Empirical evidence for safety of mechanical ventilation during simulated cardiopulmonary resuscitation on a physical model.

Abstract

Cardiac arrest is a critical event requiring adequate and timely response in order to increase a patient's chance of survival. In patients mechanically ventilated with advanced airways, cardiopulmonary resuscitation (CPR) maneuver may be simplified by keeping the ventilator on. This work assessed the response of an intensive care mechanical ventilator to CPR using a patient manikin ventilated in three conventional modes. Volume-controlled (VCV), pressure-controlled (PCV) and pressure regulated volume-controlled (PRVC) ventilation were applied in a thorax physical model, with or without chest compressions. The mechanical ventilator was set with inspiratory time of 1.0 s, ventilation rate of 10 breaths/min, positive end-expiratory pressure of 0 cmH2O, FiO2 of 1.0, target tidal volume of 600 mL and trigger level of -20 cmH2O. Airway opening pressure and ventilatory flow signals were continuously recorded. Chest compression resulted in increased airway peak pressure in all ventilation modes (p < 0.001), especially with VCV (137% in VCV, 83% in PCV, 80% in PRVC). However, these pressures were limited to levels similar to release valves in manual resuscitators (~60 cmH2O). In pressure-controlled modes tidal/min volumes decreased (PRVC = 11%, p = 0.027 and PCV = 12%, p < 0.001), while still within the variability observed during bag-valve-mask ventilation. During VCV, variation in tidal/min volumes were not significant (p = 0.140). Respiratory rate did not change with chest compression. Volume and pressure ventilation modes responded differently to chest compressions. Yet, variation in delivered volume and the measured peak pressures were within the reported for the standard bag-valve-mask system.