Abstract 248: Continuous Chest Compressions with Interposed Ventilations Are Associated with Improved Outcomes from Suspected Asphyxial Arrest

Abstract

Background: A continuous chest compression (CCC) approach to CPR avoids pauses that decrease coronary perfusion pressure. However, the ability to provide adequate ventilation during CCC remains unclear. Cardiopulmonary arrest (CPA) victims with suspected asphyxia would be expected to be the most impacted by inadequate ventilation during CPR. Objective: To explore the impact of CCC on outcome from inpatients with suspected asphyxial CPA. Methods: This study was conducted in two urban university hospitals from 2005-09. The Advanced Resuscitation Training (ART) program was implemented in 2007. The ART program advocates CCC with interposed ventilations performed at a 10:1 ratio. Ventilations are initiated with the onset of compression recoil for both unprotected and protected airways. Data for all CPAs are entered into a resuscitation database. CPA events are categorized based on suspected etiology. Survival-to-discharge rates before and after implementation of the ART protocol were evaluated using chi-square analysis including test for trend. Ventilation rates were measured over the final 18 months of the study. Results: A total of 140 inpatients had suspected asphyxial CPA during the study period. Survival-to-discharge increased from 21.8% to 47.2% following implementation of the ART CCC protocol (p<0.001). Average ventilation rates associated with CCC were 9.7 breaths/min. Conclusions: An inpatient CCC protocol with ventilations interposed at a 10:1 ratio was associated with marked improvements in outcome among patients with suspected asphyxial CPA. These data suggest that adequate ventilation can be achieved with synchronous delivery of breaths with the recoil phase of compressions. Controlled ventilation rates were also achieved.