Generation of tidal volume via gentle chest pressure in children over one year old.
BACKGROUND
In the event of cardiac arrest, cardiopulmonary resuscitation (CPR) is a well-established technique to maintain oxygenation of tissues and organs until medical equipment and staff are available. During CPR, chest compressions help circulate blood and have been shown in animal models to be a means of short-term oxygenation. In this study, we tested whether gentle chest pressure can generate meaningful tidal volume in paediatric subjects.


METHODS
This prospective cohort pilot study recruited children under the age of 17 years and undergoing any surgery requiring general anaesthetic and endotracheal intubation. After induction of general anaesthesia, tidal volumes were obtained before and after intubation by applying a downward force on the chest which was not greater than the patient's weight. Mean tidal volumes were compared for unprotected versus protected airway and for type of surgery.


RESULTS
Mean tidal volume generated with an unprotected and protected airway was 2.7 (1.7) and 2.9 (2.3) mL/kg, respectively. Mean tidal volume generated with mechanical ventilation was 13.6 (4.9) mL/kg. No statistical significance was found when comparing tidal volumes generated with an unprotected or protected airway (p = 0.20), type of surgery (tonsillectomy and/or adenoidectomy versus other surgery) (unprotected, p = 0.09; protected, p = 0.37), and when age difference between groups was taken into account (p = 0.34).


CONCLUSIONS
Using gentle chest pressure, we were able to generate over 20% of the tidal volume achieved with mechanical ventilation. Our results suggest that gentle chest pressure may be a means to support temporary airflow in children.
Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada. Electronic address: btsui@ualberta.ca.
Ban C H
BC
Tsui
Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada.
Sara
S
Horne
Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada.
Jenkin
J
Tsui
Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada.
Gareth N
GN
Corry
D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007223:Infant; D008297:Male; D010865:Pilot Projects; D011312:Pressure; D011446:Prospective Studies; D013147:Spirometry; D013909:Thorax; D013990:Tidal Volume / Q000502:physiology*; D016896:Treatment Outcome
Chest compressions; Children; Non-invasive oxygenation; Resuscitation