Guidelines for resuscitation recommend positive-pressure ventilation with a fixed ventilation rate as provided by an automated transport ventilator during cardiopulmonary resuscitation (CPR) with a secured airway. We investigated the influence of manual chest compressions (CC) on the accuracy of ventilator presets and the quality of CC with intermittent positive-pressure ventilation (IPPV), bilevel ventilation (BiLevel), and the novel ventilation mode chest compression synchronized ventilation (CCSV) in a simulation model.
Ninety paramedics performed continuous CC for 2 min on a modified advanced life support mannequin with a realistic lung model. IPPV, BiLevel, and CCSV were applied in a randomized order. CCSV is a novel type of pressure-controlled ventilation with short insufflations synchronized with CC, which are stopped before decompression begins. The ventilator presets (tolerance range) were IPPV Vt = 450 (400–500) ml, PEEP = 0 hPa, f = 10/min; BiLevel Pinsp = 19 (17.1–20.9) hPa, PEEP = 5 hPa, f = 10/min; CCSV Pinsp = 60 (54–66) hPa, PEEP = 0 hPa, Tinsp = 205 ms, f = CC rate. Preset values were compared with the measured results. Values were defined as correct within a tolerance range. Quality of CC was evaluated using ERC guidelines (depth >50 mm, CC rate 100–120/min).
Median (25th/75th percentiles) IPPV V t = 399 (386/411) ml, BiLevel Pinsp = 22.0 (19.7/25.6) hPa, and CCSV Pinsp = 55.2 (52.6/56.7) hPa. Relative frequency of delivering correct ventilation parameters according to ventilation mode: IPPV = 40 (0/100)% vs. BiLevel = 20 (0/100)%, p = 0.37 and vs. CCSV = 71 (50/83)%, p < 0.02. Pinsp was too high in BiLevel = 80 (0/100)% vs. CCSV = 0(0/0)%, p < 0.001. CC depth: IPPV 56 (48/63) mm, BiLevel 57 (48/63) mm, CCSV 60 (52/67) mm; CC rate: IPPV 117 (105/124)/min, BiLevel 116 (107/123)/min, CCSV 117 (107/125)/min.
When compared to IPPV and BiLevel, CCSV works best with preset values, without exceeding the upper pressure preset during simulated CPR. Quality of CC is not negatively affected by any of the ventilation patterns.
Parts of this study were supported by Weinmann Emergency Medical Technology GmbH + Co.KG.
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The authors would like to express their gratitude to the paramedics working for the EMS of Marburg-Biedenkopf and Giessen, who have participated in this study. We also thank Thomas Ploch for his support in planning the experiment and his statistical review. Weinmann Emergency Medical Technology GmbH + Co.KG provided support in the form of a salary for author CN, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Article processing charges were subsidized by Weinmann Emergency Medical Technology GmbH + Co.KG. There are no patents, products in development, or marketed products to declare. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval for the version to be published. All authors had full access to all of the data in this study and take complete responsibility for the integrity of the data and accuracy of the data analysis.
T. Speer received compensation for travel from Weinmann EMT. B. Kleine received compensation for travel from Weinmann EMT. T. Speer received refunds for congress fees from Weinmann EMT. T. Speer worked as a medical consultant for Weinmann EMT. C. Kill worked as a medical consultant for Weinmann EMT. C. Neuhaus is an employee of Weinmann EMT. W. Dersch has nothing to disclose.
Compliance with Ethics Guidelines
Ethics Committee of the Medical Faculty of the Philipps University of Marburg, reference number 36/14. This article does not contain any studies collecting data from human or animal. All participants received oral and written information about the study and gave informed consent, which could be withdrawn at any time.
All data generated or analyzed during this study are included as supplementary information files.
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Speer, T., Dersch, W., Kleine, B. et al. Mechanical Ventilation During Resuscitation: How Manual Chest Compressions Affect a Ventilator’s Function. Adv Ther 34, 2333–2344 (2017). https://doi.org/10.1007/s12325-017-0615-7
- Cardiopulmonary resuscitation
- Chest compressions
- Chest compression synchronized ventilation
- Simulation model