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A Cross-Over Trial Comparing Conventional to Compression-Adjusted Ventilations with Metronome-Guided Compressions

Published online by Cambridge University Press:  10 April 2019

Dhimitri A. Nikolla Open the ORCID record for Dhimitri A. Nikolla [Opens in a new window] ,
Brandon J. Kramer  and
Jestin N. Carlson
Dhimitri A. Nikolla*
Affiliation:
Department of Emergency Medicine, Allegheny Health Network, Saint Vincent Hospital, Erie, PennsylvaniaUSA
Brandon J. Kramer
Affiliation:
Department of Emergency Medicine, Meadville Medical Center, Meadville, PennsylvaniaUSA
Jestin N. Carlson
Affiliation:
Department of Emergency Medicine, Allegheny Health Network, Saint Vincent Hospital, Erie, PennsylvaniaUSA
*
Correspondence: Dhimitri A Nikolla, DO, Department of Emergency Medicine, Allegheny Health Network, Saint Vincent Hospital, 232 West 25th St., Erie, Pennsylvania 16544 USA E-mail: [email protected]
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Abstract

Introduction:

Hyperventilation during cardiopulmonary resuscitation (CPR) negatively affects cardiopulmonary physiology. Compression-adjusted ventilations (CAVs) may allow providers to deliver ventilation rates more consistently than conventional ventilations (CVs). This study sought to compare ventilation rates between these two methods during simulated cardiac arrest.

Null Hypothesis:

That CAV will not result in different rates than CV in simulated CPR with metronome-guided compressions.

Methods:

Volunteer Basic Life Support (BLS)-trained providers delivered bag-valve-mask (BVM) ventilations during simulated CPR with metronome-guided compressions at 100 beats/minute. For the first 4-minute interval, volunteers delivered CV. Volunteers were then instructed on how to perform CAV by delivering one breath, counting 12 compressions, and then delivering a subsequent breath. They then performed CAV for the second 4-minute interval. Ventilation rates were manually recorded. Minute-by-minute ventilation rates were compared between the techniques.

Results:

A total of 23 volunteers were enrolled with a median age of 36 years old and with a median of 14 years of experience. Median ventilation rates were consistently higher in the CV group versus the CAV group across all 1-minute segments: 13 vs 9, 12 vs 8, 12 vs 8, and 12 vs 8 for minutes one through four, respectively (P <.01, all). Hyperventilation (>10 breaths per minute) occurred 64% of the time intervals with CV versus one percent with CAV (P <.01). The proportion of time which hyperventilation occurred was also consistently higher in the CV group versus the CAV group across all 1-minute segments: 78% vs 4%, 61% vs 0%, 57% vs 0%, and 61% vs 0% for minutes one through four, respectively (P <.01, all).

Conclusions:

In this simulated model of cardiac arrest, CAV had more accurate ventilation rates and fewer episodes of hyperventilation compared with CV.

Nikolla DA, Kramer BJ, Carlson JN. A cross-over trial comparing conventional to compression-adjusted ventilations with metronome-guided compressions. Prehosp Disaster Med. 2019;34(2):220–223

Keywords

cardiac arrestcardiopulmonary resuscitationhyperventilationventilation
Type
Brief Report
Information
Prehospital and Disaster Medicine , Volume 34 , Issue 2 , April 2019 , pp. 220 - 223
Copyright
© World Association for Disaster and Emergency Medicine 2019 

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Footnotes

Conflicts of interest/financial support: Dr. Carlson is supported by ID #118243 from the American Heart Association (AHA; Dallas, Texas USA) and by UH2-HL125163 from the National Heart, Lung, and Blood Institute (NHLBI; Bethesda, Maryland USA). The authors have no other conflicts of interest to disclose.

References

McNally, B, Robb, R, Mehta, M, et al. Out-of-hospital cardiac arrest surveillance --- Cardiac Arrest Registry to Enhance Survival (CARES), United States, October 1, 2005--December 31, 2010. MMWR Surveill Summ. 2011;60(8):1–19.Google Scholar
Kleinman, ME, Brennan, EE, Goldberger, ZD, et al. Part 5: adult Basic Life Support and cardiopulmonary resuscitation quality: 2015 American Heart Association Guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132(18 Suppl 2):S414–435.CrossRefGoogle ScholarPubMed
Aufderheide, TP, Sigurdsson, G, Pirrallo, RG, et al. Hyperventilation-induced hypotension during cardiopulmonary resuscitation. Circulation. 2004;109(16):1960–1965.CrossRefGoogle ScholarPubMed
Aufderheide, TP, Lurie, KG. Death by hyperventilation: a common and life-threatening problem during cardiopulmonary resuscitation. Crit Care Med. 2004;32(9):S345–S351.CrossRefGoogle ScholarPubMed
Cheifetz, IM, Craig, DM, Quick, G, et al. Increasing tidal volumes and pulmonary overdistention adversely affect pulmonary vascular mechanics and cardiac output in a pediatric swine model. Crit Care Med. 1998;26(4):710–716.CrossRefGoogle Scholar
Theres, H, Binkau, J, Laule, M, et al. Phase-related changes in right ventricular cardiac output under volume-controlled mechanical ventilation with positive end-expiratory pressure. Crit Care Med. 1999;27(5):953–958.CrossRefGoogle ScholarPubMed
Abella, BS, Alvarado, JP, Myklebust, H, et al. Quality of cardiopulmonary resuscitation during in-hospital cardiac arrest. JAMA. 2005;293(3):305–310.CrossRefGoogle ScholarPubMed
McInnes, AD, Sutton, RM, Orioles, A, et al. The first quantitative report of ventilation rate during in-hospital resuscitation of older children and adolescents. Resuscitation. 2011;82(8):1025–1029.CrossRefGoogle ScholarPubMed
Maertens, VL, De Smedt, LE, Lemoyne, S, et al. Patients with cardiac arrest are ventilated two times faster than guidelines recommend: an observational prehospital study using tracheal pressure measurement. Resuscitation. 2013;84(7):921–926.CrossRefGoogle ScholarPubMed
Ryu, HH, Han, SC, Jeung, KW, Heo, T. Metronome guided CPR to improve the quality of CPR. J Korean Soc Emerg Med. 2006;17(3):217–224.Google Scholar
Nikolla, D, Lewandowski, T, Carlson, J. Mitigating hyperventilation during cardiopulmonary resuscitation. Am J Emerg Med. 2016;34(3):643–646.CrossRefGoogle ScholarPubMed
Yun, SY, Ryu, S, Cho, YC, et al. Comparison of compression adjusted ventilation to conventional ventilation: for adequate ventilation rate during cardiopulmonary resuscitation. J Korean Soc Emerg Med. 2012;23(4):460–463.Google Scholar
Cho, YC, Ryu, S, Bak, YS, et al. Usefulness of the compression-adjusted ventilation for adequate ventilation rate during cardiopulmonary resuscitation. Am J Emerg Med. 2014;32(8):913–916.CrossRefGoogle ScholarPubMed
Cho, WR, Ryu, S, Cho, YC, et al. ACLS ventilation skills-education effect of compression adjusted ventilation: a manikin study. J Korean Soc Emerg Med. 2014;25(5):589–594.Google Scholar
Vissers, G, Soar, J, Monsieurs, KG. Ventilation rate in adults with a tracheal tube during cardiopulmonary resuscitation: a systematic review. Resuscitation. 2017;119:5–12.CrossRefGoogle ScholarPubMed
Steiner, LA, Balestreri, M, Johnston, AJ, et al. Sustained moderate reductions in arterial CO2 after brain trauma time-course of cerebral blood flow velocity and intracranial pressure. Intensive Care Med. 2004;30(12):2180–2187.CrossRefGoogle ScholarPubMed
Coles, JP, Fryer, TD, Coleman, MR, et al. Hyperventilation following head injury: effect on ischemic burden and cerebral oxidative metabolism. Crit Care Med. 2007;35(2):568–578.CrossRefGoogle ScholarPubMed
Muizelaar, JP, Marmarou, A, Ward, JD, et al. Adverse effects of prolonged hyperventilation in patients with severe head injury: a randomized clinical trial. J Neurosurg. 1991;75(5):731–739.CrossRefGoogle ScholarPubMed
Khoudry, A, Sall, FS, DeLuca, A, et al. Evaluation of bag-valve-mask ventilation in manikin studies: what are the current limitations? Biomed Res Int. 2016;2016:4521767.Google Scholar
Manley, G, Knudson, MM, Morabito, D, et al. Hypotension, hypoxia, and head injury: frequency, duration, and consequences. Arch Surg. 2001;136(10):1118–1123.CrossRefGoogle ScholarPubMed