Article

Clinical and hemodynamic comparison of 15 : 2 and 30 : 2 compression-to-ventilation ratios for cardiopulmonary resuscitation

The Children's Hospital of Philadelphia, Filadelfia, Pennsylvania, United States
Critical Care Medicine (Impact Factor: 6.15). 05/2006; 34(5):1444-9. DOI: 10.1097/01.CCM.0000216705.83305.99
Source: PubMed

ABSTRACT To compare cardiopulmonary resuscitation (CPR) with a compression to ventilation (C:V) ratio of 15:2 vs. 30:2, with and without use of an impedance threshold device (ITD).
Prospective randomized animal and manikin study.
Animal laboratory and emergency medical technician training facilities.
Twenty female pigs and 20 Basic Life Support (BLS)-certified rescuers. INTERVENTIONS, MEASUREMENTS, AND MAIN RESULTS:
Acid-base status, cerebral, and cardiovascular hemodynamics were evaluated in 18 pigs in cardiac arrest randomized to a C:V ratio of 15:2 or 30:2. After 6 mins of cardiac arrest and 6 mins of CPR, an ITD was added. Compared to 15:2, 30:2 significantly increased diastolic blood pressure (20 +/- 1 to 26 +/- 1; p < .01); coronary perfusion pressure (18 +/- 1 to 25 +/- 2; p = .04); cerebral perfusion pressure (16 +/- 3 to 18 +/- 3; p = .07); common carotid blood flow (48 +/- 5 to 82 +/- 5 mL/min; p < .001); end-tidal CO2 (7.7 +/- 0.9 to 15.7 +/- 2.4; p < .0001); and mixed venous oxygen saturation (26 +/- 5 to 36 +/- 5, p < .05). Hemodynamics improved further with the ITD. Oxygenation and arterial pH were similar. Only one of nine pigs had return of spontaneous circulation with 15:2, vs. six of nine with 30:2 (p < 0.03). HUMANS: Fatigue and quality of CPR performance were evaluated in 20 BLS-certified rescuers randomized to perform CPR for 5 mins at 15:2 or 30:2 on a recording CPR manikin. There were no significant differences in the quality of CPR performance or measurement of fatigue. Significantly more compressions per minute were delivered with 30:2 in both the animal and human studies.
These data strongly support the contention that a ratio of 30:2 is superior to 15:2 during manual CPR and that the ITD further enhances circulation with both C:V ratios.

Download full-text

Full-text

Available from: Jane G Wigginton, Aug 15, 2015
0 Followers
 · 
162 Views
  • Source
    Notfall 11/2010; 13(7):559-620. DOI:10.1007/s10049-010-1370-3 · 0.32 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Dismal survival statistics associated with sudden cardiac arrest have led to the development of new strategies and mechanical devices aimed at improving the quality of cardiopulmonary resuscitation (CPR). The most recent American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care were published in 2005. Major changes included revisions to current practices related to airway and ventilation, circulation, and defibrillation management. Greater emphasis is placed on providing simple, high-quality, effective CPR. New techniques and mechanical devices have been developed to augment CPR, hopefully improving survival rates and long-term outcomes. These include active compression-decompression CPR, Lund University Cardiac Assist System, LifeBelt, AutoPulse, and the impedance threshold device. This article focuses on current strategies aimed at improving survival rates for patients with sudden cardiac arrest. New techniques and mechanical devices developed to augment cardiopulmonary resuscitation will be discussed. These strategies will most likely shape future resuscitation practices.
    AACN Advanced Critical Care 20(4):373-83. DOI:10.1097/NCI.0b013e3181baf5e4
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Sudden cardiac death (SCD) is a leading cause of mortality in the industrialized nations and, accordingly, is a major public health problem. Despite the guidelines and their updates, the survival rate of victims of out of hospital cardiac arrest (OHCA) remains disappointingly low. There are many contributors to poor survival outcome of victims with OHCA. An improper resuscitation algorithm seems to be the major contributor. Chest-compression alone cardio pulmonary resuscitation (CC-CPR), and cardio-cerebral resuscitation (CCR), seems an attractive alternative to conventional CPR. METHODS & RESULTS: Reviewing the recent literature, cardiac-only resuscitation emerges as an attractive alternative to conventional CPR, as this simpler technique of CPR, in which continuous chest compressions are provided without rescue breath-ing avoids the need for mouth-to-mouth ventilation. Under the weight of evidence supported by several recent studies, the AHA issued a science advisory for the public recommending immediate activation of emergency medical services (EMS) after the victim's collapse and high quality chest compression regarding location and depth with minimum interruptions. Bystanders not trained in CPR are encouraged to initi-ate immediately hands-only CPR and continue with compressions until an AED is available or EMS arrives at the scene. CONCLUSION: CC-CPR and CCR is not inferior to conventional CPR but also prom-ises a survival benefit for victims of OHCA.
Show more