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Continuous insufflation of oxygen without endotracheal intubation improves cardiopulmonary resuscitation, a manikin-based model
YAJEM-56303; No of Page 1 American Journal of Emergency Medicine xxx (2016) xxx
Contents lists available at ScienceDirect
American Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/ajem
Correspondence Continuous insufflation of oxygen without endotracheal intubation improves cardiopulmonary resuscitation, a manikin-based model Keywords: Cardiopulmonary resuscitation Ventilation
duration and is associated with an increased CPR fraction. This improvement of the CPR quality supports the use of CIO but requires a prospective evaluation. We may expect that CIO could improve the outcome of patients with cardiac arrest, as suggested by retrospective data [5]. Conflicts of interest None.
Continuous insufflation of oxygen (CIO) performed with specific endotracheal tube during cardiopulmonary resuscitation (CPR) is as effective as intermittent ventilation on endotracheal tube [1]. Experimental data suggest that CIO improves the efficacy of external cardiac massage [2] and reduces gastric dilatation [3]. As endotracheal intubation is a cause of CPR interruption and requires skilled staff [4], a specific device has been developed to perform CIO without intubation, the B-Card® (Vygon, France). We evaluated the efficacy of this device in a manikinbased model. CPR was performed during 10 min by 35 teams of 3 trained rescuers on a simulation manikin (Resusci Anne® QCPR, Laerdal, Norway). The rescuers were firefighters who gave informed consent to participate. Oxygenation device (CIO or valve-bag mask) was randomized using a bloc randomization list. Chest compressions were monitored by the automated external defibrillator (Zoll Medical Corporation, USA). Data are reported as median and interquartile range and were compared using the Mood test (SPSS software). Thirty-five RCPs were analyzed, 15 with the valve-bag mask and 20 with CIO. The durations of case-management and of CPR were similar in the groups, as were the rate and the depth of chest compressions (Table 1). CIO was associated with a higher CPR fraction (ratio of duration of chest compressions on total duration of CPR). These experimental data show that CIO with the B-Card device can be performed by trained rescuers, does not extend case management
References [1] Yu H, Qing H, Min Y. Continuous passive oxygen insufflation for out-of-hospital cardiac arrest: a systemic review of clinical studies. Resuscitation 2013;84:e9–10. [2] Steen S, Liao Q, Pierre L, Paskevicius A, Sjöberg T. Continuous intratracheal insufflation of oxygen improves the efficacy of mechanical chest compression-active decompression CPR. Resuscitation 2004;62:219–27. [3] Segal N, Voiglio EJ, Rerbal D, Jost D, Dubien P-Y, Lanoe V, et al. Effect of continuous oxygen insufflation on induced-gastric air volume during cardiopulmonary resuscitation in a cadaveric model. Resuscitation 2015;86:62–6. [4] Wang HE, Simeone SJ, Weaver MD, Callaway CW. Interruptions in cardiopulmonary resuscitation from paramedic endotracheal intubation. Ann Emerg Med 2009;54: 645–52, e1. [5] Bobrow BJ, Ewy GA, Clark L, Chikani V, Berg RA, Sanders AB, et al. Passive oxygen insufflation is superior to bag-valve-mask ventilation for witnessed ventricular fibrillation out-of-hospital cardiac arrest. Ann Emerg Med 2009;54:656–62, e1.
Arnaud Gaillard Haute-Savoie Fire Department, Meythet, France Cécile Ricard Department of Emergency Medicine, SAMU 74, Annecy Genevois Hospital, Annecy, France Claire Vallenet Haute-Savoie Fire Department, Meythet, France Olivier Baptiste Haute-Savoie Fire Department, Meythet, France
Table 1 CPR quality according to the oxygenation device.
CPR duration (s) Case management duration (s) Chest compression rate (/min) Chest compression depth (cm) CPR fraction (%)
Bag-valve mask
Continuous insufflation of oxygen
p
963 [948; 1116] 1003 [995; 1172] 110 [103–112] 5.7 [4.8–55.9]
962 [919; 1072]
0.81
1003 [977; 1138]
0.88
109 [104–116]
0.69
5.3 [4.1–5.6]
0.88
75.7 [72.5–78.8]
86.2 [81.7–87.2]
b0.001
Vincent Peigne⁎ Haute-Savoie Fire Department, Meythet, France Intensive Care Unit Metropole-Savoie Hospital, Chambery, France Corresponding author at: Intensive Care Unit Metropole-Savoie Hospital, Place Lucien Biset, 73000 Chambery, France. E-mail address: [email protected] 16 November 2016 Available online xxxx
http://dx.doi.org/10.1016/j.ajem.2016.11.045 0735-6757/© 2016 Elsevier Inc. All rights reserved.
Please cite this article as: Gaillard A, et al, , American Journal of Emergency Medicine (2016), http://dx.doi.org/10.1016/j.ajem.2016.11.045
Contents lists available at ScienceDirect
American Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/ajem
Correspondence Continuous insufflation of oxygen without endotracheal intubation improves cardiopulmonary resuscitation, a manikin-based model Keywords: Cardiopulmonary resuscitation Ventilation
duration and is associated with an increased CPR fraction. This improvement of the CPR quality supports the use of CIO but requires a prospective evaluation. We may expect that CIO could improve the outcome of patients with cardiac arrest, as suggested by retrospective data [5]. Conflicts of interest None.
Continuous insufflation of oxygen (CIO) performed with specific endotracheal tube during cardiopulmonary resuscitation (CPR) is as effective as intermittent ventilation on endotracheal tube [1]. Experimental data suggest that CIO improves the efficacy of external cardiac massage [2] and reduces gastric dilatation [3]. As endotracheal intubation is a cause of CPR interruption and requires skilled staff [4], a specific device has been developed to perform CIO without intubation, the B-Card® (Vygon, France). We evaluated the efficacy of this device in a manikinbased model. CPR was performed during 10 min by 35 teams of 3 trained rescuers on a simulation manikin (Resusci Anne® QCPR, Laerdal, Norway). The rescuers were firefighters who gave informed consent to participate. Oxygenation device (CIO or valve-bag mask) was randomized using a bloc randomization list. Chest compressions were monitored by the automated external defibrillator (Zoll Medical Corporation, USA). Data are reported as median and interquartile range and were compared using the Mood test (SPSS software). Thirty-five RCPs were analyzed, 15 with the valve-bag mask and 20 with CIO. The durations of case-management and of CPR were similar in the groups, as were the rate and the depth of chest compressions (Table 1). CIO was associated with a higher CPR fraction (ratio of duration of chest compressions on total duration of CPR). These experimental data show that CIO with the B-Card device can be performed by trained rescuers, does not extend case management
References [1] Yu H, Qing H, Min Y. Continuous passive oxygen insufflation for out-of-hospital cardiac arrest: a systemic review of clinical studies. Resuscitation 2013;84:e9–10. [2] Steen S, Liao Q, Pierre L, Paskevicius A, Sjöberg T. Continuous intratracheal insufflation of oxygen improves the efficacy of mechanical chest compression-active decompression CPR. Resuscitation 2004;62:219–27. [3] Segal N, Voiglio EJ, Rerbal D, Jost D, Dubien P-Y, Lanoe V, et al. Effect of continuous oxygen insufflation on induced-gastric air volume during cardiopulmonary resuscitation in a cadaveric model. Resuscitation 2015;86:62–6. [4] Wang HE, Simeone SJ, Weaver MD, Callaway CW. Interruptions in cardiopulmonary resuscitation from paramedic endotracheal intubation. Ann Emerg Med 2009;54: 645–52, e1. [5] Bobrow BJ, Ewy GA, Clark L, Chikani V, Berg RA, Sanders AB, et al. Passive oxygen insufflation is superior to bag-valve-mask ventilation for witnessed ventricular fibrillation out-of-hospital cardiac arrest. Ann Emerg Med 2009;54:656–62, e1.
Arnaud Gaillard Haute-Savoie Fire Department, Meythet, France Cécile Ricard Department of Emergency Medicine, SAMU 74, Annecy Genevois Hospital, Annecy, France Claire Vallenet Haute-Savoie Fire Department, Meythet, France Olivier Baptiste Haute-Savoie Fire Department, Meythet, France
Table 1 CPR quality according to the oxygenation device.
CPR duration (s) Case management duration (s) Chest compression rate (/min) Chest compression depth (cm) CPR fraction (%)
Bag-valve mask
Continuous insufflation of oxygen
p
963 [948; 1116] 1003 [995; 1172] 110 [103–112] 5.7 [4.8–55.9]
962 [919; 1072]
0.81
1003 [977; 1138]
0.88
109 [104–116]
0.69
5.3 [4.1–5.6]
0.88
75.7 [72.5–78.8]
86.2 [81.7–87.2]
b0.001
Vincent Peigne⁎ Haute-Savoie Fire Department, Meythet, France Intensive Care Unit Metropole-Savoie Hospital, Chambery, France Corresponding author at: Intensive Care Unit Metropole-Savoie Hospital, Place Lucien Biset, 73000 Chambery, France. E-mail address: [email protected] 16 November 2016 Available online xxxx
http://dx.doi.org/10.1016/j.ajem.2016.11.045 0735-6757/© 2016 Elsevier Inc. All rights reserved.
Please cite this article as: Gaillard A, et al, , American Journal of Emergency Medicine (2016), http://dx.doi.org/10.1016/j.ajem.2016.11.045