Constant flow insufflation of oxygen as the sole mode of ventilation during out-of-hospital cardiac arrest.
BACKGROUND
Constant flow insufflation of oxygen (CFIO) through a Boussignac multichannel endotracheal tube has been reported to be an efficient ventilatory method during chest massage for cardiac arrest.


METHODS
Patients resuscitated for out-of-hospital cardiac arrest were randomly assigned to standard endotracheal intubation and mechanical ventilation (MV; n =457) or use of CFIO at a flow rate of 15 l/min (n=487). Continuous chest compressions were similar in the two groups. Pulse oximetry level was recorded every 5[Symbol: see text]min. Outcome of initial resuscitation, hospital admission, complications, and discharge from the intensive care unit (ICU) were analyzed. The randomization scheme was changed during the study, but the in-depth analysis was performed only on the first cohort of 341 patients with CFIO and 355 with MV, because of randomization problems in the second part.


RESULTS
No difference in outcome was noted regarding return to spontaneous circulation (CFIO 21%, MV 20%), hospital admission (CFIO 17%, MV 16%), or ICU discharge (CFIO 2.4%, MV 2.3%). The level of detectable pulse saturation and the proportion of patients with saturation above 70% were higher with CFIO. Ten patients with MV but only one with CFIO had rib fractures.


CONCLUSIONS
CFIO is a simplified alternative to MV, with favorable effects regarding oxygenation and fewer complications, as observed in this group of patients with desperate prognosis.
Bertrand
Catherine
C
Henri Mondor Hospital, Paris 12 University, Department of Anesthesiology and Emergency Medical Service of Creteil, AP-HP, Creteil, France. catherine.bertrand@hmn.aphp.fr
Hemery
François
F
Carli
Pierre
P
Goldstein
Patrick
P
Espesson
Catherine
C
Rüttimann
Michel
M
Macher
Jean Michel
JM
Raffy
Brigitte
B
Fuster
Patrick
P
Dolveck
François
F
Rozenberg
Alain
A
Lecarpentier
Eric
E
Duvaldestin
Philippe
P
Saissy
Jean-Marie
JM
Boussignac
Georges
G
Brochard
Laurent
L
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation; D004632:Emergency Medical Services; D005260:Female; D005602:France; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D000860:Hypoxia / Q000517:prevention & control*; D007327:Insufflation; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012119:Respiration