Abstract 12136: Bag-mask Ventilation Without Lung Inflation is Common During Out-of-Hospital 30:2 Cardiopulmonary Resuscitation
Introduction: American Heart Association guidelines for cardiopulmonary resuscitation (CPR) recommend recurring cycles of 30 chest compressions interrupted by a pause for two ventilations when an advanced airway device has not been placed. Few studies have measured lung inflation during pauses for ventilation in 30:2 CPR for out-of-hospital cardiac arrest (OOHCA).
Objective: To determine the number of ventilation pauses with measureable lung inflation during 30:2 CPR for OOHCA.
Methods: This is an observational, retrospective analysis of non-traumatic, OOHCA in patients ≥18 years old who received 30:2 CPR by emergency medical service (EMS) rescuers. Data is from the Dallas-Fort Worth site of the Resuscitation Outcomes Consortium cardiac arrest registry. Ventilation data are derived from defibrillator electronic recordings during the first six minutes of CPR when rescuers used a bag-mask device for ventilation. The recordings display thoracic bioimpedance waveforms of chest compressions and lung inflations. An interruption for ventilation is defined as a pause in chest compressions of 3 to 15 seconds. We assessed the presence of lung inflation waveforms during the pause for ventilation. Lung inflation was defined as a waveform with at least 2 mm (0.4 ohm) amplitude and at least 1-second duration.
Results: We analyzed 200 patients with OOHCA who received 30:2 CPR cycles by EMS from February 2012 to June 2014. A total of 1,590 ventilation pauses were analyzed; of the 1,590 ventilation pauses, 57% did not have any measurable lung inflation waveforms (Table). Twenty-five (12.5%) patients had no lung inflation during the first six minutes of CPR. Return of spontaneous circulation occurred in 21%.
Conclusions: The majority of patients did not receive lung inflation during 50% or more of each 30:2 CPR episode. This could be a factor in explaining why ventilation has not been shown to improve survival outcomes. Further studies should evaluate this topic in greater detail.
- Cardiac arrest
- Cardiopulmonary resuscitation
- Quality assessment
- Emergency medical services (EMS)
Author Disclosures: A. Fredericks: None. Y. Lu: None. L. Schroeder: None. T. Cooper: Employment; Significant; UT Southwestern Medical Center. L. Floyd: None. M. Chang: Employment; Significant; UT Southwestern Medical Center. A.H. Idris: Employment; Significant; UT Southwestern Medical Center. Research Grant; Significant; NIH/NHLBI, HeartSine, Inc.. Consultant/Advisory Board; Modest; Unpaid volunteer PhysioControl.
- © 2016 by American Heart Association, Inc.