Mechanical Ventilation During Resuscitation: How Manual Chest Compressions Affect a Ventilator's Function

Area of Science:

• Emergency Medicine
• Critical Care
• Respiratory Physiology

Background:

• Automated transport ventilators are recommended for positive-pressure ventilation during CPR with a secured airway.
• The impact of manual chest compressions (CC) on ventilator accuracy and CC quality requires investigation.

Purpose of the Study:

• To evaluate the accuracy of ventilator presets and the quality of chest compressions (CC) using three ventilation modes: intermittent positive-pressure ventilation (IPPV), bilevel ventilation (BiLevel), and chest compression synchronized ventilation (CCSV).

Main Methods:

• Ninety paramedics performed continuous CC on a mannequin with a realistic lung model.
• IPPV, BiLevel, and CCSV were applied in a randomized order, with CCSV featuring short insufflations synchronized with CC.
• Ventilator presets were compared to measured results, and CC quality was assessed based on depth and rate according to ERC guidelines.

Main Results:

• CCSV achieved a higher rate of correct ventilation parameters (71%) compared to IPPV (40%) and BiLevel (20%).
• BiLevel ventilation frequently resulted in excessively high inspiratory pressure (80%), whereas CCSV did not exceed presets.
• CC depth and rate were maintained within recommended guidelines across all ventilation modes, with CCSV showing slightly better depth.

Conclusions:

• CCSV is more accurate in maintaining preset ventilation values during simulated CPR compared to IPPV and BiLevel.
• Ventilation patterns, including CCSV, do not negatively impact the quality of chest compressions.