Tidal volumes which are perceived to be adequate for resuscitation

Observers trained in basic life support assessed chest rise in 34 patients who were anaesthetised and paralysed and whose lungs were being mechanically ventilated prior to routine surgery. Making 67 independent assessments, the observers indicated the tidal volume that they considered produced adequate chest rise for resuscitation. The mean tidal volume perceived to be adequate was 384 ml with 95% confidence limits of 362-406 ml. The perceived volumes correlated with the Body Mass Index. Guidelines by various authorities recommend that tidal volumes sufficient to make the chest rise normally should be used during resuscitation. The volumes perceived as adequate by the observers are much lower than the numerical values recommended by the American Heart Association (800-1200 ml). High tidal volumes are associated with an increased risk of gastric regurgitation in patients with an unprotected airway, CO2 delivery to the lungs is likely to be low during cardiac arrest obviating the need for high tidal volumes. In the light of present knowledge and the findings in this study, we would recommend that resuscitation training manikins are recalibrated to indicate satisfactory ventilation at tidal volumes of 400-600 ml. These volumes should reduce the risk of gastric inflation and permit more chest compressions to be carried out in a minute because the ventilation fraction of the CPR sequence is shorter. Adequate CO2 elimination should still be assured.