Abstract
Background: Optimal ventilation during cardio-pulmonary resuscitation (CPR) is still controversial. Ventilation is expected to provide sufficient arterial oxygen content and adequate carbon dioxide removal, while minimizing the risk of circulatory impairment. The objective of the present study was to compare three ventilation strategies in a porcine model during mechanical continuous chest compressions (CCC) according to arterial oxygenation and hemodynamic impact. Method: Ventricular fibrillation was induced and followed by five no-flow minutes and thirty low-flow minutes resuscitation with mechanical-CCC without vasopressive drugs administration. Three groups of eight Landras pig were randomized according to the ventilation strategy: 1. Standard nonsynchronized volume-control mode (SD-group); 2. synchronized bilevel pressure-controlled ventilation (CPV-group); 3. continuous insufflation with Boussignac Cardiac-Arrest Device (BC-group). We assessed 1. arterial blood gases, 2. macro hemodynamics, 3. tissular cerebral macro and micro-circulation and 4. airway pressure, minute ventilation at baseline and every 5 minutes during the protocol. Results: Arterial PaO2 level was higher at each measurement time in SD-group (>200 mm Hg) compare to CPV-group and BC-group ( P < 0.01). In BC-group, arterial PaCO2 level was significantly higher (>90mm Hg) than in SD and CPV groups ( P < 0.01). There was no difference between groups concerning hemodynamic parameters, cerebral perfusion and microcirculation. Conclusion: Ventilation modalities in this porcine model of prolonged CPR influence oxygenation and decarboxylation without impairing circulation and cerebral perfusion. Synchronized bi-level pressure-controlled ventilation' use avoid hyperoxia and was as efficient as asynchronized volume ventilation to maintain alveolar ventilation and systemic perfusion during prolonged CPR.
Highlights
Neurologic prognosis of cardiac arrest is highly dependent of the quality of cardio-pulmonary resuscitation (CPR)
The objective of this study was to compare three ventilation strategies used on the field (Standard, CPV and B-CARD) based on results on arterial oxygenation and decarboxylation, systemic and cerebral hemodynamics in a porcine model of prolonged CA under mechanical continuous chest compressions (MCCC)
The three groups behavior were similar during baseline period [TB-T0] for all hemodynamic, ventilatory and biology parameters as well as during the No-Flow period [T0-T5] before randomization (Table 1)
Summary
Neurologic prognosis of cardiac arrest is highly dependent of the quality of CPR. The International Liaison Committee on Resuscitation strongly encourages high-quality chest compressions (CC). Ventilation is expected to provide sufficient arterial oxygenation and adequate carbon dioxide removal, while minimizing the risk of circulatory impairment, with imprecise targets during CRP. Ventilation strategies may impact gas exchanges and circulation differently [5], especially when CPR with mechanical chest compression is prolonged [6]. Optimal ventilation during cardio-pulmonary resuscitation (CPR) is still controversial. Ventilation is expected to provide sufficient arterial oxygen content and adequate carbon dioxide removal, while minimizing the risk of circulatory impairment. The objective of the present study was to compare three ventilation strategies in a porcine model during mechanical continuous chest compressions (CCC) according to arterial oxygenation and hemodynamic impact
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