Optimum cardiopulmonary resuscitation for basic and advanced life support: a simulation study.

Abstract

Optimum cardiopulmonary resuscitation (CPR) for both basic and advanced cardiac life support depends on a compromise between the number of chest compressions delivered and the amount of ventilation provided. This study used theoretical models of blood flow and both arterial and venous blood gas values to investigate the influence of different compression to ventilation ratios on CPR efficiency, as well as the effects of different inspired oxygen concentrations. With mouth-to-mouth ventilation, greater numbers of compressions between each ventilation provided progressively greater blood flow. However, a greater the number of compressions, reduced the arterial oxygen levels and carbon dioxide clearance. There was an optimum ratio, in terms of both oxygen delivery and carbon dioxide clearance, of around 20:1 compressions to ventilation. Optimum oxygen delivery was 0.19 L/min at 20:1, which was better than the oxygen delivery for standard CPR based on a ratio of 15:2 (0.13 L/min). When patients were ventilated with supplemental oxygen (either 50 or 85%) the lungs rapidly became saturated with oxygen, and oxygen delivery depended more on blood flow. Higher numbers of compressions provided greater oxygen delivery, but at the cost of increasing hypercarbia, which is thought to affect resuscitation success rates adversely. The simulation results suggested ratios around 20:1 would be the best compromise between blood flow, oxygen delivery (0.25 L/min) and avoidance of hypercarbia. The best results were provided by continuous chest compressions and simultaneous, asynchronous ventilation in an intubated patient. Arterial and venous oxygen and carbon dioxide levels were well maintained, with very good oxygen delivery (0.32 L/min). Intubation with continuous chest compressions and asynchronous ventilation can therefore significantly improve the quality of CPR as a whole, and not just ventilation.