Yonsei Med J.  2018 Dec;59(10):1232-1239. 10.3349/ymj.2018.59.10.1232.

Single Ventilation during Cardiopulmonary Resuscitation Results in Better Neurological Outcomes in a Porcine Model of Cardiac Arrest

• Kim YW
• Kim HI
• Hwang SO
• Kim YS
• An GJ
• Cha KC

• KMID: 2426338
• DOI: http://doi.org/10.3349/ymj.2018.59.10.1232

Abstract

PURPOSE
Recent basic life support (BLS) guidelines recommend a 30:2 compression-to-ventilation ratio (CV2) or chest compression-only cardiopulmonary resuscitation (CC); however, there are inevitable risks of interruption of high-quality cardiopulmonary resuscitation (CPR) in CV2 and hypoxemia in CC. In this study, we compared the short-term outcomes among CC, CV2, and 30:1 CV ratio (CV1).
MATERIALS AND METHODS
In total, 42 pigs were randomly assigned to CC, CV1, or CV2 groups. After induction of ventricular fibrillation (VF), we observed pigs for 2 minutes without any intervention. Thereafter, BLS was started according to the assigned method and performed for 8 minutes. Defibrillation was performed after BLS and repeated every 2 minutes, followed by rhythm analysis. Advanced cardiac life support, including continuous chest compression with ventilation every 6 seconds and intravenous injection of 1 mg epinephrine every 4 minutes, was performed until the return of spontaneous circulation (ROSC) or 22 minutes after VF induction. Hemodynamic parameters and arterial blood gas profiles were compared among groups. ROSC, 24-hour survival, and neurologic outcomes were evaluated at 24 hours.
RESULTS
The hemodynamic parameters during CPR did not differ among the study groups. Partial pressure of oxygen in arterial blood and arterial oxygen saturation were lowest in the CC group, compared to those in the other groups, during the BLS period (p=0.002 and p < 0.001, respectively). The CV1 groups showed a significantly higher rate of favorable neurologic outcome (swine CPC 1 or 2) than the other groups (p=0.044).
CONCLUSION
CPR with CV1 could promote better neurologic outcome than CV2 and CC.

Keyword

Heart arrest; cardiopulmonary resuscitation; ventilation; treatment outcome

MeSH Terms

Advanced Cardiac Life Support
Anoxia
Cardiopulmonary Resuscitation*
Epinephrine
Heart Arrest*
Hemodynamics
Injections, Intravenous
Methods
Oxygen
Partial Pressure
Swine
Thorax
Treatment Outcome
Ventilation*
Ventricular Fibrillation
Epinephrine
Oxygen

Figure

• 

  Fig. 1 Study protocol. VF, ventricular fibrillation; BLS, basic life support; ACLS, advanced cardiac life support; CC, chest compression-only CPR; CV1, CPR with 30:1 compression-to-ventilation ratio, CV2, CPR with 30:2 compression-to-ventilation ratio; ROSC, return of spontaneous circulation; CPC, cerebral performance category.

• 

  Fig. 2 Comparison of arterial oxygen parameters during basic life support. CV ratio, compression-to-ventilation ratio; CC, chest compression-only CPR; CV1, 30:1 CV ratio; CV2, 30:2 CV ratio.

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