Quantification of ventilation volumes produced by compressions during emergency department cardiopulmonary resuscitation |
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Authors: | Robyn McDannold Bentley J. Bobrow Vatsal Chikani Annemarie Silver Daniel W. Spaite Tyler Vadeboncoeur |
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Affiliation: | 1. University of Arizona, College of Medicine-Phoenix, 550 E. Van Buren Street, Phoenix, AZ 85004, United States of America;2. Department of Emergency Medicine, University of Arizona, PO Box 245057, 1501 N. Campbell, Tucson, AZ 85724-5057, United States of America;3. Arizona Department of Health Services, United States of America;4. ZOLL Medical, 269 Mill Rd, Chelmsford, MA 01824, United States of America;5. Department of Emergency Medicine, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, United States of America;6. Arizona Department of Health Services, 150 N 18th Ave, Phoenix, AZ 85007, United States of America |
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Abstract: | BackgroundClinical investigations have shown improved outcomes with primary compression cardiopulmonary resuscitation strategies. It is unclear whether this is a result of passive ventilation via chest compressions, a low requirement for any ventilation during the early aspect of resuscitation or avoidance of inadvertent over-ventilation.ObjectivesTo quantify whether chest compressions with guideline-compliant depth (>2?in) produce measurable and substantial ventilation volumes during emergency department resuscitation of out-of-hospital cardiac arrest.MethodsThis was a prospective, convenience sampling of adult non-traumatic out-of-hospital cardiac arrest patients receiving on-going cardiopulmonary resuscitation in an academic emergency department from June 1, 2011 to July 30, 2013. Cardiopulmonary resuscitation quality files were analyzed using R-Series defibrillator/monitors (ZOLL Medical) and ventilation data were measured using a Non-Invasive Cardiac Output monitor (Philips/Respironics, Wallingford, CT).Resultscardiopulmonary resuscitation quality data were analyzed from 21 patients (17 males, median age 59). The median compression depth was 2.2?in (IQR?=?1.9, 2.5) and the median chest compression fraction was 88.4% (IQR?=?82.2, 94.1). We were able to discern 580 ventilations that occurred during compressions. The median passive tidal volume recorded during compressions was 7.5?ml (IQR 3.5, 12.6). While the highest volume recorded was 45.8?ml, 81% of the measured tidal volumes were <20?ml.ConclusionVentilation volume measurements during emergency department cardiopulmonary resuscitation after out-of-hospital cardiac arrest suggest that chest compressions alone, even those meeting current guideline recommendations for depth, do not provide physiologically significant tidal volumes. |
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Keywords: | OHCA out-of-hospital cardiac arrest NICO Non-Invasive Cardiac Output CPR cardiopulmonary resuscitation ED emergency department CPR Out-of-hospital cardiac arrest Emergency medicine Respiration Cardiac output |
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