title: Artificial ventilation for basic life support leads to hyperventilation in first aid providers.
abstract: The 'Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care - International Consensus on Science' recommend an artificial ventilation volume of 10 ml/kg bodyweight (equivalent to a tidal volume of 700-1000 ml) without the use of supplemental oxygen in adults with respiratory arrest. For first aid providers using the mouth-to-mouth or mouth-to-nose-ventilation technique, respectively, a ventilation volume of approximately 9.6 l/min results. Additionally, a deep breath is recommended before each ventilation to increase the end-expiratory oxygen concentration of the air exhaled by the first aid provider. To investigate the effects of these recommendations in healthy volunteers, test persons were asked to ventilate an artificial lung model for a period of up to 10 min. The tidal volume was set at 800 ml at a breathing rate of 12/min. End-tidal carbon dioxide, oxygen saturation (measured by pulse oximetry), and heart rate were measured continuously. Capillary blood gas samples were collected and non-invasive blood pressure readings were recorded prior to the start of ventilation and immediately after the end of the measuring period. The data reveal a statistically significant and clinically relevant decrease in end-tidal carbon dioxide pressure (P<0.001, median decrease 14 mmHg), and the occurrence of hyperventilation-associated symptoms such as paraesthesia, dizziness, and carpopedal spasms in more than 75% of the participants. Clinically and statistically significant hyperventilation results in first aid providers performing artificial ventilation according to the guidelines. This artificial ventilation is associated with a significant decrease in capillary and end-tidal carbon dioxide pressure as well as with multiple symptoms of an acute hyperventilation syndrome. Ventilation performed according to these guidelines may cause injury to the health of the first aid provider. Rescuers ventilating the victim should be replaced at regular intervals and the recommendation to take a deep breath before each ventilation should not be upheld in order to minimise the risk of hyperventilation.
authors.affiliation: Clinic of Anaesthesiology, Johannes Gutenberg-University, Langenbeckstrasse 1, 55131 Mainz, Germany. thierbac@mail.uni-mainz.de
authors.forename: A R
authors.initials: AR
authors.lastname: Thierbach
authors.forename: B B
authors.initials: BB
authors.lastname: Wolcke
authors.forename: F
authors.initials: F
authors.lastname: Krummenauer
authors.forename: M
authors.initials: M
authors.lastname: Kunde
authors.forename: C
authors.initials: C
authors.lastname: Jänig
authors.forename: W F
authors.initials: WF
authors.lastname: Dick
mesh_terms: D000328:Adult; D002245:Carbon Dioxide / Q000032:analysis; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects* / Q000379:methods*; D015331:Cohort Studies; D004632:Emergency Medical Services; D005260:Female; D005392:First Aid / Q000009:adverse effects; D005500:Follow-Up Studies; D006282:Health Personnel; D006801:Humans; D006985:Hyperventilation / Q000453:epidemiology / Q000209:etiology*; D015994:Incidence; D008297:Male; D010100:Oxygen / Q000097:blood; D011659:Pulmonary Gas Exchange; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000379:methods; D018570:Risk Assessment
chemical_list: D002245:Carbon Dioxide; D010100:Oxygen