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Observational Study
. 2019 Aug:141:174-181.
doi: 10.1016/j.resuscitation.2019.05.006. Epub 2019 May 18.

Association of ventilation with outcomes from out-of-hospital cardiac arrest

Mary P Chang  1 , Yuanzheng Lu  2 , Brian Leroux  3 , Elisabete Aramendi Ecenarro  4 , Pamela Owens  1 , Henry E Wang  5 , Ahamed H Idris  6
Affiliations
Observational Study

Association of ventilation with outcomes from out-of-hospital cardiac arrest

Mary P Chang et al. Resuscitation. 2019 Aug.

Abstract

Aim of study: To determine the association between bioimpedence-detected ventilation and out-of-hospital cardiac arrest (OHCA) outcomes.

Methods: This is a retrospective, observational study of 560 OHCA patients from the Dallas-Fort Worth site enrolled in the Resuscitation Outcomes Consortium Trial of Continuous or Interrupted Chest Compressions During CPR from 4/2012 to 7/2015. We measured bioimpedance ventilation (lung inflation) waveforms in the pause between chest compression segments (Physio-Control LIFEPAK 12 and 15, Redmond, WA) recorded through defibrillation pads. We included cases ≥18 years with presumed cardiac cause of arrest assigned to interrupted 30:2 chest compressions with bag-valve-mask ventilation and ≥2 min of recorded cardiopulmonary resuscitation. We compared outcomes in two a priori pre-specified groups: patients with ventilation waveforms in <50% of pauses (Group 1) versus those with waveforms in ≥50% of pauses (Group 2).

Results: Mean duration of 30:2 CPR was 13 ± 7 min with a total of 7762 pauses in chest compressions. Group 1 (N = 424) had a median 11 pauses and 3 ventilations per patient vs. Group 2 (N = 136) with a median 12 pauses and 8 ventilations per patient, which was associated with improved return of spontaneous circulation (ROSC) at any time (35% vs. 23%, p < 0.005), prehospital ROSC (19.8% vs. 8.7%, p < 0.0009), emergency department ROSC (33% vs. 21%, p < 0.005), and survival to hospital discharge (10.3% vs. 4.0%, p = 0.008).

Conclusions: This novel study shows that ventilation with lung inflation occurs infrequently during 30:2 CPR. Ventilation in ≥50% of pauses was associated with significantly improved rates of ROSC and survival.

Keywords: Bioimpedance; Cardiopulmonary resuscitation; Heart arrest; Outcomes; Ventilation detection.

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Conflict of interest statement

Conflicts of Interest Statement

Dr. Idris receives grant support from the US National Institutes of Health (NIH), the American Heart Association, and the US Department of Defense. He serves as an unpaid volunteer on the American Heart Association National Emergency Cardiovascular Care Committee and the HeartSine, Inc. Clinical Advisory Board.

The other investigators do not have conflicts to disclose.

Figures

Figure 1.
Figure 1.
Study cohort and exclusions. ROC indicates Resuscitation Outcomes Consortium; CCC, Trial of Continuous or Interrupted Chest Compressions during CPR; CPR, cardiopulmonary resuscitation; LP, LIFEPAK.
FIGURE 2.
FIGURE 2.
The figure is an 80 second segment of a LIFEPAK 12 defibrillator electronic file recorded during 30:2 CPR on a patient in our study. The black line shows the electrical channel, the green line shows thoracic bioimpedance. The green waveforms marked with red arrows show chest compressions; the low frequency waveforms during interruptions in chest compressions show ventilations.
FIGURE 3.
FIGURE 3.
Mean (±SD) bioimpedance amplitude (mm) (y – axis) measured with a LIFEPAK 12 defibrillator vs. tidal volume (mL) (x – axis) of breaths given with a Maquet SERVO-I ventilator in seven volunteers.
Figure 4.
Figure 4.
Association between number of ventilations per pause and outcomes using natural splines: (a) probability of return of spontaneous circulation (ROSC) on arrival in the emergency department vs. ventilations per pause, (b) probability of hospital admission (admission) vs. ventilations per pause, (c) probability of survival (surv) to hospital discharge vs. ventilations per pause, (d) probability of mRs of 3 or less (favorable neurological outcome) vs. ventilations per pause.
See this image and copyright information in PMC

Comment in

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