Continuous chest compressions are associated with higher peak inspiratory pressures when compared to 30:2 in an experimental cardiac arrest model

Johan Mälberg; Silvia Marchesi; Douglas Spangler; Nermin Hadziosmanovic; David Smekal; Sten Rubertsson

doi:10.1186/s40635-023-00559-7

Continuous chest compressions are associated with higher peak inspiratory pressures when compared to 30:2 in an experimental cardiac arrest model

Intensive Care Med Exp. 2023 Nov 8;11(1):75. doi: 10.1186/s40635-023-00559-7.

Authors

Johan Mälberg¹, Silvia Marchesi², Douglas Spangler³, Nermin Hadziosmanovic⁴, David Smekal³, Sten Rubertsson³

Affiliations

¹ Department of Surgical Sciences-Anesthesia and Intensive Care, Uppsala University, Uppsala, Sweden. johan.malberg@surgsci.uu.se.
² Division of Intensive- and Perioperative Care, Skåne University Hospital, Malmö, Sweden.
³ Department of Surgical Sciences-Anesthesia and Intensive Care, Uppsala University, Uppsala, Sweden.
⁴ Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.

Abstract

Background: Ventilation during cardiopulmonary resuscitation (CPR) has long been a part of the standard treatment during cardiac arrests. Ventilation is usually given either during continuous chest compressions (CCC) or during a short pause after every 30 chest compressions (30:2). There is limited knowledge of how ventilation is delivered if it effects the hemodynamics and if it plays a role in the occurrence of lung injuries. The aim of this study was to compare ventilation parameters, hemodynamics, blood gases and lung injuries during experimental CPR given with CCC and 30:2 in a porcine model.

Methods: Sixteen pigs weighing approximately 33 kg were randomized to either receive CPR with CCC or 30:2. Ventricular fibrillation was induced by passing an electrical current through the heart. CPR was started after 3 min and given for 20 min. Chest compressions were provided mechanically with a chest compression device and ventilations were delivered manually with a self-inflating bag and 12 l/min of oxygen. During the experiment, ventilation parameters and hemodynamics were sampled continuously, and arterial blood gases were taken every five minutes. After euthanasia and cessation of CPR, the lungs and heart were removed in block and visually examined followed by sampling of lung tissue which were examined using microscopy.

Results: In the CCC group and the 30:2 group, peak inspiratory pressure (PIP) was 58.6 and 35.1 cmH₂O (p < 0.001), minute volume (MV) 2189.6 and 1267.1 ml (p < 0.001), peak expired carbon dioxide (PECO₂) 28.6 and 39.4 mmHg (p = 0.020), partial pressure of carbon dioxide (PaCO₂) 50.2 and 61.1 mmHg (p = 0.013) and pH 7.3 and 7.2 (p = 0.029), respectively. Central venous pressure (CVP) decreased more over time in the 30:2 group (p = 0.023). All lungs were injured, but there were no differences between the groups.

Conclusions: Ventilation during CCC resulted in a higher PIP, MV and pH and lower PECO₂ and PaCO₂, showing that ventilation mode during CPR can affect ventilation parameters and blood gases.

Keywords: Animal model; Cardiac arrest; Cardiopulmonary resuscitation; Lung injuries; Ventilation.