The Role of Chest Compressions on Ventilation during Advanced Cardiopulmonary Resuscitation
<b>Background:</b> There is growing interest in the quality of manual ventilation during cardiopulmonary resuscitation (CPR), but accurate assessment of ventilation parameters remains a challenge. Waveform capnography is currently the reference for monitoring ventilation rate in intubate...
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| Format: | Article |
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MDPI AG
2023-11-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/21/6918 |
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| author | Izaskun Azcarate Jose Antonio Urigüen Mikel Leturiondo Camilo Leonardo Sandoval Koldo Redondo José Julio Gutiérrez James Knox Russell Pia Wallmüller Fritz Sterz Mohamud Ramzan Daya Sofía Ruiz de Gauna |
| author_facet | Izaskun Azcarate Jose Antonio Urigüen Mikel Leturiondo Camilo Leonardo Sandoval Koldo Redondo José Julio Gutiérrez James Knox Russell Pia Wallmüller Fritz Sterz Mohamud Ramzan Daya Sofía Ruiz de Gauna |
| author_sort | Izaskun Azcarate |
| collection | DOAJ |
| description | <b>Background:</b> There is growing interest in the quality of manual ventilation during cardiopulmonary resuscitation (CPR), but accurate assessment of ventilation parameters remains a challenge. Waveform capnography is currently the reference for monitoring ventilation rate in intubated patients, but fails to provide information on tidal volumes and inspiration–expiration timing. Moreover, the capnogram is often distorted when chest compressions (CCs) are performed during ventilation compromising its reliability during CPR. Our main purpose was to characterize manual ventilation during CPR and to assess how CCs may impact on ventilation quality. <b>Methods:</b> Retrospective analysis were performed of CPR recordings fromtwo databases of adult patients in cardiac arrest including capnogram, compression depth, and airway flow, pressure and volume signals. Using automated signal processing techniques followed by manual revision, individual ventilations were identified and ventilation parameters were measured. Oscillations on the capnogram plateau during CCs were characterized, and its correlation with compression depth and airway volume was assessed. Finally, we identified events of reversed airflow caused by CCs and their effect on volume and capnogram waveform. <b>Results:</b> Ventilation rates were higher than the recommended 10 breaths/min in 66.7% of the cases. Variability in ventilation rates correlated with the variability in tidal volumes and other ventilatory parameters. Oscillations caused by CCs on capnograms were of high amplitude (median above 74%) and were associated with low pseudo-volumes (median 26 mL). Correlation between the amplitude of those oscillations with either the CCs depth or the generated passive volumes was low, with correlation coefficients of −0.24 and 0.40, respectively. During inspiration and expiration, reversed airflow events caused opposed movement of gases in 80% of ventilations. <b>Conclusions:</b> Our study confirmed lack of adherence between measured ventilation rates and the guideline recommendations, and a substantial dispersion in manual ventilation parameters during CPR. Oscillations on the capnogram plateau caused by CCs did not correlate with compression depth or associated small tidal volumes. CCs caused reversed flow during inspiration, expiration and in the interval between ventilations, sufficient to generate volume changes and causing oscillations on capnogram. Further research is warranted to assess the impact of these findings on ventilation quality during CPR. |
| first_indexed | 2024-03-11T11:25:58Z |
| format | Article |
| id | doaj.art-0fd2d0e719324d0db36497476ab2cf03 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-11T11:25:58Z |
| publishDate | 2023-11-01 |
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| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-0fd2d0e719324d0db36497476ab2cf032023-11-10T15:06:55ZengMDPI AGJournal of Clinical Medicine2077-03832023-11-011221691810.3390/jcm12216918The Role of Chest Compressions on Ventilation during Advanced Cardiopulmonary ResuscitationIzaskun Azcarate0Jose Antonio Urigüen1Mikel Leturiondo2Camilo Leonardo Sandoval3Koldo Redondo4José Julio Gutiérrez5James Knox Russell6Pia Wallmüller7Fritz Sterz8Mohamud Ramzan Daya9Sofía Ruiz de Gauna10Group of Signal and Communications, Bilbao School of Engineering, University of the Basque Country UPV/EHU, Plaza Torres Quevedo 1, 48013 Bilbao, SpainGroup of Signal and Communications, Bilbao School of Engineering, University of the Basque Country UPV/EHU, Plaza Torres Quevedo 1, 48013 Bilbao, SpainGroup of Signal and Communications, Bilbao School of Engineering, University of the Basque Country UPV/EHU, Plaza Torres Quevedo 1, 48013 Bilbao, SpainUnidades Tecnologicas de Santander, Bucaramanga, Santander 680005, ColombiaGroup of Signal and Communications, Bilbao School of Engineering, University of the Basque Country UPV/EHU, Plaza Torres Quevedo 1, 48013 Bilbao, SpainGroup of Signal and Communications, Bilbao School of Engineering, University of the Basque Country UPV/EHU, Plaza Torres Quevedo 1, 48013 Bilbao, SpainCenter for Policy and Research in Emergency Medicine (CPR-EM), Department of Emergency Medicine, Oregon Health & Science University, Portland, OR 97239, USADepartment of Emergency Medicine, Medical University of Vienna, 1090 Vienna, AustriaDepartment of Emergency Medicine, Medical University of Vienna, 1090 Vienna, AustriaCenter for Policy and Research in Emergency Medicine (CPR-EM), Department of Emergency Medicine, Oregon Health & Science University, Portland, OR 97239, USAGroup of Signal and Communications, Bilbao School of Engineering, University of the Basque Country UPV/EHU, Plaza Torres Quevedo 1, 48013 Bilbao, Spain<b>Background:</b> There is growing interest in the quality of manual ventilation during cardiopulmonary resuscitation (CPR), but accurate assessment of ventilation parameters remains a challenge. Waveform capnography is currently the reference for monitoring ventilation rate in intubated patients, but fails to provide information on tidal volumes and inspiration–expiration timing. Moreover, the capnogram is often distorted when chest compressions (CCs) are performed during ventilation compromising its reliability during CPR. Our main purpose was to characterize manual ventilation during CPR and to assess how CCs may impact on ventilation quality. <b>Methods:</b> Retrospective analysis were performed of CPR recordings fromtwo databases of adult patients in cardiac arrest including capnogram, compression depth, and airway flow, pressure and volume signals. Using automated signal processing techniques followed by manual revision, individual ventilations were identified and ventilation parameters were measured. Oscillations on the capnogram plateau during CCs were characterized, and its correlation with compression depth and airway volume was assessed. Finally, we identified events of reversed airflow caused by CCs and their effect on volume and capnogram waveform. <b>Results:</b> Ventilation rates were higher than the recommended 10 breaths/min in 66.7% of the cases. Variability in ventilation rates correlated with the variability in tidal volumes and other ventilatory parameters. Oscillations caused by CCs on capnograms were of high amplitude (median above 74%) and were associated with low pseudo-volumes (median 26 mL). Correlation between the amplitude of those oscillations with either the CCs depth or the generated passive volumes was low, with correlation coefficients of −0.24 and 0.40, respectively. During inspiration and expiration, reversed airflow events caused opposed movement of gases in 80% of ventilations. <b>Conclusions:</b> Our study confirmed lack of adherence between measured ventilation rates and the guideline recommendations, and a substantial dispersion in manual ventilation parameters during CPR. Oscillations on the capnogram plateau caused by CCs did not correlate with compression depth or associated small tidal volumes. CCs caused reversed flow during inspiration, expiration and in the interval between ventilations, sufficient to generate volume changes and causing oscillations on capnogram. Further research is warranted to assess the impact of these findings on ventilation quality during CPR.https://www.mdpi.com/2077-0383/12/21/6918cardiopulmonary resuscitation (CPR)ventilationventilation ratetidal volumeairway flowchest compressions |
| spellingShingle | Izaskun Azcarate Jose Antonio Urigüen Mikel Leturiondo Camilo Leonardo Sandoval Koldo Redondo José Julio Gutiérrez James Knox Russell Pia Wallmüller Fritz Sterz Mohamud Ramzan Daya Sofía Ruiz de Gauna The Role of Chest Compressions on Ventilation during Advanced Cardiopulmonary Resuscitation Journal of Clinical Medicine cardiopulmonary resuscitation (CPR) ventilation ventilation rate tidal volume airway flow chest compressions |
| title | The Role of Chest Compressions on Ventilation during Advanced Cardiopulmonary Resuscitation |
| title_full | The Role of Chest Compressions on Ventilation during Advanced Cardiopulmonary Resuscitation |
| title_fullStr | The Role of Chest Compressions on Ventilation during Advanced Cardiopulmonary Resuscitation |
| title_full_unstemmed | The Role of Chest Compressions on Ventilation during Advanced Cardiopulmonary Resuscitation |
| title_short | The Role of Chest Compressions on Ventilation during Advanced Cardiopulmonary Resuscitation |
| title_sort | role of chest compressions on ventilation during advanced cardiopulmonary resuscitation |
| topic | cardiopulmonary resuscitation (CPR) ventilation ventilation rate tidal volume airway flow chest compressions |
| url | https://www.mdpi.com/2077-0383/12/21/6918 |
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