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SHR Neuro Cancer Cardio Lipid Metab Microb

Orlob, S; Wittig, J; Hobisch, C; Auinger, D; Honnef, G; Fellinger, T; Ristl, R; Schindler, O; Metnitz, P; Feigl, G; Prause, G.
Reliability of mechanical ventilation during continuous chest compressions: a crossover study of transport ventilators in a human cadaver model of CPR.
Scand J Trauma Resusc Emerg Med. 2021; 29(1):102 Doi: 10.1186/s13049-021-00921-2 [OPEN ACCESS]
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Leading authors Med Uni Graz
Orlob Simon
Co-authors Med Uni Graz
Auinger Daniel
Feigl Georg
Hobisch Christoph
Honnef Gabriel
Metnitz Philipp
Prause Gerhard
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Abstract:
BACKGROUND: Previous studies have stated that hyperventilation often occurs in cardiopulmonary resuscitation (CPR) mainly due to excessive ventilation frequencies, especially when a manual valve bag is used. Transport ventilators may provide mandatory ventilation with predetermined tidal volumes and without the risk of hyperventilation. Nonetheless, interactions between chest compressions and ventilations are likely to occur. We investigated whether transport ventilators can provide adequate alveolar ventilation during continuous chest compression in adult CPR. METHODS: A three-period crossover study with three common transport ventilators in a cadaver model of CPR was carried out. The three ventilators 'MEDUMAT Standard²', 'Oxylog 3000 plus', and 'Monnal T60' represent three different interventions, providing volume-controlled continuous mandatory ventilation (VC-CMV) via an endotracheal tube with a tidal volume of 6 mL/kg predicted body weight. Proximal airflow was measured, and the net tidal volume was derived for each respiratory cycle. The deviation from the predetermined tidal volume was calculated and analysed. Several mixed linear models were calculated with the cadaver as a random factor and ventilator, height, sex, crossover period and incremental number of each ventilation within the period as covariates to evaluate differences between ventilators. RESULTS: Overall median deviation of net tidal volume from predetermined tidal volume was - 21.2 % (IQR: 19.6, range: [- 87.9 %; 25.8 %]) corresponding to a tidal volume of 4.75 mL/kg predicted body weight (IQR: 1.2, range: [0.7; 7.6]). In a mixed linear model, the ventilator model, the crossover period, and the cadaver's height were significant factors for decreased tidal volume. The estimated effects of tidal volume deviation for each ventilator were - 14.5 % [95 %-CI: -22.5; -6.5] (p = 0.0004) for 'Monnal T60', - 30.6 % [95 %-CI: -38.6; -22.6] (p < 0.0001) for 'Oxylog 3000 plus' and - 31.0 % [95 %-CI: -38.9; -23.0] (p < 0.0001) for 'MEDUMAT Standard²'. CONCLUSIONS: All investigated transport ventilators were able to provide alveolar ventilation even though chest compressions considerably decreased tidal volumes. Our results support the concept of using ventilators to avoid excessive ventilatory rates in CPR. This experimental study suggests that healthcare professionals should carefully monitor actual tidal volumes to recognise the occurrence of hypoventilation during continuous chest compressions.
Find related publications in this database (using NLM MeSH Indexing)
Adult - administration & dosage
Cadaver - administration & dosage
Cardiopulmonary Resuscitation - administration & dosage
Cross-Over Studies - administration & dosage
Humans - administration & dosage
Reproducibility of Results - administration & dosage
Respiration, Artificial - administration & dosage
Tidal Volume - administration & dosage
Ventilators, Mechanical - administration & dosage

Find related publications in this database (Keywords)
Cardiac arrest
Artificial respiration
Ventilators
mechanical
Cardiopulmonary resuscitation
Tidal volume
Reversed airflow
Out-of-hospital cardiac arrest
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