title: A clinical observational study analysing the factors associated with hyperventilation during actual cardiopulmonary resuscitation in the emergency department.
abstract: OBJECTIVE
  This is the first study to identify the factors associated with hyperventilation during actual cardiopulmonary resuscitation (CPR) in the emergency department (ED).
  
  
  METHODS
  All CPR events in the ED were recorded by video from April 2011 to December 2011. The following variables were analysed using review of the recorded CPR data: ventilation rate (VR) during each minute and its associated factors including provider factors (experience, advanced cardiovascular life support (ACLS) certification), clinical factors (auscultation to confirm successful intubation, suctioning, and comments by the team leader) and time factors (time or day of CPR).
  
  
  RESULTS
  Fifty-five adult CPR cases including a total of 673 min sectors were analysed. The higher rates of hyperventilation (VR>10/min) were delivered by inexperienced (53.3% versus 14.2%) or uncertified ACLS provider (52.2% versus 10.8%), during night time (61.0 versus 34.5%) or weekend CPR (53.1% versus 35.6%) and when auscultation to confirm successful intubation was performed (93.5% versus 52.8%) than not (all p<0.0001). However, experienced (25.3% versus 29.7%; p=0.448) or certified ACLS provider (20.6% versus 31.3%; p<0.0001) could not deliver high rate of proper ventilation (VR 8-10/min). Comment by the team leader was most strongly associated with the proper ventilation (odds ratio 7.035, 95% confidence interval 4.512-10.967).
  
  
  CONCLUSIONS
  Hyperventilation during CPR was associated with inexperienced or uncertified ACLS provider, auscultation to confirm intubation, and night time or weekend CPR. And to deliver proper ventilation, comments by the team leader should be given regardless of providers' expert level.
authors.affiliation: Department of Emergency Medicine, School of Medicine, Konkuk University, Konkuk University Medical Center, Seoul, Republic of Korea.
authors.forename: Sang O
authors.initials: SO
authors.lastname: Park
authors.forename: Dong Hyuk
authors.initials: DH
authors.lastname: Shin
authors.forename: Kwang Je
authors.initials: KJ
authors.lastname: Baek
authors.forename: Dae Young
authors.initials: DY
authors.lastname: Hong
authors.forename: Eun Jung
authors.initials: EJ
authors.lastname: Kim
authors.forename: Sang Chul
authors.initials: SC
authors.lastname: Kim
authors.forename: Kyeong Ryong
authors.initials: KR
authors.lastname: Lee
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D004636:Emergency Service, Hospital; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology / Q000628:therapy*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D006985:Hyperventilation / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D056910:Republic of Korea / Q000453:epidemiology; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors