Higher Ventilation Rate is Associated with Increased Return of Spontaneous Circulation in In-Hospital Cardiac Arrest Patients with Advanced Airways
Listed in
This article is not in any list yet, why not save it to one of your lists.Abstract
Background
Current cardiopulmonary resuscitation (CPR) guidelines recommend a ventilation rate of 10 breaths/min in adult cardiac arrest patients with an advanced airway in place; however, this guideline is based almost exclusively on animal model studies. The objective of this study was to examine the association between mean ventilation rates during in-hospital cardiac arrest with return of spontaneous circulation (ROSC).
Methods
This was a secondary analysis of a cohort undergoing CPR for in-hospital cardiac arrest with an advanced airway in place had that ventilation rate and end-tidal CO 2 (ETCO 2 ) continuously recorded. Subjects were enrolled at 25 tertiary care centers in the United States and United Kingdom. A subset of subjects also had intra-cardiac arrest arterial blood gases collected as part of routine clinical care.
Results
Ventilation rate and ETCO 2 measurements were collected for 222 subjects and arterial blood gas data for 127 subjects. We observed 84.7% of subjects were ventilated > 10 breaths/min. When dichotomized to subjects receiving close to current guidelines (6-12 breaths/min) and those with higher ventilation rates >12 breaths/min, subjects with higher ventilation rates had greater rate of ROSC (45% vs. 24% p = 0.009). Ventilation rate had a significant impact on ROSC even after adjusting for age, sex, shockable initial rhythm, pre-cardiac arrest severity of critical illness, and mechanical chest compression device usage, with an adjusted odds ratio of 1.15 per two breaths/min increase (95% CI 1.04-1.28; p = 0.006). Regression analysis suggested increasing ventilation rates may start to have a negative association with ROSC when beyond 26 breaths/min. Patients ventilated > 12 breaths/min demonstrated increased mean ETCO 2 levels (median 25 mm Hg vs. 17 mm Hg for those with mean ventilation rates within 6-12 breaths/min; p < 0.001). PaO 2 and PaCO 2 levels did not differ between ventilation groups, suggesting that the observed effects may relate to hemodynamic rather than ventilatory effects.
Conclusions
Ventilation in excess of guideline-recommended rates is common. Higher ventilation rates above 6-12 breaths and below 26 breaths/min were associated with increased odds of ROSC. This may be due to improved hemodynamics. Guidelines on ventilation during CPR may require further examination.
