Published Online
on April 5, 2004

A more recent version of this article appeared on April 27, 2004

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Submitted on October 22, 2003
Revised on December 30, 2003
Accepted on February 2, 2004

Hyperventilation-Induced Hypotension During Cardiopulmonary Resuscitation

Tom P. Aufderheide MD, Gardar Sigurdsson MD, Ronald G. Pirrallo MD, MHSA, Demetris Yannopoulos MD, Scott McKnite BA, Chris von Briesen BA, EMT, Christopher W. Sparks EMT, Craig J. Conrad RN, Terry A. Provo BA, EMT-P, and Keith G. Lurie MD^*

From the Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee (T.P.A., R.G.P., C.J.C.); Advanced Circulatory Systems, Inc, Eden Prairie, Minn (C.v.B., C.W.S., T.A.P., K.G.L.); and the Cardiac Arrhythmia Center, Departments of Internal Medicine and Emergency Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis (G.S., D.Y., S.M.).

^* To whom correspondence should be addressed. E-mail: lurie002{at}tc.umn.edu.

Background--A clinical observational study revealed that rescuers consistently hyperventilated patients during out-of-hospital cardiopulmonary resuscitation (CPR). The objective of this study was to quantify the degree of excessive ventilation in humans and determine if comparable excessive ventilation rates during CPR in animals significantly decrease coronary perfusion pressure and survival.

Methods and Results--In humans, ventilation rate and duration during CPR was electronically recorded by professional rescuers. In 13 consecutive adults (average age, 63±5.8 years) receiving CPR (7 men), average ventilation rate was 30±3.2 per minute (range, 15 to 49). Average duration per breath was 1.0±0.07 per second. No patient survived. Hemodynamics were studied in 9 pigs in cardiac arrest ventilated in random order with 12, 20, or 30 breaths per minute. Survival rates were then studied in 3 groups of 7 pigs in cardiac arrest that were ventilated at 12 breaths per minute (100% O₂), 30 breaths per minute (100% O₂), or 30 breaths per minute (5% CO₂/95% O₂). In animals treated with 12, 20, and 30 breaths per minute, the mean intrathoracic pressure (mm Hg/min) and coronary perfusion pressure (mm Hg) were 7.1±0.7, 11.6±0.7, 17.5±1.0 (P<0.0001), and 23.4±1.0, 19.5±1.8, and 16.9±1.8 (P=0.03), respectively. Survival rates were 6/7, 1/7, and 1/7 with 12, 30, and 30+ CO₂ breaths per minute, respectively (P=0.006).

Conclusions--Professional rescuers were observed to excessively ventilate patients during out-of-hospital CPR. Subsequent animal studies demonstrated that similar excessive ventilation rates resulted in significantly increased intrathoracic pressure and markedly decreased coronary perfusion pressures and survival rates.

Key words: cardiopulmonary resuscitation • death, sudden • heart arrest • ventilation • hypotension

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