title: Chest Compression Synchronized Ventilation versus Intermitted Positive Pressure Ventilation during Cardiopulmonary Resuscitation in a Pig Model.
abstract: BACKGROUND
  Guidelines recommend mechanical ventilation with Intermitted Positive Pressure Ventilation (IPPV) during resuscitation. The influence of the novel ventilator mode Chest Compression Synchronized Ventilation (CCSV) on gas exchange and arterial blood pressure compared with IPPV was investigated in a pig model.
  
  
  METHODS
  In 12 pigs (general anaesthesia/intubation) ventricular fibrillation was induced and continuous chest compressions were started after 3 min. Pigs were mechanically ventilated in a cross-over setting with 5 ventilation periods of 4 min each: Ventilation modes were during the first and last period IPPV (100% O2, tidal volumes = 7 ml/kgKG, respiratory rate = 10/min), during the 2nd, 3rd and 4th period CCSV (100% O2), a pressure-controlled and with each chest compression synchronized breathing pattern with three different presets in randomized order. Presets: CCSVA: P insp = 60 mbar, inspiratory time = 205 ms; CCSVB: P insp = 60 mbar, inspiratory time = 265 ms; CCSVC: P insp = 45 mbar, inspiratory time = 265 ms. Blood gas samples were drawn for each period, mean arterial (MAP) and central venous (CVP) blood pressures were continuously recorded. Results as median (25%/75%percentiles).
  
  
  RESULTS
  Ventilation with each CCSV mode resulted in higher PaO2 than IPPV: PaO2: IPPV first: 19.6(13.9/36.2)kPa, IPPV last: 22.7(5.4/36.9)kPa (p = 0.77 vs IPPV first), CCSVA: 48.9(29.0/58.2)kPa (p = 0.028 vs IPPV first, p = 0.0001 vs IPPV last), CCSVB: 54.0 (43.8/64.1) (p = 0.001 vs IPPV first, p = 0.0001 vs IPPV last), CCSVC: 46.0 (20.2/58.4) (p = 0.006 vs IPPV first, p = 0.0001 vs IPPV last). Both the MAP and the difference MAP-CVP did not decrease during twelve minutes CPR with all three presets of CCSV and were higher than the pressures of the last IPPV period.
  
  
  CONCLUSIONS
  All patterns of CCSV lead to a higher PaO2 and avoid an arterial blood pressure drop during resuscitation compared to IPPV in this pig model of cardiac arrest.
authors.affiliation: Department of Anesthesiology and Critical Care, Philipps-University, Marburg, Germany; Department of Emergency Medicine, Philipps-University, Marburg, Germany.
authors.forename: Clemens
authors.initials: C
authors.lastname: Kill
authors.affiliation: Department of Anesthesiology and Critical Care, Philipps-University, Marburg, Germany.
authors.forename: Monika
authors.initials: M
authors.lastname: Galbas
authors.affiliation: Weinmann Emergency Medical Technology GmbH+Co.KG, Hamburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Neuhaus
authors.affiliation: Department of Anesthesiology and Critical Care, Philipps-University, Marburg, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Hahn
authors.affiliation: Department of Anesthesiology and Critical Care, Philipps-University, Marburg, Germany.
authors.forename: Pascal
authors.initials: P
authors.lastname: Wallot
authors.affiliation: Department of Internal Medicine, Section Respiratory Diseases, Philipps-University, Marburg, Germany.
authors.forename: Karl
authors.initials: K
authors.lastname: Kesper
authors.affiliation: Department of Anesthesiology and Critical Care, Philipps-University, Marburg, Germany.
authors.forename: Hinnerk
authors.initials: H
authors.lastname: Wulf
authors.affiliation: Department of Anesthesiology and Critical Care, Philipps-University, Marburg, Germany; Department of Emergency Medicine, Philipps-University, Marburg, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Dersch
mesh_terms: D000818:Animals; D001784:Blood Gas Analysis; D001794:Blood Pressure; D016887:Cardiopulmonary Resuscitation; D035641:Chest Wall Oscillation; D004195:Disease Models, Animal; D007385:Intermittent Positive-Pressure Ventilation; D023421:Models, Animal; D010100:Oxygen / Q000378:metabolism; D010313:Partial Pressure; D011312:Pressure; D012121:Respiration, Artificial; D034421:Sus scrofa; D013997:Time Factors
chemical_list: D010100:Oxygen