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Resuscitation. 2019 Aug;141:174-181. doi: 10.1016/j.resuscitation.2019.05.006. Epub 2019 May 18.

Association of ventilation with outcomes from out-of-hospital cardiac arrest.

Author information

1
Department of Emergency Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8579, United States.
2
Emergency and Disaster Medicine Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518107, China.
3
Department of Biostatistics and Oral Health Sciences, University of Washington, Seattle, WA, United States.
4
Dpto. Ingeniería de Comunicaciones, University of the Basque Country, Bilbao, Spain.
5
University of Texas Health Science Center at Houston, Department of Emergency Medicine, Houston, TX, United States.
6
Department of Emergency Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8579, United States. Electronic address: ahamed.idris@utsouthwestern.edu.

Abstract

AIM OF STUDY:

To determine the association between bioimpedence-detected ventilation and out-of-hospital cardiac arrest (OHCA) outcomes.

METHODS:

This is a retrospective, observational study of 560 OHCA patients from the Dallas-Fort Worth site enrolled in the Resuscitation Outcomes Consortium Trial of Continuous or Interrupted Chest Compressions During CPR from 4/2012 to 7/2015. We measured bioimpedance ventilation (lung inflation) waveforms in the pause between chest compression segments (Physio-Control LIFEPAK 12 and 15, Redmond, WA) recorded through defibrillation pads. We included cases ≥18 years with presumed cardiac cause of arrest assigned to interrupted 30:2 chest compressions with bag-valve-mask ventilation and ≥2 min of recorded cardiopulmonary resuscitation. We compared outcomes in two a priori pre-specified groups: patients with ventilation waveforms in <50% of pauses (Group 1) versus those with waveforms in ≥50% of pauses (Group 2).

RESULTS:

Mean duration of 30:2 CPR was 13 ± 7 min with a total of 7762 pauses in chest compressions. Group 1 (N = 424) had a median 11 pauses and 3 ventilations per patient vs. Group 2 (N = 136) with a median 12 pauses and 8 ventilations per patient, which was associated with improved return of spontaneous circulation (ROSC) at any time (35% vs. 23%, p < 0.005), prehospital ROSC (19.8% vs. 8.7%, p < 0.0009), emergency department ROSC (33% vs. 21%, p < 0.005), and survival to hospital discharge (10.3% vs. 4.0%, p = 0.008).

CONCLUSIONS:

This novel study shows that ventilation with lung inflation occurs infrequently during 30:2 CPR. Ventilation in ≥50% of pauses was associated with significantly improved rates of ROSC and survival.

KEYWORDS:

Bioimpedance; Cardiopulmonary resuscitation; Heart arrest; Outcomes; Ventilation detection

PMID:
31112744
PMCID:
PMC6650372
[Available on 2020-08-01]
DOI:
10.1016/j.resuscitation.2019.05.006

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