jerusalem, Israel
| | - Ruth Shaylor
- Department of Anesthesiology and Critical Care Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,The Department of Anaesthesia, Pain and Intensive Care, Sourasky Medical Center, Tel Aviv, Israel
| | - Charles Weissman
- Department of Anesthesiology and Critical Care Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Arik Eisenkraft
- Institute for Research in Military Medicine (IRMM) of the Faculty of Medicine, The Hebrew University of Jerusalem, Israel and the Israel Defense Forces Medical Corps, Israel
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Althunayyan SM, Alotaibi RN, Aljanoubi MA, Alharthi MZ, Mubarak AM, Al-Otaibi AM. Comparison of the Effectiveness and Comfort Level of Two Commonly Used Mask Ventilation Techniques in a Model. Respir Care 2021; 66:460-465. [PMID: 32788318 PMCID: PMC9994061 DOI: 10.4187/respcare.07949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Mask ventilation is an important rescue airway skill for providing oxygenation and ventilation. Maintaining a good face mask seal is a fundamental factor for successful ventilation. Therefore, the aim of this study was to compare the effectiveness and comfortability of 2 commonly used mask ventilation techniques. METHODS A randomized crossover study was performed to compare the 2-handed C-E and 2-handed V-E techniques on a simulation model. Respiratory therapists were recruited by convenience sampling to hold the mask during mechanical ventilation with a fixed tidal volume (VT) of 500 mL, a rate of 12 breaths/min and a PEEP of zero were provided. Each participant performed a 2-min ventilation session, with a total of 24 breaths for each technique. For each technique, we recorded the median VT and the number of successful breaths (≥300 mL). Provider comfort was assessed by using a 5-point Likert scale at the end of the 2 techniques. Subgroup analyses were conducted for sex, experience, and height of the participants. RESULTS Of the 75 respiratory therapists recruited, 74 participants were included in the analysis. There was no statistically significant difference in the median VT between the V-E (417 mL [interquartile range, 396-427] mL) and C-E techniques (410 [interquartile range, 391-423] mL) (P = .82). Approximately 74% of breaths delivered by the C-E technique were effective, whereas only 68% of those delivered by the V-E technique were effective (P < .001). Most of the participants reported that using the 2-handed C-E technique was more comfortable. CONCLUSIONS In our study, the median VT did not differ significantly between the 2 techniques. However, the C-E technique seemed to be superior to the V-E technique in terms of the number of effectively delivered breaths and comfortability. Further studies are recommended for basic airway management techniques.
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Affiliation(s)
- Saqer M Althunayyan
- Department of Accident and Trauma, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Raied N Alotaibi
- Department of Basic Science, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Kingdom of Saudi Arabia.
| | - Mohammed A Aljanoubi
- Mr Department of Aviation and Marines, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Musab Z Alharthi
- Department of Accident and Trauma, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Abdullah M Mubarak
- Department of Basic Science, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Ahmed M Al-Otaibi
- Department of Emergency Medical Services, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Kingdom of Saudi Arabia
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Noordergraaf GJG, De Vormer AJMA. ETCO 2 values during CPR: Your ventilation tempo matters. Resuscitation 2020; 156:260-262. [PMID: 32866547 DOI: 10.1016/j.resuscitation.2020.08.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 10/23/2022]
Affiliation(s)
- G J Gerrit Noordergraaf
- Department of Anesthesiology, Resuscitation & Pain Management, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, Netherlands.
| | - A J M Anouk De Vormer
- Department of Anesthesiology, Resuscitation & Pain Management, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, Netherlands
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Kakkar K, Gupta B. Is the use of automated artificial manual breathing unit resuscitators justified during a pandemic mechanical ventilator crisis? Acute Crit Care 2020; 35:220-222. [PMID: 32907312 PMCID: PMC7483006 DOI: 10.4266/acc.2020.00311] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/09/2020] [Indexed: 12/02/2022] Open
Affiliation(s)
- Kamna Kakkar
- Department of Anaesthesiology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Bhavna Gupta
- Department of Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, India
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Ruiz de Gauna S, Gutiérrez JJ, Ruiz J, Leturiondo M, Azcarate I, González-Otero DM, Corcuera C, Russell JK, Daya MR. The impact of ventilation rate on end-tidal carbon dioxide level during manual cardiopulmonary resuscitation. Resuscitation 2020; 156:215-222. [PMID: 32622015 DOI: 10.1016/j.resuscitation.2020.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/03/2020] [Accepted: 06/05/2020] [Indexed: 11/29/2022]
Abstract
AIM Ventilation rate is a confounding factor for interpretation of end-tidal carbon dioxide (ETCO2) during cardiopulmonary resuscitation (CPR). The aim of our study was to model the effect of ventilation rate on ETCO2 during manual CPR in adult out-of-hospital cardiac arrest (OHCA). METHODS We conducted a retrospective analysis of OHCA monitor-defibrillator files with concurrent capnogram, compression depth, transthoracic impedance and ECG. We annotated pairs of capnogram segments presenting differences in average ventilation rate and average ETCO2 value but with other influencing factors (e.g. compression rate and depth) presenting similar values within the pair. ETCO2 variation as a function of ventilation rate was adjusted through curve fitting using non-linear least squares as a measure of goodness of fit. RESULTS A total of 141 pairs of segments from 102 patients were annotated. Each pair provided a single data point for curve fitting. The best goodness of fit yielded a coefficient of determination R2 of 0.93. Our model described that ETCO2 decays exponentially with increasing ventilation rate. The model showed no differences attributable to the airway type (endotracheal tube or supraglottic King-LT-D). CONCLUSION Capnogram interpretation during CPR is challenging since many factors influence ETCO2. For adequate interpretation, we need to know the effect of each factor on ETCO2. Our model allows quantifying the effect of ventilation rate on ETCO2 variation. Our findings could contribute to better interpretation of ETCO2 during CPR.
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Affiliation(s)
| | | | - Jesus Ruiz
- University of the Basque Country, UPV/EHU, Bilbao, Bizkaia, Spain
| | - Mikel Leturiondo
- University of the Basque Country, UPV/EHU, Bilbao, Bizkaia, Spain
| | - Izaskun Azcarate
- University of the Basque Country, UPV/EHU, Bilbao, Bizkaia, Spain
| | | | - Carlos Corcuera
- Emergentziak-Osakidetza, Basque Country Health System, Basque Country, Spain
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Heo S, Yoon SY, Kim J, Kim HS, Kim K, Yoon H, Hwang SY, Cha WC, Kim T. Effectiveness of a Real-Time Ventilation Feedback Device for Guiding Adequate Minute Ventilation: A Manikin Simulation Study. ACTA ACUST UNITED AC 2020; 56:medicina56060278. [PMID: 32516894 PMCID: PMC7353869 DOI: 10.3390/medicina56060278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 11/24/2022]
Abstract
Background and objectives: It is often challenging even for skilled rescuers to provide adequate positive pressure ventilation consistently. This study aimed to investigate the effectiveness of a newly developed real-time ventilation feedback device (RTVFD) that estimates tidal volume (TV) and ventilation interval (VI) in real time. Materials and methods: We conducted a randomised, crossover, manikin simulation study. A total of 26 medical providers were randomly assigned to the RTVFD-assisted ventilation (RAV) first group (n = 13) and the non-assisted ventilation (NV) first group (n = 13). Participants provided ventilation using adult and paediatric bag valves (BVs) for 2 min each. After a washout period, the simulation was repeated by exchanging the participants’ groups. Results: The primary outcome was optimal TV in the RAV and NV groups using adult and paediatric BVs. A secondary outcome was optimal VI in the RAV and NV groups using adult and paediatric BVs. The proportions of optimal TV values were higher for the RAVs when using both adult and paediatric BVs (adult BV: 47.29% vs. 18.46%, p < 0.001; paediatric BV: 89.51% vs. 72.66%, p < 0.001) than for the NVs. The proportions of optimal VI were significantly higher in RAVs when using both adult and paediatric BVs than that in NVs (adult BV: 95.64% vs. 50.20%, p < 0.001; paediatric BV: 95.83% vs. 57.14%, p < 0.001). Additionally, we found that with paediatric BVs, the simulation had a higher OR for both optimal TV (13.26; 95% CI, 9.96–17.65; p < 0.001) and VI (1.32; 1.08–1.62, p = 0.007), regardless of RTVFD use. Conclusion: Real-time feedback using RTVFD significantly improves the TV and VI in both adult and paediatric BVs in a manikin simulation study.
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Affiliation(s)
- Sejin Heo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.H.); (S.Y.Y.); (H.Y.); (S.Y.H.); (W.C.C.)
| | - Sun Young Yoon
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.H.); (S.Y.Y.); (H.Y.); (S.Y.H.); (W.C.C.)
| | - Jongchul Kim
- Department of Biomedical Engineering, Samsung Medical Center, Seoul 06351, Korea;
| | - Hye Seung Kim
- Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Seoul 06351, Korea; (H.S.K.); (K.K.)
| | - Kyunga Kim
- Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Seoul 06351, Korea; (H.S.K.); (K.K.)
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul 06355, Korea
| | - Hee Yoon
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.H.); (S.Y.Y.); (H.Y.); (S.Y.H.); (W.C.C.)
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.H.); (S.Y.Y.); (H.Y.); (S.Y.H.); (W.C.C.)
| | - Won Chul Cha
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.H.); (S.Y.Y.); (H.Y.); (S.Y.H.); (W.C.C.)
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul 06355, Korea
| | - Taerim Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.H.); (S.Y.Y.); (H.Y.); (S.Y.H.); (W.C.C.)
- Correspondence: ; Tel.: +82-2-3410-2053; Fax: +82-2-3410-0049
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Mask Ventilation Grip: A Life-Saving Innovation. Ochsner J 2018; 18:112-113. [PMID: 30258288 DOI: 10.31486/toj.18.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Soltész S, Alm P, Mathes A, Hellmich M, Hinkelbein J. The effect of neuromuscular blockade on the efficiency of facemask ventilation in patients difficult to facemask ventilate: a prospective trial. Anaesthesia 2017; 72:1484-1490. [PMID: 28913862 DOI: 10.1111/anae.14035] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2017] [Indexed: 11/29/2022]
Abstract
Facemask ventilation of the lungs can be an important rescue intervention in a 'cannot intubate' scenario. We assessed the effect of neuromuscular blockade on expiratory tidal volumes in patients with expected difficulty in mask ventilation. The lungs of patients with at least three predictors of difficulty in mask ventilation were ventilated using a facemask held with two hands, with mechanical ventilation set in a pressure-controlled mode. Tidal volumes were recorded before and after the establishment of complete neuromuscular block. In 113 patients, median (IQR [range]) tidal volume increased from 350 (260-492 [80-850]) ml initially, by 48% to 517 (373-667 [100-1250]) ml 30 s after rocuronium administration, (p < 0.001). After the onset of the complete neuromuscular block, a median tidal volume of 600 (433-750 [250-1303]) ml was observed, corresponding to an increase of 71% from baseline values (p < 0.001), and 16% from values obtained 30 s after rocuronium administration, respectively; p = 0.003). No decrease in the tidal volume during the measurements was observed. We conclude that the administration of rocuronium at a dose of 0.6 mg.kg-1 was able to improve facemask ventilation in all cases with a potentially clinically relevant increase in tidal volume. The early use of a neuromuscular blocking agent can be considered as a therapeutic option in case of difficulty with mask ventilation.
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Affiliation(s)
- S Soltész
- Department of Anaesthesia and Intensive Care, Kreiskrankenhaus Dormagen, Germany
| | - P Alm
- Department of Anaesthesia and Intensive Care, Kreiskrankenhaus Dormagen, Germany
| | - A Mathes
- Department of Anaesthesia and Intensive Care Medicine, University Hospital of Cologne, Germany
| | - M Hellmich
- Institute of Medical Statistics and Computational Biology, University of Cologne, Germany
| | - J Hinkelbein
- Department of Anaesthesia and Intensive Care Medicine, University Hospital of Cologne, Germany
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You KM, Lee C, Kwon WY, Lee JC, Suh GJ, Kim KS, Park MJ, Kim S. Real-time tidal volume feedback guides optimal ventilation during simulated CPR. Am J Emerg Med 2016; 35:292-298. [PMID: 27887820 DOI: 10.1016/j.ajem.2016.10.085] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 10/10/2016] [Accepted: 10/11/2016] [Indexed: 11/16/2022] Open
Abstract
PURPOSE We performed this study to investigate whether real-time tidal volume feedback increases optimal ventilation and decreases hyperventilation during manikin-simulated cardiopulmonary resuscitation (CPR). BASIC PROCEDURES We developed a new real-time tidal volume monitoring device (TVD) which estimated tidal volume in real time using a magnetic flowmeter. The TVD was validated with a volume-controlled mechanical ventilator with various tidal volumes. We conducted a randomized, crossover, manikin-simulation study in which 14 participants were randomly divided into a control (without tidal volume feedback, n = 7) and a TVD group (with real-time tidal volume feedback, n = 7) and underwent manikin simulation. The optimal ventilation was defined as 420-490 mL of tidal volumes for a 70-kg adult manikin. After 2 weeks of the washout period, the simulation was repeated via the participants' crossover. MAIN FINDINGS In the validation study, 97.6% and 100% of the difference ratios in tidal volumes between the mechanical ventilator and TVD were within ±1.5% and ±2.5%, respectively. During manikin-simulated CPR, TVD use increased the proportion of optimal ventilation per person. Its median values (range) of the control group and the TVD group were 37.5% (0.0-65.0) and 87.5% (65.0-100.0), respectively, P < .001). TVD use also decreased hyperventilation. The proportions of hyperventilation in the control group and the TVD group were 25.0% vs 8.9%, respectively (P < .001). PRINCIPAL CONCLUSIONS Real-time tidal volume feedback using the new TVD guided the rescuers to provide optimal ventilation and to avoid hyperventilation during manikin-simulated CPR.
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Affiliation(s)
- Kyoung Min You
- Department of Biomedical Engineering, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Chiwon Lee
- Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Woon Yong Kwon
- Department of Emergency Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - Jung Chan Lee
- Department of Biomedical Engineering, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Biomedical Engineering, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - Gil Joon Suh
- Department of Emergency Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Kyung Su Kim
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Min Ji Park
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Sungwan Kim
- Department of Biomedical Engineering, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Biomedical Engineering, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
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15
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Evaluation of Bag-Valve-Mask Ventilation in Manikin Studies: What Are the Current Limitations? BIOMED RESEARCH INTERNATIONAL 2016; 2016:4521767. [PMID: 27294119 PMCID: PMC4884794 DOI: 10.1155/2016/4521767] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 04/07/2016] [Accepted: 04/19/2016] [Indexed: 11/17/2022]
Abstract
Introduction. Manikin-based studies for evaluation of ventilation performance show high heterogeneity in the analysis and experimental methods used as we pointed out in previous studies. In this work, we aim to evaluate these potential limitations and propose a new analysis methodology to reliably assess ventilation performance. Methods. One hundred forty healthcare providers were selected to ventilate a manikin with two adult self-inflating bags in random order. Ventilation parameters were analysed using different published analysis methods compared to ours. Results. Using different methods impacts the evaluation of ventilation efficiency which ranges from 0% to 45.71%. Our new method proved relevant and showed that all professionals tend to cause hyperventilation and revealed a significant relationship between professional category, grip strength of the hand keeping the mask, and ventilation performance (p = 0.0049 and p = 0.0297, resp.). Conclusion. Using adequate analysis methods is crucial to avoid many biases. Extrapolations to humans still have to be taken with caution as many factors impact the evaluation of ventilation performance. Healthcare professionals tend to cause hyperventilation with current devices. We believe this problem could be prevented by implementing monitoring tools in order to give direct feedback to healthcare professionals regarding ventilation efficiency and ventilatory parameter values.
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