Effects of inspired gas content during respiratory arrest and cardiopulmonary resuscitation.
Mouth-to-mouth and bag-valve-mask ventilation have been an indispensable part of cardiopulmonary resuscitation (CPR). However, only recently have the effects of different tidal volumes on arterial oxygenation been reported for mouth-to-mouth and bag-valve-mask ventilation. Currently recommended tidal volumes (10-15 mL/kg) are associated with an increased risk of gastric inflation because they produce high peak inspiratory pressures. An animal model of ventilation with an unprotected airway showed that a smaller tidal volume (6 mL/kg) is as effective as a larger tidal volume (12 mL/kg) in maintaining Sao2 at >96%. However, a smaller tidal volume with exhaled gas ventilation produced a mean Sao2 of 48%, which is ineffective. Ventilation gas mixtures have been studied in models of cardiac arrest and CPR. One study showed that ventilation with air during 6 mins of CPR resulted in a return of spontaneous circulation in 10 of 12 animals compared with only 5 of 12 animals ventilated with exhaled gas (p<.04). Arterial and mixed-venous Po2 were significantly higher, and Pco2 was significantly lower in the air ventilation group. Investigations of the cardiovascular effects of mouth-to-mouth ventilation during CPR suggest that there are adverse effects during low blood flow states. However, mouth-to-mouth ventilation during respiratory arrest is lifesaving and should continue to be taught and emphasized in basic life support courses.
Idris
A H
AH
Department of Emergency Medicine, University of Florida College of Medicine, Gainesville, USA.
D000142:Acidosis, Respiratory / Q000209:etiology / Q000517:prevention & control; D000328:Adult; D000818:Animals; D002245:Carbon Dioxide / Q000097:blood; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002648:Child; D006801:Humans; D008397:Masks; D010100:Oxygen / Q000097:blood; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000379:methods*; D012131:Respiratory Insufficiency / Q000628:therapy*; D013552:Swine; D013990:Tidal Volume
D002245:Carbon Dioxide; D010100:Oxygen