Abstract
For many years, ventilation has been an essential part of advanced life support (ALS) in cardiopulmonary resuscitation (CPR). Nevertheless, there is little evidence about the best method of ventilation during resuscitation for both out-of-hospital cardiac arrest (OHCA) and inhospital cardiac arrest (IHCA) patients. Effective ventilation is one of the two main keys to successful resuscitation. In this context, the question always arises as to which airway management, along with which ventilation mode, constitutes the best strategy. Conventional ventilation modes are not designed for cardiac arrest and show important limitations that must be considered when used in CPR. Manual ventilation without the use of an automated transport ventilator (ATV) could be shown to be uncontrolled in applied volumes and pressures and should be avoided. Mechanical ventilation with an ATV is therefore superior to manual ventilation, but both volume- and pressure-controlled ventilation modes are significantly influenced by chest compressions. With the newly designed chest compression synchronized ventilation (CCSV), a special ventilation mode for resuscitation is available. Further research should be conducted to obtain more evidence of the effect of ventilation during CPR on outcomes following OHCA and not only about how to secure the airway for ventilation during CPR.
Key Points
- Importance of Ventilation in ALS: Effective ventilation is crucial for oxygen delivery during CPR, addressing the reduced pulmonary perfusion and gas exchange caused by chest compressions.
- Challenges with Conventional Ventilation: Volume- and pressure-controlled ventilation modes are influenced by chest compressions, leading to deviations from preset parameters.
- Manual Ventilation Risks: Manual bag-mask and bag-endotracheal tube (ETI) ventilation often result in uncontrolled pressures and volumes, increasing the risk of complications such as gastric insufflation and aspiration.
- Chest Compression Synchronized Ventilation (CCSV): CCSV, designed for resuscitation, synchronizes ventilation with chest compressions, improving oxygenation, cerebral perfusion, and arterial pressures compared to conventional modes.
- Extraglottic Airway Devices (EGAs): EGAs are widely used in out-of-hospital cardiac arrest (OHCA) but show limitations in prolonged resuscitation compared to ETI.
- Oxygen and Ventilation Requirements: During CPR, higher oxygen concentrations are recommended, while maintaining adequate ventilation volumes to avoid respiratory acidosis and hypercapnia.
- Passive Ventilation: Passive ventilation through chest recoil is insufficient for prolonged resuscitation and is generally limited to initial efforts.
- Mechanical Ventilation Advantages: Automated transport ventilators (ATVs) provide consistent and controlled ventilation, reducing variability and dependency on manual efforts.
- Research Gaps: There is limited evidence on the ideal ventilation modes and volumes during CPR, highlighting the need for more targeted studies, particularly on CCSV.
- Future Directions: Integrating specialized ventilation modes like CCSV and enhancing training on advanced airway management are critical for improving ALS outcomes.
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