Comparison of a 10-Breaths-Per-Minute Versus a 2-Breaths-Per-Minute Strategy During Cardiopulmonary Resuscitation in a Porcine Model of Cardiac Arrest

Authors: Lurie, Keith G1; Yannopoulos, Demetris2; McKnite, Scott H3; Herman, Margot L3; Idris, Ahamed H4; Nadkarni, Vinay M5; Tang, Wanchun6; Gabrielli, Andrea7; Barnes, Thomas A8; Metzger, Anja K3

Source: Respiratory Care, Volume 53, Number 7, July 2008 , pp. 862-870(9)

Publisher: The Journal Respiratory Care Company

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Abstract:

BACKGROUND: Hyperventilation during cardiopulmonary resuscitation (CPR) is harmful. METHODS: We tested the hypotheses that, during CPR, 2 breaths/min would result in higher cerebral perfusion pressure and brain-tissue oxygen tension than 10 breaths/min, and an impedance threshold device (known to increase circulation) would further enhance cerebral perfusion and brain-tissue oxygen tension, especially with 2 breaths/min. RESULTS: Female pigs (30.4 ± 1.3 kg) anesthetized with propofol were subjected to 6 min of untreated ventricular fibrillation, followed by 5 min of CPR (100 compressions/min, compression depth of 25% of the anterior-posterior chest diameter), and ventilated with either 10 breaths/min or 2 breaths/min, while receiving 100% oxygen and a tidal volume of 12 mL/kg. Brain-tissue oxygen tension was measured with a probe in the parietal lobe. The impedance threshold device was then used during an 5 additional min of CPR. During CPR the mean ± SD calculated coronary and cerebral perfusion pressures with 10 breaths/min versus 2 breaths/min, respectively, were 17.6 ± 9.3 mm Hg versus 14.3 ± 6.5 mm Hg (p = 0.20) and 16.0 ± 9.5 mm Hg versus 9.3 ± 12.5 mm Hg (p = 0.25). Carotid artery blood flow, which was prospectively designated as the primary end point, was 65.0 ± 49.6 mL/min in the 10-breaths/min group, versus 34.0 ± 17.1 mL/min in the 2-breaths/min group (p = 0.037). Brain-tissue oxygen tension was 3.0 ± 3.3 mm Hg in the 10-breaths/min group, versus 0.5 ± 0.5 mm Hg in the 2-breaths/min group (p = 0.036). After 5 min of CPR there were no significant differences in arterial pH, PO2, or PCO2 between the groups. During CPR with the impedance threshold device, the mean carotid blood flow and brain-tissue oxygen tension in the 10-breaths/min group and the 2-breaths/min group, respectively, were 102.5 ± 67.9 mm Hg versus 38.8 ± 23.7 mm Hg (p = 0.006) and 4.5 ± 6.0 mm Hg versus 0.7 ± 0.7 mm Hg (p = 0.032). CONCLUSIONS: Contrary to our initial hypothesis, during the first 5 min of CPR, 2 breaths/min resulted in significantly lower carotid blood flow and brain-tissue oxygen tension than did 10 breaths/min. Subsequent addition of an impedance threshold device significantly enhanced carotid flow and brain-tissue oxygen tension, especially in the 10-breaths/min group.

Keywords: BRAIN-TISSUE OXYGENATION; CARDIAC ARREST; CARDIOPULMONARY RESUSCITATION; CEREBRAL PERFUSION PRESSURE; CIRCULATION; CPR; HYPERVENTILATION; IMPEDANCE THRESHOLD DEVICE; RESPIRATION

Document Type: Research Article

Affiliations: 1: Departments of Emergency Medicine and Internal Medicine, and the Cardiac Arrhythmia Center, University of Minnesota, Minneapolis, Minnesota, the Minneapolis Medical Research Foundation, Hennepin County Medical Center, Minneapolis, Minnesota, and Advanced Circulatory Systems, Eden Prairie Minnesota, Advanced Circulatory Systems, 7615 Golden Triangle Drive, Suite A, Eden Prairie MN 55344;, Email: klurie@advancedcirculatory.com 2: Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota 3: Departments of Emergency Medicine and Internal Medicine, and the Cardiac Arrhythmia Center, University of Minnesota, Minneapolis, Minnesota, the Minneapolis Medical Research Foundation, Hennepin County Medical Center, Minneapolis, Minnesota, and Advanced Circulatory Systems, Eden Prairie Minnesota 4: Department of Surgery (Emergency Medicine), University of Texas Southwestern Medical Center, Dallas, Texas 5: Department of Anesthesia and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 6: Weil Institute of Critical Care Medicine, Rancho Mirage, California, and the Department of Anesthesiology, Keck School of Medicine of the University of Southern California, Los Angeles, California 7: Departments of Anesthesiology, Physiology, and Surgery, University of Florida College of Medicine, Gainesville, Florida 8: Respiratory Therapy Program, Northeastern University, Boston, Massachusetts

Publication date: July 1, 2008

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