title: A ventilation technique for oxygenation and carbon dioxide elimination in CPR: Continuous insufflation of oxygen at three levels of pressure in a pig model.
abstract: OBJECTIVE
  Pulmonary ventilation remains an important part of cardiopulmonary resuscitation, affecting gas exchange and haemodynamics. We designed and studied an improved method of ventilation for CPR, constructed specifically to support both gas exchange and haemodynamics. This method uses continuous insufflation of oxygen at three levels of pressure, resulting in tri-level pressure ventilation (TLPV). We hypothesized that TLPV improves gas exchange and haemodynamics compared to manual gold standard ventilation (GSV).
  
  
  METHODS
  In 14 pigs, ventricular fibrillation was induced and automated CPR performed for 10 min with either TLPV or GSV. After defibrillation, CPR was repeated with the other ventilation method. Gas exchange and haemodynamics were monitored. Data are presented as mean±standard error of the mean.
  
  
  RESULTS
  TLPV was superior to GSV for PaO2 (163±36 mmHg difference; P=0.001), and peak AWP (-20±2 cmH2O difference; P=0.000) and higher for mean AWP (8±0.2 cmH2O difference; P=0.000). TLPV was comparable to GSV for CPP (5±3 mmHg difference; P=0.012), VCO2 (0.07±0.3 mL/min/kg difference; P=0.001), SvO2 (4±3%-point; P=0.001), mean carotid flow (-0.5±4 mL/min difference; P=0.016), and pHa (0.00±0.03 difference; P=0.002). The PaCO2 data do not provide a conclusive result (4±4 mmHg difference).
  
  
  CONCLUSIONS
  We conclude that the ventilation strategy with a tri-level pressure cycle performs comparable to an expert, manual ventilator in an automated-CPR swine model.
authors.affiliation: Philips Research, High Tech Campus 34, 5656 AE Eindhoven, The Netherlands. Electronic address: simone.ordelman@philips.com.
authors.forename: Simone C M A
authors.initials: SC
authors.lastname: Ordelman
authors.affiliation: Philips Research, High Tech Campus 34, 5656 AE Eindhoven, The Netherlands; Cardiovascular Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Den Dolech 2 (De Wielen), 5612 AZ Eindhoven, The Netherlands.
authors.forename: Paul
authors.initials: P
authors.lastname: Aelen
authors.affiliation: Philips Research, High Tech Campus 34, 5656 AE Eindhoven, The Netherlands.
authors.forename: Pierre H
authors.initials: PH
authors.lastname: Woerlee
authors.affiliation: Department of Anaesthesiology, St. Elisabeth Hospital, Hilvarenbeekseweg 60, 5082 GC Tilburg, The Netherlands.
authors.forename: Paul F J
authors.initials: PF
authors.lastname: van Berkom
authors.affiliation: Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, The Netherlands.
authors.forename: Gert-Jan
authors.initials: GJ
authors.lastname: Scheffer
authors.affiliation: Department of Anaesthesiology, St. Elisabeth Hospital, Hilvarenbeekseweg 60, 5082 GC Tilburg, The Netherlands.
authors.forename: Gerrit J
authors.initials: GJ
authors.lastname: Noordergraaf
mesh_terms: D000818:Animals; D002245:Carbon Dioxide; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D005260:Female; D006439:Hemodynamics; D007327:Insufflation / Q000379:methods; D023421:Models, Animal; D010100:Oxygen / Q000008:administration & dosage*; D011312:Pressure; D011659:Pulmonary Gas Exchange; D012121:Respiration, Artificial / Q000379:methods*; D013552:Swine
chemical_list: D002245:Carbon Dioxide; D010100:Oxygen
keywords: CPP; CPR; Continuous ventilation; Insufflation; Intrathoracic pressure; Ventilation