title: Continuous passive oxygen insufflation results in a similar outcome to positive pressure ventilation in a swine model of out-of-hospital ventricular fibrillation.
abstract: BACKGROUND
  The deleterious effects of positive pressure ventilation may be prevented by substituting passive oxygen insufflation during advanced cardiac life support (ACLS) cardiopulmonary resuscitation (CPR).
  
  
  METHODS
  We compared 24-h neurologically normal survival among three different ventilation scenarios for ACLS in a realistic swine model of out-of-hospital prolonged ventricular fibrillation (VF) cardiac arrest. No bystander CPR was provided during the first 8 min of untreated VF before the simulated arrival of an emergency medical system (EMS). Thirty-six swine were randomly assigned to one of three experimental groups. Group I (standard ventilation) was mechanically ventilated at 10 respirations per minute (RPM) at a tidal volume (TV) of 10 ml/kg with 100% oxygen. Group II (hyperventilation) was ventilated at 35 RPM at a TV of 20 ml/kg with 100% oxygen. In Group III (insufflation) animals, a nasal cannula was placed in the oropharynx to administer oxygen continuously at 10 l/min.
  
  
  RESULTS
  There was no significant difference in the 24h neurologically normal survival among groups (standard: 2/12, hyperventilation: 2/12, insufflation: 4/12; p=.53).
  
  
  CONCLUSIONS
  Passive insufflation may be an acceptable alternative to the currently recommended positive pressure ventilation during resuscitation efforts for out-of-hospital VF cardiac arrest. Potential advantages of this technique include: (1) easier to teach, (2) easier to administer, (3) prevention of the adverse effects of positive pressure ventilation and (4) allows EMS personnel to concentrate upon other critically important duties.
authors: Department of Anesthesiology, University of Arizona, College of Medicine, Sarver Heart Center, Tucson, AZ 85724, USA.
authors: Melinda M
authors: MM
authors: Hayes
authors: Gordon A
authors: GA
authors: Ewy
authors: Nathan D
authors: ND
authors: Anavy
authors: Ronald W
authors: RW
authors: Hilwig
authors: Arthur B
authors: AB
authors: Sanders
authors: Robert A
authors: RA
authors: Berg
authors: Charles W
authors: CW
authors: Otto
authors: Karl B
authors: KB
authors: Kern
mesh_terms: D000818:Animals; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D016009:Chi-Square Distribution; D004195:Disease Models, Animal; D005260:Female; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D011175:Positive-Pressure Respiration; D012372:ROC Curve; D011897:Random Allocation; D015996:Survival Rate; D013552:Swine; D013990:Tidal Volume; D014693:Ventricular Fibrillation / Q000503:physiopathology / Q000628:therapy*