Laboratory evaluation of the Vortran Automatic Resuscitator Model RTM.
BACKGROUND
One device that has been proposed to address the need for emergency ventilation is the Vortran Automatic Resuscitator.


OBJECTIVE
To test the hypothesis that increasing load (ie, increasing resistance or decreasing compliance) significantly affects minute alveolar ventilation.


METHODS
A Vortran Automatic Resuscitator was connected to a passive lung model and we measured load with 8 combinations of 4 compliances (14, 28, 46, and 63 mL/cm H(2)O) and 2 resistances (20 and 42 cm H(2)O/L/s). Source gas flow was either 20 or 40 L/min. We measured tidal volume (V(T)), frequency, inspiratory time, expiratory time, peak inspiratory pressure, and intrinsic positive end-expiratory pressure. We calculated the ratio of inspiratory time to total cycle time (T(I)/T(tot)), minute ventilation, minute alveolar ventilation, and estimated P(aCO(2)). Raw data were summarized with descriptive statistics. A subset of the experimental data (outcome measures for conditions with high and low values for resistance, compliance, and source gas flow) was analyzed with a 2-level factorial design, with standard "design of experiments" procedure, including analysis of variance. Differences associated with p values < or = 0.05 were considered significant.


RESULTS
Assuming the model lung represented a 68-kg adult, the measured V(T) ranged from a low of 1.7 mL/kg to a high of 16.7 mL/kg. T(I)/T(tot) was greatly affected by the input flow. At 40 L/min the average T(I)/T(tot) was 30%, and at 20 L/min T(I)/T(tot) was 52%. As the load increased, V(T) decreased and frequency increased. However, neither the minute ventilation nor the minute alveolar ventilation stayed constant. Minute ventilation ranged from 5.2 L/min to 11.3 L/min at 40 L/min source flow. More importantly, minute alveolar ventilation ranged from zero to 9.8 L/min, resulting in a calculated P(aCO(2)) range of over 100 mm Hg to 16 mm Hg, respectively. Indeed, calculated P(aCO(2)) was never in the normal range (35-45 mm Hg). "Design of experiments" analysis showed that V(T) was affected by compliance and resistance (p < 0.001 and p < 0.05, respectively). Frequency was affected only by compliance (p < 0.001). Minute alveolar ventilation was affected by compliance and resistance (p < 0.001 and p < 0.01, respectively). Minute alveolar ventilation increases as compliance increases and/or resistance decreases, but these variables were essentially independent.


CONCLUSIONS
The Vortran Automatic Resuscitator showed an automatic increase in frequency and decrease in V(T) that resulted in inappropriate levels of minute alveolar ventilation over a range of compliance and resistance values expected in paralyzed patients ventilated for respiratory failure. The variable performance under changing load, along with the lack of alarms, should prompt caution in using the Vortran Automatic Resuscitator for emergency ventilatory support in situations where the patient cannot be constantly monitored by trained and experienced operators.
Babic
Mark D
MD
Respiratory Care Services, Fairview Hospital, 18101 Lorain Avenue, Cleveland OH 44111, USA. babicm2@ccf.org
Chatburn
Robert L
RL
Stoller
James K
JK
D045422:Continuous Positive Airway Pressure; D004632:Emergency Medical Services; D004867:Equipment Design; D006801:Humans; D008168:Lung / Q000503:physiopathology; D008953:Models, Anatomic; D014481:United States; D012122:Ventilators, Mechanical / Q000592:standards*