ADHERENCE TO GUIDELINE-RECOMMENDED VENTILATION RATE DURING CARDIAC ARREST: A QUALITY IMPROVEMENT STUDY

Abstract

SESSION TITLE: Monday Electronic Posters 2 SESSION TYPE: Original Inv Poster Discussion PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM PURPOSE: The delivery of cardiopulmonary resuscitation (CPR) with correct chest compression quality and ventilation rate is critical for patient survival. The American Heart Association adult advanced cardiac life support guidelines recommend a respiratory rate of 8-10 breaths per minute after advanced airway placement during CPR. However, multiple small observational studies have demonstrated ventilation rates during CPR are in excess of recommendations. Physiologically, hyperventilation raises positive intrathoracic pressure, decreases preload, reduces cardiac output, and may therefore worsen clinical outcomes. We sought out to evaluate real-world guideline adherence to ventilation rate during CPR during in-hospital cardiac arrest. METHODS: This was a retrospective analysis of a multicenter prospective observational study that evaluates outcomes in cardiac arrest involving 15 sites in the US and the UK. RESULTS: Of the 393 patients with end-tidal CO2 (EtCO2) monitoring, 100 had tracings to evaluate median respiratory rate. The average patient was 69 years old (SD 16), 33% were female, average CPR duration was 33.4 minutes (SD 32.3), median end-tidal CO2 was 21.6 (SD 11), and median respiratory rate was 15 breaths/min (SD 7). Of the cohort, 56% had return of spontaneous circulation (ROSC) with 32% of the cohort achieving sustained ROSC for >20 minutes. Eight percent were ventilated at a rate of 0-6 breaths/min, 28% at 7-12 breaths/min, 46% at 13-19 breaths/min, 18% at ≥20 breaths/min. Among this group of patients, there was no association with ventilation rate and ROSC. CONCLUSIONS: Nearly two thirds of patients in our database were receiving hyperventilation during CPR. Approximately a fifth of patients were being ventilated over double the recommended rate. CLINICAL IMPLICATIONS: There may be a role for ventilation rate feedback devices, or timers during in-hospital cardiac arrest. DISCLOSURES: no disclosure on file for James Horowitz; No relevant relationships by Oscar Mitchell, source=Web Response No relevant relationships by Sam Parnia, source=Web Response No relevant relationships by Emma Roellke, source=Web Response No relevant relationships by Rachel Sibley, source=Web Response No relevant relationships by Eugene Yuriditsky, source=Web Response