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Use of airway management techniques during cardiac arrests
S16
Poster Presentations / Resuscitation 84S (2013) S8–S98
improvement for optimizing CO2 expulsion and minimizing lung injury.
References 1. Bobrow BJ, et al. Circulation 2008;118:2550–4. 2. Robinson A, et al. BMJ Open 2012;2, http://dx.doi.org/10.1136/bmjopen-2012001785, pii:e001785. Print 2012. 3. Hess D, et al. Anesthesiology 1994;81:1256–63.
AP022
Yassar Mustafa ∗ , Carol Downing
Ventilations during automated compression in pigs, continuous or 30:2 mode: Effectiveness and potential trauma
Queen Elizabeth Hospital, Birmingham, UK
Paul van Berkom 1,∗ , Simone Ordelman 2 , Paul Aelen 2 , Pierre Woerlee 2 , Gerrit Jan Noordergraaf 1 1
St. Elisabeth Hospital, Tilburg, The Netherlands Philips Research, Eindhoven, The Netherlands
Introduction: ERC guidelines state that as soon as possible 30:2 compression to ventilation should be replaced by continuous compressions and interposed ventilations. This to avoid interruptions, maintaining CPP. However, automated compressions at 100 min−1 allow little time for ventilation, possibly causing volume loss. We compared both regimes under controlled conditions. Methods and materials: In 26 anesthetised pigs (30.5 ± 3.35 kg) ventricular fibrillation was induced. CPR was performed with Lucas2 or a proprietary device at 100 min−1 . Ventilations were performed with a 500 ml BVD either continuously (0.3 s between compressions) or in 30:2 mode (3.8 s ventilation pause). Airway pressures, tidal volumes and end-tidal CO2 (ETCO2 ) were measured (Philips MP50). Simultaneous arterial and venous gasses were used to assess CO2 build up at 5 and 20 min of CPR. Ventilation measurements averaged over 40 s prior to the first blood sample formed the ventilation baseline, with tidal volumes corrected for dead space by subtracting 3 ml/kg. Results: Minute volume ventilation is much higher in continuous mode than in 30:2 mode. ETCO2 was in line with blood samples. Peak pressure was dangerously high in continuous mode. In the continuous group, 2/10 pigs were excluded due to severe pulmonary oedema. Continuous (n = 8) Corr. tidal volume ml/kg (−3 ml/kg dead space) Corr. Min. volume ventilation (ml/min/kg) Peak pressure (cmH2 O) paCO2 kPa (baseline to 5 min. of CPR) pvCO2 kPa (baseline to 5 min. of CPR) paCO2 kPa (baseline to 20 min. of CPR) pvCO2 kPa (baseline to 20 min. of CPR) ETCO2 (kPa)
7.78 ± 3.7
30:2 (n = 16)
1st vs 2nd breath
AP023 Use of airway management techniques during cardiac arrests
http://dx.doi.org/10.1016/j.resuscitation.2013.08.053
2
http://dx.doi.org/10.1016/j.resuscitation.2013.08.054
p-value
Purpose: A range of airway management techniques are frequently employed in cardiac arrest calls, and therefore significant time is dedicated to teaching members of the medical emergency teams on their appropriate usage, such as during the Advanced Life Support course. However, what is poorly understood is the actual frequency of usage of various airway adjuncts and stabilisation methods that occur in real cardiac arrest calls. This study elucidates this information, thereby enabling clinical trainers to allocate a more proportionate amount of time on teaching those adjuncts more frequently encountered. Method: We undertook a retrospective study investigating post-cardiac arrest surveys from the past four years at a large university teaching hospital that incorporates a level 1 trauma centre and tertiary cardiac unit. In particular, we focussed on the adjuncts and techniques utilised during the airway management of these cardiac arrests. Results: In the four year study period, there were a total of 1314 cardiac arrests at the trust, wherein an airway management method was utilised. An oropharyngeal tube was used in 244 episodes (18%), a laryngeal mask airway was used in 60 episodes (5%), a nasopharyngeal tube was used in 43 episodes (3%) and a jaw thrust was performed in just 6 episodes (1%). Interestingly, in approximately a third of all cases, a bag valve mask (438 episodes) and an endotracheal tube (442 episodes) were employed. Conclusions: The most frequently utilised airway management method during cardiac arrests in our trust is the endotracheal tube. Of the simple airway adjuncts, the oropharyngeal tube and the bag valve mask are most commonly used. Therefore, although all simple airway management techniques should be taught, clinical trainers such as in Advanced Life Support courses, should focus on ensuring candidates have both a thorough understanding and practical experience, of these two aforementioned methods.
8.83 ± 1.89
.360
77.78 ± 36.99
49.47 ± 10.57
.008
64 ± 24.9 1.01 ± 0.88
25 ± 5.2 1.24 ± 0.89
.000 .565
2.45 ± 0.70
2.04 ± 0.81
.212
0.22 ± 2.16
2.33 ± 1.58
.015
The effect of ventilation rate on the survival in adults receiving cardiopulmonary resuscitation: A systematic review
3.29 ± 2.48
3.89 ± 1.06
.533
Gino Vissers 1 , Koenraad G. Monsieurs 2,∗
.793 .033
1
http://dx.doi.org/10.1016/j.resuscitation.2013.08.055
3.73 ± 0.8
4 ± 0.53
4.1 ± 0.5 vs 3.7 ± 0.5
Conclusion: Effective minute volume was much larger in continuous mode than in 30:2 mode. The difference in ETCO2 indicates that the second breath in 30:2 mode is less effective for CO2 removal than the first. Pressures were higher in continuous mode, suggesting insufficient ventilating time between compressions. These high pressures may lead to pulmonary oedema and less effective gas exchange in prolonged CPR, as seen in our sample. Volumes in continuous mode prevented paCO2 build-up during the 20 min, but did this while exceeded volumes suggested by guidelines. A ventilation pause (e.g. 0.5 s) in continuous mode automated CPR could be an
AP024
2
Antwerp University, Antwerp, Belgium Antwerp University Hospital, Edegem, Belgium
Purpose of the study: Current guidelines suggest that hyperventilation during resuscitation reduces outcome. This review investigates whether in adults with cardiac arrest with a secure airway, a ventilation rate of 10 breaths/min, compared to any other rate, improves outcome (Return Of Spontaneous Circulation (ROSC), survival to hospital, survival to discharge, survival to discharge with good neurological outcome, 30-day mortality).
Poster Presentations / Resuscitation 84S (2013) S8–S98
improvement for optimizing CO2 expulsion and minimizing lung injury.
References 1. Bobrow BJ, et al. Circulation 2008;118:2550–4. 2. Robinson A, et al. BMJ Open 2012;2, http://dx.doi.org/10.1136/bmjopen-2012001785, pii:e001785. Print 2012. 3. Hess D, et al. Anesthesiology 1994;81:1256–63.
AP022
Yassar Mustafa ∗ , Carol Downing
Ventilations during automated compression in pigs, continuous or 30:2 mode: Effectiveness and potential trauma
Queen Elizabeth Hospital, Birmingham, UK
Paul van Berkom 1,∗ , Simone Ordelman 2 , Paul Aelen 2 , Pierre Woerlee 2 , Gerrit Jan Noordergraaf 1 1
St. Elisabeth Hospital, Tilburg, The Netherlands Philips Research, Eindhoven, The Netherlands
Introduction: ERC guidelines state that as soon as possible 30:2 compression to ventilation should be replaced by continuous compressions and interposed ventilations. This to avoid interruptions, maintaining CPP. However, automated compressions at 100 min−1 allow little time for ventilation, possibly causing volume loss. We compared both regimes under controlled conditions. Methods and materials: In 26 anesthetised pigs (30.5 ± 3.35 kg) ventricular fibrillation was induced. CPR was performed with Lucas2 or a proprietary device at 100 min−1 . Ventilations were performed with a 500 ml BVD either continuously (0.3 s between compressions) or in 30:2 mode (3.8 s ventilation pause). Airway pressures, tidal volumes and end-tidal CO2 (ETCO2 ) were measured (Philips MP50). Simultaneous arterial and venous gasses were used to assess CO2 build up at 5 and 20 min of CPR. Ventilation measurements averaged over 40 s prior to the first blood sample formed the ventilation baseline, with tidal volumes corrected for dead space by subtracting 3 ml/kg. Results: Minute volume ventilation is much higher in continuous mode than in 30:2 mode. ETCO2 was in line with blood samples. Peak pressure was dangerously high in continuous mode. In the continuous group, 2/10 pigs were excluded due to severe pulmonary oedema. Continuous (n = 8) Corr. tidal volume ml/kg (−3 ml/kg dead space) Corr. Min. volume ventilation (ml/min/kg) Peak pressure (cmH2 O) paCO2 kPa (baseline to 5 min. of CPR) pvCO2 kPa (baseline to 5 min. of CPR) paCO2 kPa (baseline to 20 min. of CPR) pvCO2 kPa (baseline to 20 min. of CPR) ETCO2 (kPa)
7.78 ± 3.7
30:2 (n = 16)
1st vs 2nd breath
AP023 Use of airway management techniques during cardiac arrests
http://dx.doi.org/10.1016/j.resuscitation.2013.08.053
2
http://dx.doi.org/10.1016/j.resuscitation.2013.08.054
p-value
Purpose: A range of airway management techniques are frequently employed in cardiac arrest calls, and therefore significant time is dedicated to teaching members of the medical emergency teams on their appropriate usage, such as during the Advanced Life Support course. However, what is poorly understood is the actual frequency of usage of various airway adjuncts and stabilisation methods that occur in real cardiac arrest calls. This study elucidates this information, thereby enabling clinical trainers to allocate a more proportionate amount of time on teaching those adjuncts more frequently encountered. Method: We undertook a retrospective study investigating post-cardiac arrest surveys from the past four years at a large university teaching hospital that incorporates a level 1 trauma centre and tertiary cardiac unit. In particular, we focussed on the adjuncts and techniques utilised during the airway management of these cardiac arrests. Results: In the four year study period, there were a total of 1314 cardiac arrests at the trust, wherein an airway management method was utilised. An oropharyngeal tube was used in 244 episodes (18%), a laryngeal mask airway was used in 60 episodes (5%), a nasopharyngeal tube was used in 43 episodes (3%) and a jaw thrust was performed in just 6 episodes (1%). Interestingly, in approximately a third of all cases, a bag valve mask (438 episodes) and an endotracheal tube (442 episodes) were employed. Conclusions: The most frequently utilised airway management method during cardiac arrests in our trust is the endotracheal tube. Of the simple airway adjuncts, the oropharyngeal tube and the bag valve mask are most commonly used. Therefore, although all simple airway management techniques should be taught, clinical trainers such as in Advanced Life Support courses, should focus on ensuring candidates have both a thorough understanding and practical experience, of these two aforementioned methods.
8.83 ± 1.89
.360
77.78 ± 36.99
49.47 ± 10.57
.008
64 ± 24.9 1.01 ± 0.88
25 ± 5.2 1.24 ± 0.89
.000 .565
2.45 ± 0.70
2.04 ± 0.81
.212
0.22 ± 2.16
2.33 ± 1.58
.015
The effect of ventilation rate on the survival in adults receiving cardiopulmonary resuscitation: A systematic review
3.29 ± 2.48
3.89 ± 1.06
.533
Gino Vissers 1 , Koenraad G. Monsieurs 2,∗
.793 .033
1
http://dx.doi.org/10.1016/j.resuscitation.2013.08.055
3.73 ± 0.8
4 ± 0.53
4.1 ± 0.5 vs 3.7 ± 0.5
Conclusion: Effective minute volume was much larger in continuous mode than in 30:2 mode. The difference in ETCO2 indicates that the second breath in 30:2 mode is less effective for CO2 removal than the first. Pressures were higher in continuous mode, suggesting insufficient ventilating time between compressions. These high pressures may lead to pulmonary oedema and less effective gas exchange in prolonged CPR, as seen in our sample. Volumes in continuous mode prevented paCO2 build-up during the 20 min, but did this while exceeded volumes suggested by guidelines. A ventilation pause (e.g. 0.5 s) in continuous mode automated CPR could be an
AP024
2
Antwerp University, Antwerp, Belgium Antwerp University Hospital, Edegem, Belgium
Purpose of the study: Current guidelines suggest that hyperventilation during resuscitation reduces outcome. This review investigates whether in adults with cardiac arrest with a secure airway, a ventilation rate of 10 breaths/min, compared to any other rate, improves outcome (Return Of Spontaneous Circulation (ROSC), survival to hospital, survival to discharge, survival to discharge with good neurological outcome, 30-day mortality).