Optimum compression to ventilation ratios in CPR under realistic, practical conditions: a physiological and mathematical analysis
Related Experiment Video
Updated: Sep 30, 2026
Combining Volumetric Capnography And Barometric Plethysmography To Measure The Lung Structure-function Relationship
Published on: January 8, 2019
1Department of Basic Medical Sciences, Purdue University, 1426 Lynn Hall, West Lafayette, IN 47907-1246, USA. babbs@purdue.edu
Objective:
To develop and evaluate a practical formula for the optimum ratio of compressions to ventilations in cardiopulmonary resuscitation (CPR). The optimum value of a variable is that for which a desired result is maximized. Here the desired result is assumed to be either oxygen delivery to peripheral tissues or a combination of oxygen delivery and waste product removal.
Method:
Equations describing oxygen delivery and blood flow during CPR as functions of the number of compressions and the number of ventilations delivered over time were developed from principles of classical physiology. These equations were solved explicitly in terms of the compression/ventilation ratio and evaluated for a wide range of conditions using Monte Carlo simulations.
Results:
As the compression to ventilation ratio was increased from 0 to 50 or more, both oxygen delivery and the combination of oxygen delivery with blood flow increased to maximum values and then gradually declined. For variables typical of standard CPR as taught and specified in international guidelines, maximum values occurred at compression/ventilation ratios near 30:2. For variables typical of actual lay rescuer performance in the field, maximal values occurred at compression/ventilation ratios near 60:2.
Conclusion:
Current guidelines overestimate the need for ventilation during standard CPR by two to four-fold. Blood flow and oxygen delivery to the periphery can be improved by eliminating interruptions of chest compression for these unnecessary ventilations.
Related Concept Videos
01:20Assessment of Ventilation I: Respiratory Rate
A Ventilation assessment is critical for monitoring a patient's health status. Respiration, one of the most accessible vital signs, provides insights into the function of numerous body systems and can indicate serious health issues, such as brainstem injuries from head trauma.
Critical Guidelines for Assessing Ventilation:
01:23Physiological Control of Respiration
Breathing, a seemingly passive process, is regulated by the respiratory center in the brainstem. This center coordinates the involuntary control of respirations, which means it occurs without conscious effort, ensuring a smooth and uninterrupted pattern.
Regulation of Ventilation
The body maintains ventilation by monitoring levels of carbon dioxide (CO2), oxygen (O2), and hydrogen ion concentration (pH) in the arterial blood. Among these factors, the level of CO2 plays a crucial...
01:21Cardiopulmonary Resuscitation I: Adult
01:22Respiratory Volumes and Capacities
01:17Assessment of Diffusion and Perfusion
The Role of Diffusion in Respiration
Diffusion is the process by which molecules move from an area of higher concentration to an area of lower concentration. In the respiratory system, this principle...
01:24Pressure Relationships in Thoracic Cavity
Breathing Mechanisms
Both intra-alveolar and intrapleural pressures rely on specific lung properties. The ability to breathe—allowing air to enter the lungs during...