title: Real-time tidal volume feedback guides optimal ventilation during simulated CPR.
abstract: OBJECTIVE
  We performed this study to investigate whether real-time tidal volume feedback increases optimal ventilation and decreases hyperventilation during manikin-simulated cardiopulmonary resuscitation (CPR).
  
  
  METHODS
  We developed a new real-time tidal volume monitoring device (TVD) which estimated tidal volume in real time using a magnetic flowmeter. The TVD was validated with a volume-controlled mechanical ventilator with various tidal volumes. We conducted a randomized, crossover, manikin-simulation study in which 14 participants were randomly divided into a control (without tidal volume feedback, n = 7) and a TVD group (with real-time tidal volume feedback, n = 7) and underwent manikin simulation. The optimal ventilation was defined as 420-490 mL of tidal volumes for a 70-kg adult manikin. After 2 weeks of the washout period, the simulation was repeated via the participants' crossover.
  
  
  RESULTS
  In the validation study, 97.6% and 100% of the difference ratios in tidal volumes between the mechanical ventilator and TVD were within ±1.5% and ±2.5%, respectively. During manikin-simulated CPR, TVD use increased the proportion of optimal ventilation per person. Its median values (range) of the control group and the TVD group were 37.5% (0.0-65.0) and 87.5% (65.0-100.0), respectively, P < .001). TVD use also decreased hyperventilation. The proportions of hyperventilation in the control group and the TVD group were 25.0% vs 8.9%, respectively (P < .001).
  
  
  CONCLUSIONS
  Real-time tidal volume feedback using the new TVD guided the rescuers to provide optimal ventilation and to avoid hyperventilation during manikin-simulated CPR.
authors.affiliation: Department of Biomedical Engineering, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
authors.forename: Kyoung Min
authors.initials: KM
authors.lastname: You
authors.affiliation: Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
authors.forename: Chiwon
authors.initials: C
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea. Electronic address: kwy711@hanmail.net.
authors.forename: Woon Yong
authors.initials: WY
authors.lastname: Kwon
authors.affiliation: Department of Biomedical Engineering, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Biomedical Engineering, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea. Electronic address: ljch@snu.ac.kr.
authors.forename: Jung Chan
authors.initials: JC
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
authors.forename: Gil Joon
authors.initials: GJ
authors.lastname: Suh
authors.affiliation: Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
authors.forename: Kyung Su
authors.initials: KS
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
authors.forename: Min Ji
authors.initials: MJ
authors.lastname: Park
authors.affiliation: Department of Biomedical Engineering, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Biomedical Engineering, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
authors.forename: Sungwan
authors.initials: S
authors.lastname: Kim
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000592:standards*; D003199:Computer Systems; D018592:Cross-Over Studies; D025461:Feedback, Physiological; D005260:Female; D006801:Humans; D006985:Hyperventilation / Q000150:complications / Q000517:prevention & control*; D008297:Male; D008348:Manikins; D012121:Respiration, Artificial / Q000379:methods / Q000592:standards*; D000066908:Simulation Training / Q000379:methods*; D013990:Tidal Volume