ventilation during cpr - resuscitation council (uk)...ventilation during cpr –during compressions...
TRANSCRIPT
![Page 1: Ventilation during CPR - Resuscitation Council (UK)...Ventilation during CPR –During compressions (down-stroke) ↑ blood flow from thoracic cavity ↑ airway pressure –During](https://reader034.vdocuments.us/reader034/viewer/2022050122/5f529f3be4743b272b061831/html5/thumbnails/1.jpg)
Ventilation during CPR
Theresa Mariero Olasveengen MD PhD
Department of Anesthesiology
Oslo University Hospital
No conflicts of interest.
![Page 2: Ventilation during CPR - Resuscitation Council (UK)...Ventilation during CPR –During compressions (down-stroke) ↑ blood flow from thoracic cavity ↑ airway pressure –During](https://reader034.vdocuments.us/reader034/viewer/2022050122/5f529f3be4743b272b061831/html5/thumbnails/2.jpg)
Do we really need ventilationduring CPR?
![Page 3: Ventilation during CPR - Resuscitation Council (UK)...Ventilation during CPR –During compressions (down-stroke) ↑ blood flow from thoracic cavity ↑ airway pressure –During](https://reader034.vdocuments.us/reader034/viewer/2022050122/5f529f3be4743b272b061831/html5/thumbnails/3.jpg)
Do we really need POSITIVE PRESSURE ventilation during CPR?
![Page 4: Ventilation during CPR - Resuscitation Council (UK)...Ventilation during CPR –During compressions (down-stroke) ↑ blood flow from thoracic cavity ↑ airway pressure –During](https://reader034.vdocuments.us/reader034/viewer/2022050122/5f529f3be4743b272b061831/html5/thumbnails/4.jpg)
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
![Page 5: Ventilation during CPR - Resuscitation Council (UK)...Ventilation during CPR –During compressions (down-stroke) ↑ blood flow from thoracic cavity ↑ airway pressure –During](https://reader034.vdocuments.us/reader034/viewer/2022050122/5f529f3be4743b272b061831/html5/thumbnails/5.jpg)
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
![Page 6: Ventilation during CPR - Resuscitation Council (UK)...Ventilation during CPR –During compressions (down-stroke) ↑ blood flow from thoracic cavity ↑ airway pressure –During](https://reader034.vdocuments.us/reader034/viewer/2022050122/5f529f3be4743b272b061831/html5/thumbnails/6.jpg)
Death by hyperventilation
Aufderheide et al. Crit Care 2004
![Page 7: Ventilation during CPR - Resuscitation Council (UK)...Ventilation during CPR –During compressions (down-stroke) ↑ blood flow from thoracic cavity ↑ airway pressure –During](https://reader034.vdocuments.us/reader034/viewer/2022050122/5f529f3be4743b272b061831/html5/thumbnails/7.jpg)
Ventilation during CPR
– During compressions (down-stroke)
↑ blood flow from thoracic cavity
↑ airway pressure
– During de-compressions (up-stroke)
↓ venous return
↓ coronary perfusion pressure
![Page 8: Ventilation during CPR - Resuscitation Council (UK)...Ventilation during CPR –During compressions (down-stroke) ↑ blood flow from thoracic cavity ↑ airway pressure –During](https://reader034.vdocuments.us/reader034/viewer/2022050122/5f529f3be4743b272b061831/html5/thumbnails/8.jpg)
Synchronized ventilations?
– Ventilation during compressions (down-stroke)
↑ blood flow from thoracic cavity
↑ airway pressure
![Page 9: Ventilation during CPR - Resuscitation Council (UK)...Ventilation during CPR –During compressions (down-stroke) ↑ blood flow from thoracic cavity ↑ airway pressure –During](https://reader034.vdocuments.us/reader034/viewer/2022050122/5f529f3be4743b272b061831/html5/thumbnails/9.jpg)
Synchronized ventilations?
Human case series – 11 patients
Chandra et al 1980
![Page 10: Ventilation during CPR - Resuscitation Council (UK)...Ventilation during CPR –During compressions (down-stroke) ↑ blood flow from thoracic cavity ↑ airway pressure –During](https://reader034.vdocuments.us/reader034/viewer/2022050122/5f529f3be4743b272b061831/html5/thumbnails/10.jpg)
Synchronized ventilations?
OHCA RCT
![Page 11: Ventilation during CPR - Resuscitation Council (UK)...Ventilation during CPR –During compressions (down-stroke) ↑ blood flow from thoracic cavity ↑ airway pressure –During](https://reader034.vdocuments.us/reader034/viewer/2022050122/5f529f3be4743b272b061831/html5/thumbnails/11.jpg)
Synchronized ventilations?
– Ventilation during de-compressions (down-stroke)
↓ venous return
↓ coronary perfusion pressure?
reasonable airway pressure
![Page 12: Ventilation during CPR - Resuscitation Council (UK)...Ventilation during CPR –During compressions (down-stroke) ↑ blood flow from thoracic cavity ↑ airway pressure –During](https://reader034.vdocuments.us/reader034/viewer/2022050122/5f529f3be4743b272b061831/html5/thumbnails/12.jpg)
Guideline ventilation
Baseline → CA → 30:2 CPR
(2 min) (4 min) «Upstroke» ventilation
(8 min)
![Page 13: Ventilation during CPR - Resuscitation Council (UK)...Ventilation during CPR –During compressions (down-stroke) ↑ blood flow from thoracic cavity ↑ airway pressure –During](https://reader034.vdocuments.us/reader034/viewer/2022050122/5f529f3be4743b272b061831/html5/thumbnails/13.jpg)
![Page 14: Ventilation during CPR - Resuscitation Council (UK)...Ventilation during CPR –During compressions (down-stroke) ↑ blood flow from thoracic cavity ↑ airway pressure –During](https://reader034.vdocuments.us/reader034/viewer/2022050122/5f529f3be4743b272b061831/html5/thumbnails/14.jpg)
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
![Page 15: Ventilation during CPR - Resuscitation Council (UK)...Ventilation during CPR –During compressions (down-stroke) ↑ blood flow from thoracic cavity ↑ airway pressure –During](https://reader034.vdocuments.us/reader034/viewer/2022050122/5f529f3be4743b272b061831/html5/thumbnails/15.jpg)
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
![Page 16: Ventilation during CPR - Resuscitation Council (UK)...Ventilation during CPR –During compressions (down-stroke) ↑ blood flow from thoracic cavity ↑ airway pressure –During](https://reader034.vdocuments.us/reader034/viewer/2022050122/5f529f3be4743b272b061831/html5/thumbnails/16.jpg)
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
![Page 17: Ventilation during CPR - Resuscitation Council (UK)...Ventilation during CPR –During compressions (down-stroke) ↑ blood flow from thoracic cavity ↑ airway pressure –During](https://reader034.vdocuments.us/reader034/viewer/2022050122/5f529f3be4743b272b061831/html5/thumbnails/17.jpg)
Do we really need POSITIVE PRESSURE ventilation during CPR?
→We might very well not…
![Page 18: Ventilation during CPR - Resuscitation Council (UK)...Ventilation during CPR –During compressions (down-stroke) ↑ blood flow from thoracic cavity ↑ airway pressure –During](https://reader034.vdocuments.us/reader034/viewer/2022050122/5f529f3be4743b272b061831/html5/thumbnails/18.jpg)
Thank you!Questions?