Skip to main content
SpringerLink
Log in

Evaluation of pressure-controlled ventilation concepts during cardiopulmonary resuscitation (CPR) in dental chairs

  • Original Article
  • Published:
Oral and Maxillofacial Surgery Aims and scope Submit manuscript

Abstract

Background

Infrequent training of lay rescuers in cardiopulmonary resuscitation may lead to stomach inflation during ventilation of the unsecured airway. This is caused by a pressure loss of the lower oesophageal sphincter (LOSP) after onset of cardiac arrest. To minimise the risk of stomach inflation, the SMART BAG® (SB), a disposable flow-limited bag-valve-mask resuscitator, has been designed.

Aim The aim of this study was to evaluate the occurrence of stomach inflation by use of SB in comparison to two other ventilation devices with respect to the ventilation capability.

Method

An Easy Grip® disposable bag-valve-mask resuscitator (EG), an SB and an EG with an interposed T-piece attached to a 0.5 l reservoir bag (EG/R) were compared in a manikin ventilation training setting. Fourteen dentists performed ventilations on a Mini Ventilation Training Analyzer using EG, SB and EG/R with lung compliance (LC) and LOSP being adjusted to 700 ml/kPa and 1.5 kPa (best case) and 500 ml/kPa and 0.5 kPa (worst case) in a randomised order.

Results

Sufficient tidal volumes were obtained by use of all the three test devices regardless of LC or LOSP. No statistical differences were detected between the use of SB and EG/R. Using EG led to statistically larger volumes. Stomach inflation could only be avoided using SB and EG/R at a high LOSP regardless of LC.

Conclusion

Even in the worst case scenario, use of SB and EG/R administered sufficient tidal volumes with a significantly smaller stomach inflation compared to EG. Combination of standard bag-valve devices with a reservoir bag may provide similar protection from gastric inflation as the SMART BAG®.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Wenzel V, Idris AH (1997) The current status of ventilation strategies during cardiopulmonary resuscitation. Curr Opin Crit Care 3:206–213

    Article  Google Scholar 

  2. Bowman FP, Menegazzi JJ, Check BD, Duckett TM (1995) Lower esophageal sphincter pressure during prolonged cardiac arrest and resuscitation. Ann Emerg Med 26:216–219

    Article  PubMed  CAS  Google Scholar 

  3. Melker RJ (1986) Alternative methods of ventilation during respiratory and cardiac arrest. Circulation 74:IV63–IV65

    PubMed  CAS  Google Scholar 

  4. Gabrielli A, Wenzel V, Layon AJ, von Goedecke A, Verne NG, Idris AH (2005) Lower esophageal sphincter pressure measurement during cardiac arrest in humans: potential implications for ventilation of the unprotected airway. Anesthesiology 103:897–899

    Article  PubMed  Google Scholar 

  5. Ruben H, Knudsen EJ, Carugati G (1961) Gastric inflation in relation to airway pressure. Acta Anaesthesiol Scand 5:107–114

    Article  PubMed  CAS  Google Scholar 

  6. Spence AA, Moir DD, Finlay WE (1967) Observations on intragastric pressure. Anaesthesia 22:249–256

    Article  PubMed  CAS  Google Scholar 

  7. Wenzel V, Idris AH, Banner MJ, Kubilis PS, Band R, Williams JL Jr et al (1998) Respiratory system compliance decreases after cardiopulmonary resuscitation and stomach inflation: impact of large and small tidal volumes on calculated peak airway pressure. Resuscitation 38:113–118

    Article  PubMed  CAS  Google Scholar 

  8. Morton HJ, Wylie WD (1951) Anaesthetic deaths due to regurgitation or vomiting. Anaesthesia 6:190–201, passim

    Article  PubMed  CAS  Google Scholar 

  9. Lawes EG, Baskett PJ (1987) Pulmonary aspiration during unsuccessful cardiopulmonary resuscitation. Intensive Care Med 13:379–382

    Article  PubMed  CAS  Google Scholar 

  10. Sans S, Kesteloot H, Kromhout D (1997) The burden of cardiovascular diseases mortality in Europe. Task Force of the European Society of Cardiology on Cardiovascular Mortality and Morbidity Statistics in Europe. Eur Hear J 18:1231–1248

    Article  Google Scholar 

  11. Atwood C, Eisenberg MS, Herlitz J, Rea TD (2005) Incidence of EMS-treated out-of-hospital cardiac arrest in Europe. Resuscitation 67:75–80

    Article  PubMed  Google Scholar 

  12. Koster RW, Baubin MA, Bossaert LL, Caballero A, Cassan P, Castren M et al (2010) European Resuscitation Council Guidelines for Resuscitation 2010. Section 2. Adult basic life support and use of automated external defibrillators. Resuscitation 81:1277–1292

    Article  PubMed  Google Scholar 

  13. Hunter PL (1991) Cardiac arrest in the dental surgery. Br Dent J 170:284

    Article  PubMed  CAS  Google Scholar 

  14. Rabus FC, Luebbers HT, Graetz KW, Mutzbauer TS (2008) Comparison of different flow-reducing bag-valve ventilation devices regarding respiratory mechanics and gastric inflation in an unprotected airway model. Resuscitation 78:224–229

    Article  PubMed  Google Scholar 

  15. De Regge M, Vogels C, Monsieurs KG, Calle PA (2006) Retention of ventilation skills of emergency nurses after training with the SMART BAG compared to a standard bag-valve-mask. Resuscitation 68:379–384

    Article  PubMed  Google Scholar 

  16. von Goedecke A, Wagner-Berger HG, Stadlbauer KH, Krismer AC, Jakubaszko J, Bratschke C et al (2004) Effects of decreasing peak flow rate on stomach inflation during bag-valve-mask ventilation. Resuscitation 63:131–136

    Article  Google Scholar 

  17. Deakin CD, Nolan JP, Soarc J, Sunded K, Kostere RW, Smith GB et al (2010) European Resuscitation Council Guidelines for Resuscitation 2010. Section 4. Adult advanced life support. Resuscitation 81:1305–1352

    Article  PubMed  Google Scholar 

  18. Stohler FC, Becker MF, Tabacek G, Drommer RB, Mutzbauer TS (2007) Alternative concept of ventilation during cardiopulmonary resuscitation (CPR) in dental chairs. Schweiz Monatsschr Zahnmed 117:814–819

    PubMed  Google Scholar 

  19. Herrf H, Paal P, von Goedecke A, Mitterlechner T, Danninger T, Wenzel V (2008) Minimizing stomach inflation versus optimizing chest compressions. Anesth Analg 106:535–537

    Article  Google Scholar 

Download references

Conflict of interest

There is no financial conflict of interest for any of the authors.

Author information

Authors and Affiliations

  1. Department of Craniomaxillofacial and Oral Surgery, University Hospital Zurich, Frauenklinikstr 24, CH-8091, Zurich, Switzerland

    P. Dietrich & K. W. Graetz

  2. Department of Maxillofacial Surgery and Dental Anaesthesiology, Mutzbauer&Partner, Tiefenhoefe 11, CH-8001, Zurich, Switzerland

    T. S. Mutzbauer

Authors
  1. P. Dietrich
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K. W. Graetz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. T. S. Mutzbauer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. S. Mutzbauer.

Additional information

Work was performed at Clinic of Oral Surgery, Center of Dental Medicine, Zurich.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dietrich, P., Graetz, K.W. & Mutzbauer, T.S. Evaluation of pressure-controlled ventilation concepts during cardiopulmonary resuscitation (CPR) in dental chairs. Oral Maxillofac Surg 17, 173–179 (2013). https://doi.org/10.1007/s10006-012-0351-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10006-012-0351-8

Keywords

Search

Navigation