Post on 17-Jul-2020
Ventilation during CPR
Laurent Brochard
Conflicts of interest
• Our clinical research laboratory has received research grants for clinical trials from the following companies – Covidien (PAV+) – Dräger (SmartCare) – General Electric (FRC) – Respironics (NIV) – Vygon (CPAP)
AMBU Bag Ventilation
CCM 2004
No ABC anymore?
Ventilation during cardiac arrest
• Very low ventilatory needs • Gas trapping • Amplification of pressure effects because of
hypovolemia • Difficult airway access • Benefits of « gasps » • Interruption of compression
Adverse Hemodynamic Effects of Interrupting Chest Compressions for Rescue Breathing During CPR for Ventricular Fibrillation Cardiac Arrest Berg et al. Circulation. 2001;104:2465
« Interrupting chest compressions for rescue breathing can adversely affect hemodynamics during CPR for VF »
CCM 2010
Cardiopulmonary resuscitation without a ventilator using a novel endotracheal tube in a human.
Brochard L, Boussignac G et al. Anesthesiology 1990; 72: 389
ml
a
b c
d
e
f
f
FRC
g
a. Spring b. Bellows c. Adiabatic
compressor d. Intrathoracic
pressure measurment
e. Airway opening f. Pencil and
milimetric paper
g. Compressible conducting airway connector
FRC
Dynamic thoracic volume change
C: Compression
C D
D: Decompression
Lung position after LUCAS 2® positioned
Without ventilation
Without ventilation
With CFI
CFI Effect
Vol
mL
-400
-300
-200
-100
0
Without ventilation
Manual Bag
CFI 10
CFI 5
RESULTS WITH CFI 5
L/min
RESULTS MV WITH CFI 5
Without ventilation
Manual Bag
CFI 10
CFI 5
Dead space ventilation (Estimated physiological dead space = 200ml)
Calculated alveolar ventilation
0
10
20
30
40
-60
-40
-20
0
20
40
60
RESULTS PRESSURE WITH CFI 5
cmH2O
Without ventilation
Manual Bag
CFI 10
CFI 5
Mean positive lung pressure Mean negative lung pressure
Too much of a good thing?