ventilation during cpr - resuscitation council (uk)...ventilation during cpr –during compressions...
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Ventilation during CPR
Theresa Mariero Olasveengen MD PhD
Department of Anesthesiology
Oslo University Hospital
No conflicts of interest.
Do we really need ventilationduring CPR?
Do we really need POSITIVE PRESSURE ventilation during CPR?
ILCOR/ANZCOR ALS Guidelines
6-10 ventilations/minute
1 second inspiration time
Volume = normal chest movement
No pauses when intubated
www.ilcor.org
resus.org.au
ILCOR/ANZCOR ALS Guidelines
10 ventilations pr minute with 1 secondinspiration time = 10 seconds/min
→ 17% of CPR time spent ventilating
100 compressions pre minute
→ 17 compressions during active ventilation
Death by hyperventilation
Aufderheide et al. Crit Care 2004
Ventilation during CPR
– During compressions (down-stroke)
↑ blood flow from thoracic cavity
↑ airway pressure
– During de-compressions (up-stroke)
↓ venous return
↓ coronary perfusion pressure
Synchronized ventilations?
– Ventilation during compressions (down-stroke)
↑ blood flow from thoracic cavity
↑ airway pressure
Synchronized ventilations?
Human case series – 11 patients
Chandra et al 1980
Synchronized ventilations?
OHCA RCT
Synchronized ventilations?
– Ventilation during de-compressions (down-stroke)
↓ venous return
↓ coronary perfusion pressure?
reasonable airway pressure
Guideline ventilation
Baseline → CA → 30:2 CPR
(2 min) (4 min) «Upstroke» ventilation
(8 min)
Pathology (y/n)“Upstroke”
(n=10)Guideline
(n=10)P-value
Blood/foam in thoracic cavity 0/10 4/6 0.025
Tracheal lacerations 5/5 6/4 0.1
Bronchial laceration 7/3 6/4 0.6
Traumatic bullae (severity score) 2±2 4±2 0.03
Atelectasis (severity score) 4±2 5±2 0.3
Low perfusion area (severity score) 26±11 22±12 0.9
Microhemorrhages (severity score) 11±8 15±9 0.3
Animals: Continuous passive oxygen insufflation?
• Improved effectiveness from compressions
– Higher arterial pressures
– Higher flow rates
• Comparable blood gases
• Comparable 24 h survival (swine)
Steen et al. Resuscitation 2004
Hayes et al. Resuscitation 2007
Soltez et al. Resuscitation 2019
Humans: Continuous passive oxygen insufflation?
• French RCT, 686 patients
– Survival to ICU discharge 2.4 vs. 2.3%
• US observational study, 1019 patients
– Neurologically intact survival 38.2 vs. 25.8%
– Adjusted odds ratio 2.5 (95% CI 1.3 to 4.6)
Bertrand et al. Crit Care Med 2006
Bobrow et al. Ann Emerg Med 2009
Do we really need POSITIVE PRESSURE ventilation during CPR?
→We might very well not…
Thank you!Questions?