title: Mechanical ventilation during cardiopulmonary resuscitation with intermittent positive-pressure ventilation, bilevel ventilation, or chest compression synchronized ventilation in a pig model.
abstract: OBJECTIVE
  Mechanical ventilation with an automated ventilator is recommended during cardiopulmonary resuscitation with a secured airway. We investigated the influence of intermittent positive-pressure ventilation, bilevel ventilation, and the novel ventilator mode chest compression synchronized ventilation, a pressure-controlled ventilation triggered by each chest compression, on gas exchange, hemodynamics, and return of spontaneous circulation in a pig model.
  
  
  METHODS
  Animal study.
  
  
  METHODS
  University laboratory.
  
  
  METHODS
  Twenty-four three-month-old female domestic pigs.
  
  
  METHODS
  The study was performed on pigs under general anesthesia with endotracheal intubation. Arterial and central venous catheters were inserted and IV rocuronium (1 mg/kg) was injected. After 3 minutes of cardiac arrest (ventricular fibrillation at t = 0 min), animals were randomized into intermittent positive-pressure ventilation (control group), bilevel, or chest compression synchronized ventilation group. Following 10 minute uninterrupted chest compressions and mechanical ventilation, advanced life support was performed (100% O2, up to six defibrillations, vasopressors).
  
  
  RESULTS
  Blood gas samples were drawn at 0, 4 and 13 minutes. At 13 minutes, hemodynamics was analyzed beat-to-beat in the end-inspiratory and end-expiratory cycle comparing the IPPV with the bilevel group and the CCSV group. Data were analyzed with the Mann-Whitney U test. Return of spontaneous circulation was achieved in five of eight (intermittent positive-pressure ventilation), six of eight (bilevel), and four of seven (chest compression synchronized ventilation) pigs. The results of arterial blood gas analyses at t = 4 minutes and t = 13 minutes (torr) were as follows: PaO2 intermittent positive-pressure ventilation, 143 (76/256) and 262 (81/340); bilevel, 261 (109/386) (p = 0.195 vs intermittent positive-pressure ventilation) and 236 (86/364) (p = 0.878 vs intermittent positive-pressure ventilation); and chest compression synchronized ventilation, 598 (471/650) (p < 0.001 vs intermittent positive-pressure ventilation) and 634 (115/693) (p = 0.054 vs intermittent positive-pressure ventilation); PaCO2 intermittent positive-pressure ventilation, 40 (38/43) and 45 (36/52); bilevel, 39 (35/41) (p = 0.574 vs intermittent positive-pressure ventilation) and 46 (42/49) (p = 0.798); and chest compression synchronized ventilation, 28 (27/32) (p = 0.001 vs intermittent positive-pressure ventilation) and 26 (18/29) (p = 0.004); mixed venous pH intermittent positive-pressure ventilation, 7.34 (7.31/7.35) and 7.26 (7.25/7.31); bilevel, 7.35 (7.29/7.37) (p = 0.645 vs intermittent positive-pressure ventilation) and 7.27 (7.17/7.31) (p = 0.645 vs intermittent positive-pressure ventilation); and chest compression synchronized ventilation, 7.34 (7.33/7.39) (p = 0.189 vs intermittent positive-pressure ventilation) and 7.35 (7.34/7.36) (p = 0.006 vs intermittent positive-pressure ventilation). Mean end-inspiratory and end-expiratory arterial pressures at t = 13 minutes (mm Hg) were as follows: intermittent positive-pressure ventilation, 28.0 (25.0/29.6) and 27.9 (24.4/30.0); bilevel, 29.1 (25.6/37.1) (p = 0.574 vs intermittent positive-pressure ventilation) and 28.7 (24.2/36.5) (p = 0.721 vs intermittent positive-pressure ventilation); and chest compression synchronized ventilation, 32.7 (30.4/33.4) (p = 0.021 vs intermittent positive-pressure ventilation) and 27.0 (24.5/27.7) (p = 0.779 vs intermittent positive-pressure ventilation).
  
  
  CONCLUSIONS
  Both intermittent positive-pressure ventilation and bilevel provided similar oxygenation and ventilation during cardiopulmonary resuscitation. Chest compression synchronized ventilation elicited the highest mean arterial pressure, best oxygenation, and a normal mixed venous pH during cardiopulmonary resuscitation.
authors.affiliation: 1Department of Anaesthesiology and Critical Care, Philipps University, Marburg, Germany. 2Department of Emergency Medicine, Philipps University, Marburg, Germany. 3Weinmann Geräte für Medizin GmbH + Co. KG, Hamburg, Germany. 4Institut für Assistenzsysteme und Qualifizierung an der SRH-Hochschule Heidelberg e.V., Heidelberg, Germany. 5Department of Internal Medicine, Section Respiratory Diseases, Philipps University, Marburg, Germany.
authors.forename: Clemens
authors.initials: C
authors.lastname: Kill
authors.forename: Oliver
authors.initials: O
authors.lastname: Hahn
authors.forename: Florian
authors.initials: F
authors.lastname: Dietz
authors.forename: Christian
authors.initials: C
authors.lastname: Neuhaus
authors.forename: Stefan
authors.initials: S
authors.lastname: Schwarz
authors.forename: Robert
authors.initials: R
authors.lastname: Mahling
authors.forename: Pascal
authors.initials: P
authors.lastname: Wallot
authors.forename: Andreas
authors.initials: A
authors.lastname: Jerrentrup
authors.forename: Thorsten
authors.initials: T
authors.lastname: Steinfeldt
authors.forename: Hinnerk
authors.initials: H
authors.lastname: Wulf
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Dersch
mesh_terms: D000818:Animals; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D035641:Chest Wall Oscillation; D005260:Female; D006439:Hemodynamics; D007385:Intermittent Positive-Pressure Ventilation; D023421:Models, Animal; D012121:Respiration, Artificial / Q000379:methods*; D034421:Sus scrofa