High-performance ventilation
Put the “P” back in CPR

Pre-hospital cardiopulmonary resuscitation, as it is approached today, focuses on cardiac massage techniques, leaving aside the essential aspect of oxygenation of the patient in cardiac arrest. It has been shown that a well conducted manual ventilation doubles the chances of survival of patients in cardiac arrest  I.

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High-performance ventilation criteria
Insufflation gastrique

Deliver an appropriate volume of air to the patient (6 to 8 ml/kg of theoretical weight) while minimizing the risk of gastric insufflation.

Hyperventilation

Prevent hyperventilation and the risk of lung infections.

Fuites

Prevent excessive gaz leak that can lead to hypoxia and result in brain injuries or the patient's death.

Cardiac arrest

Cardiac arrest remains the leading cause of death in the world, affecting nearly 7 million people a year. The survival rate is only 5% and has not significantly improved since the massive adoption of automatic defibrillators. Putting ventilation back at the heart of cardiopulmonary resuscitation responds to several public health issues.

By preventing those risks, a good ventilation improves the chances of survival and limits long-term pulmonary sequelae and length of intensive care stays II.

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Survival rate of
cardiac arrest
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Number of victims
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Number of victims
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Risks of hyperventilation

Hyperventilation causes

  • lung damages and barotroma
  • lung infections and pneumonia
  • reduced blood flow to the heart and brain.
“Hyperventilation by excessive volume or rate can impair survival.” (III)

– Hyperventilation reduces the chances of survival by 70%. IV

– On intubated patients, hyperventilation is present in almost 80% of situations.

Leakage management

One of the biggest challenges with BVM ventilation is excessive gas leakage.

  • – Gas leakage reduces the chances of survival by 60%. V
  • – Insufficient tidal volumes decrease the chance of ROSC from 19.8% to 8.7% and reduce the survival rate from 10.3% to 4%.*. VI
  • – Leakage does represent on average 69% of the insufflated volume with the one-hand technique. VII
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I Chang MP, Lu Y, Leroux B, Aramendi Ecenarro E, Owens P, Wang HE, Idris AH. Association of ventilation with outcomes from out of hospital cardiac arrest.
Resuscitation. 2019 Aug.

IIMongardon N, Perbet S, et al. Infectious complications in out-of-hospital cardiac arrest patients in the therapeutic hypothermia era. Crit Care Med. 2011;39(6):1359-

1364.

IIIAufderheide TP and Lurie KG. «Death by hyperventilation: a common and life-threatening problem during

cardiopulmonary resuscitation.», Critical Care Medicine, vol. 32, supplement 9, pages S345–S351, 2004

iv Aufderheide TP and Lurie KG. «Death by hyperventilation: a common and life-threatening problem during cardiopulmonary resuscitation.», Critical Care Medicine, vol. 32, supplement 9, pages S345–S351, 2004

v David Otten, MD, Michael M. Liao, MD, MSc, Robert Wolken, RRT, Ivor S. Douglas, MD, Ramya Mishra, MD, Amanda Kao, MD, Whitney Barrett, MD, Erin Drasler, MD, Richard L. Byyny, MD, MSc, and Jason S. Haukoos, MD, MSc, «Comparison of Bag-Valve-Mask Hand-Sealing Techniques in a Simulated Model», August 2013.

vi Chang MP, Lu Y, Leroux B, Aramendi Ecenarro E, Owens P, Wang HE, Idris AH. «Association of ventilation with outcomes from out of hospital cardiac arrest.» Resuscitation. pages 141:174-181, august 2019.

vii Mongardon N, Perbet S, et al. Infectious complications in out-of-hospital cardiac arrest patients in the therapeutic hypothermia era. Crit Care Med. 2011;39(6):1359-1364.

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