There are few studies examining the ventilation strategies recommended by current CPR guidelines. We investigated the influence of different minute volume applying to untreated cardiac arrest with different duration, on resuscitation effects in a pig model. 32 Landrace pigs with 4 or 8 min (16 pigs each) ventricular fibrillation (VF) randomly received two ventilation strategies during CPR. “Guideline” groups received mechanical ventilation with a tidal volume of 7 ml/kg and a frequency of 10/min, while “Baseline” groups received a tidal volume (10 ml/kg) and a frequency used at baseline to maintain an end-tidal PCO2 (PETCO2) between 35 and 40 mmHg before VF. Mean airway pressures and intrathoracic pressures (PIT) in the Baseline-4 min group were significantly higher than those in the Guideline-4 min group (all P < 0.05). Similar results were observed in the 8 min pigs, except for no significant difference in minimal PIT and PETCO2 during 10 min of CPR. Venous pH and venous oxygen saturation were significantly higher in the Baseline-8 min group compared to the Guideline-8 min group (all P < 0.05). Aortic pressure in the Baseline-8 min group was higher than in the Guideline-8 min group. Seven pigs in each subgroup of 4 min VF models achieved the return of spontaneous circulation (ROSC). Higher ROSC was observed in the Baseline-8 min group than in the Guideline-8 min group (87.5% vs. 37.5%, P = 0.039). For 4 min VF but not 8 min VF, a guideline-recommended ventilation strategy had satisfactory results during CPR. A higher minute ventilation resulted in better outcomes for subjects with 8 min of untreated VF through thoracic pump.
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Soar J, Nolan JP, Bottiger BW, Perkins GD, Lott C, Carli P, et al. European resuscitation council guidelines for resuscitation 2015: section 3. Adult Adv Life Support Resusc. 2015;95:100–47.
Kleinman ME, Brennan EE, Goldberger ZD, Swor RA, Terry M, Bobrow BJ, 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:S414–35.
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.
Cordioli RL, Brochard L, Suppan L, Lyazidi A, Templier F, Khoury A, et al. How ventilation is delivered during cardiopulmonary resuscitation: an international survey. Respir Care. 2018;63:1293–301.
Idris AH. Reassessing the need for ventilation during CPR. Ann Emerg Med. 1996;27:569–75.
Tan D, Xu J, Shao S, Fu Y, Sun F, Zhang Y, et al. Comparison of different inspiratory triggering settings in automated ventilators during cardiopulmonary resuscitation in a porcine model. PLoS ONE. 2017;12:e0171869.
Kwon Y, Debaty G, Puertas L, Metzger A, Rees J, McKnite S, et al. Effect of regulating airway pressure on intrathoracic pressure and vital organ perfusion pressure during cardiopulmonary resuscitation: a non-randomized interventional cross-over study. Scand J Trauma Resusc Emerg Med. 2015;23:83.
Hallstrom A, Cobb L, Johnson E, Copass M. Cardiopulmonary resuscitation by chest compression alone or with mouth-to-mouth ventilation. N Engl J Med. 2000;342:1546–53.
Rea TD, Fahrenbruch C, Culley L, Donohoe RT, Hambly C, Innes J, et al. CPR with chest compression alone or with rescue breathing. N Engl J Med. 2010;363(5):423–33.
Svensson L, Bohm K, Castren M, Pettersson H, Engerstrom L, Herlitz J, et al. Compression-only CPR or standard CPR in out-of-hospital cardiac arrest. N Engl J Med. 2010;363:434–42.
Iwami T, Kawamura T, Hiraide A, Berg RA, Hayashi Y, Nishiuchi T, et al. Effectiveness of bystander-initiated cardiac-only resuscitation for patients with out-of-hospital cardiac arrest. Circulation. 2007;116:2900–7.
Hupfl M, Selig HF, Nagele P. Chest-compression-only versus standard cardiopulmonary resuscitation: a meta-analysis. Lancet. 2010;376:1552–7.
Wang S, Li C, Ji X, Yang L, Su Z, Wu J. Effect of continuous compressions and 30:2 cardiopulmonary resuscitation on global ventilation/perfusion values during resuscitation in a porcine model. Crit Care Med. 2010;38:2024–30.
Ewy GA, Hilwig RW, Zuercher M, Sattur S, Sanders AB, Otto CW, et al. Continuous chest compression resuscitation in arrested swine with upper airway inspiratory obstruction. Resuscitation. 2010;81:585–90.
Yannopoulos D, Matsuura T, McKnite S, Goodman N, Idris A, Tang W, et al. No assisted ventilation cardiopulmonary resuscitation and 24-hour neurological outcomes in a porcine model of cardiac arrest. Crit Care Med. 2010;38:254–60.
Lurie KG, Yannopoulos D, McKnite SH, Herman ML, Idris AH, Nadkarni VM, et al. Comparison of a 10-breaths-per-minute versus a 2-breaths-per-minute strategy during cardiopulmonary resuscitation in a porcine model of cardiac arrest. Respir Care. 2008;53:862–70.
Pitts S, Kellermann AL. Hyperventilation during cardiac arrest. Lancet. 2004;364(9431):313–5.
Chalkias A, Pavlopoulos F, Koutsovasilis A, d’Aloja E, Xanthos T. Airway pressure and outcome of out-of-hospital cardiac arrest: a prospective observational study. Resuscitation. 2017;110:101–6.
Gazmuri RJ, Ayoub IM, Radhakrishnan J, Motl J, Upadhyaya MP. Clinically plausible hyperventilation does not exert adverse hemodynamic effects during CPR but markedly reduces end-tidal PCO(2). Resuscitation. 2012;83:259–64.
Markstaller K, Karmrodt J, Doebrich M, Wolcke B, Gervais H, Weiler N, et al. Dynamic computed tomography: a novel technique to study lung aeration and atelectasis formation during experimental CPR. Resuscitation. 2002;53:307–13.
Chalkias A, Xanthos T. Timing positive-pressure ventilation during chest compression: the key to improving the thoracic pump? Eur Heart J Acute Cardiovasc Care. 2015;4:24–7.
Cordioli RL, Lyazidi A, Rey N, Granier JM, Savary D, Brochard L, et al. Impact of ventilation strategies during chest compression. An experimental study with clinical observations. J Appl Physiol (1985). 2016;120:196–203.
Georgiou M, Papathanassoglou E, Xanthos T. Systematic review of the mechanisms driving effective blood flow during adult CPR. Resuscitation. 2014;85:1586–93.
Liu Y, Tian Z, Yu C, Walline J, Xu J, Zhu H, et al. Transesophageal echocardiography to assess mitral valve movement and flow during long term cardiopulmonary resuscitation: how cardiac effects fade with time. Int J Cardiol. 2016;223:693–8.
Idris AH, Staples ED, O’Brien DJ, Melker RJ, Rush WJ, Del Duca KD, et al. Effect of ventilation on acid-base balance and oxygenation in low blood-flow states. Crit Care Med. 1994;22:1827–34.
Cavus E, Meybohm P, Bein B, Steinfath M, Poppel A, Wenzel V, et al. Impact of different compression-ventilation ratios during basic life support cardiopulmonary resuscitation. Resuscitation. 2008;79:118–24.
Rivers EP, Martin GB, Smithline H, Rady MY, Schultz CH, Goetting MG, et al. The clinical implications of continuous central venous oxygen saturation during human CPR. Ann Emerg Med. 1992;21:1094–101.
Idris AH, Wenzel V, Becker LB, Banner MJ, Orban DJ. Does hypoxia or hypercarbia independently affect resuscitation from cardiac arrest? Chest. 1995;108:522–8.
Perkins GD, Ji C, Deakin CD, Quinn T, Nolan JP, Scomparin C, et al. A randomized trial of epinephrine in out-of-hospital cardiac arrest. N Engl J Med. 2018;379:711–21.
Gough CJR, Nolan JP. The role of adrenaline in cardiopulmonary resuscitation. Crit Care. 2018;22:139.
Steen S, Liao Q, Pierre L, Paskevicius A, Sjoberg T. Continuous intratracheal insufflation of oxygen improves the efficacy of mechanical chest compression-active decompression CPR. Resuscitation. 2004;62:219–27.
We thank the Institute of Life Monitoring, Mindray Corporation for providing the T8 monitors used in this study. Mindray Corporation did not have any role in the study design, data collection, data analysis, preparation of the manuscript, or decision to publish.
This work was supported by China’s Ministry of Health (Special scientific research funds for health industry 201502019) and Yangzhou Science and Technology Development Plan (YZ2018090).
Conflict of interest
The authors declare that they have no competing interests.
The study was approved by the Animal Care and Use Committee at Peking Union Medical College Hospital (The institutional Protocol Number: XHDW-2016-0015).
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Tan, D., Sun, J., Geng, P. et al. Duration of cardiac arrest requires different ventilation volumes during cardiopulmonary resuscitation in a pig model. J Clin Monit Comput 34, 525–533 (2020). https://doi.org/10.1007/s10877-019-00336-6
- Cardiopulmonary resuscitation
- Intrathoracic pressure
- Thoracic pump