ABSTRACT
Background Cardiac arrest is a critical event requiring adequate and timely response in order to increase patient’s chance of survival. In patients mechanically ventilated with advance airways cardiopulmonary resuscitation (CPR) maneuver may be simplified by keeping the ventilator on. This work assessed the response of a intensive care mechanical ventilator to CPR using a patient manikin ventilated in three conventional modes.
Methods Volume controlled (VCV), pressure controlled (PCV) and pressure regulated volume controlled (PRVC) ventilation were applied in a thorax physical model with or without chest compressions. The mechanical ventilator was set with inspiratory time of 1.0 s, ventilation rate of 10 breaths/minute, positive end-expiratory pressure of 0 cmH2O, FiO2 of 1.0, target tidal volume of 600 ml and trigger level of -20 cmH2O. Airway opening pressure and ventilatory flow signals were continuously recorded..
Results Chest compression resulted in increased airway peak pressure in all ventilation modes (p<0.001), specially with VCV (137% in VCV, 83% in PCV, 80% in PRVC). However, these pressures were limited to levels similar to release valves in manual resuscitators (∼60 cmH2O). In pressure controlled modes tidal/minute volumes decreased (PRVC=11%, p=0.027 and PCV=12%, p<0.001), while still within the variability observed during bag-valve-mask ventilation. During VCV, variation in tidal/minute volumes were not significant (p=0.140). Respiratory rates were constant with and without chest compression.
Conclusions A intensive care mechanical ventilator could provide adequate ventilation during compressions in a manikin model while using conventional ventilation modes.
Competing Interest Statement
The authors have declared no competing interest.
Clinical Trial
The experiments were performed on a physical model
Funding Statement
This work was partially supported by the Brazilian National Council for Scientific and Technological Development (CNPq), Coordination of Superior Level Staff Improvement (CAPES) and Carlos Chagas Filho Foundation for Research Support of the State of Rio de Janeiro (FAPERJ) with study grants to the authors and funding to acquire the mechanical ventilator used. Sponsors had no role on study design, data collection and analysis, text writing, or decision about publication.
Author Declarations
All relevant ethical guidelines have been followed; any necessary IRB and/or ethics committee approvals have been obtained and details of the IRB/oversight body are included in the manuscript.
Yes
All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.
Yes
I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).
Yes
I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.
Yes
Data Availability
All experimental data is available under request.