Chest Compression Synchronized Ventilation versus Intermitted Positive Pressure Ventilation during Cardiopulmonary Resuscitation in a Pig Model |
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| Authors: | Clemens Kill Monika Galbas Christian Neuhaus Oliver Hahn Pascal Wallot Karl Kesper Hinnerk Wulf Wolfgang Dersch |
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| Institution: | 1Department of Anesthesiology and Critical Care, Philipps-University, Marburg, Germany;2Department of Emergency Medicine, Philipps-University, Marburg, Germany;3Department of Internal Medicine, Section Respiratory Diseases, Philipps-University, Marburg, Germany;4Weinmann Emergency Medical Technology GmbH+Co.KG, Hamburg, Germany;Azienda Ospedaliero-Universitaria Careggi, ITALY |
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| Abstract: | BackgroundGuidelines recommend mechanical ventilation with Intermitted Positive Pressure Ventilation (IPPV) during resuscitation. The influence of the novel ventilator mode Chest Compression Synchronized Ventilation (CCSV) on gas exchange and arterial blood pressure compared with IPPV was investigated in a pig model.MethodsIn 12 pigs (general anaesthesia/intubation) ventricular fibrillation was induced and continuous chest compressions were started after 3min. Pigs were mechanically ventilated in a cross-over setting with 5 ventilation periods of 4min each: Ventilation modes were during the first and last period IPPV (100% O2, tidalvolumes = 7ml/kgKG, respiratoryrate = 10/min), during the 2nd, 3rd and 4th period CCSV (100% O2), a pressure-controlled and with each chest compression synchronized breathing pattern with three different presets in randomized order. Presets: CCSVA: Pinsp = 60mbar, inspiratorytime = 205ms; CCSVB: Pinsp = 60mbar, inspiratorytime = 265ms; CCSVC: Pinsp = 45mbar, inspiratorytime = 265ms. Blood gas samples were drawn for each period, mean arterial (MAP) and centralvenous (CVP) blood pressures were continuously recorded. Results as median (25%/75%percentiles).ResultsVentilation with each CCSV mode resulted in higher PaO2 than IPPV: PaO2: IPPVfirst: 19.6(13.9/36.2)kPa, IPPVlast: 22.7(5.4/36.9)kPa (p = 0.77 vs IPPVfirst), CCSVA: 48.9(29.0/58.2)kPa (p = 0.028 vs IPPVfirst, p = 0.0001 vs IPPVlast), CCSVB: 54.0 (43.8/64.1) (p = 0.001 vs IPPVfirst, p = 0.0001 vs IPPVlast), CCSVC: 46.0 (20.2/58.4) (p = 0.006 vs IPPVfirst, p = 0.0001 vs IPPVlast). Both the MAP and the difference MAP-CVP did not decrease during twelve minutes CPR with all three presets of CCSV and were higher than the pressures of the last IPPV period.ConclusionsAll patterns of CCSV lead to a higher PaO2 and avoid an arterial blood pressure drop during resuscitation compared to IPPV in this pig model of cardiac arrest. |
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