TY - JOUR
T1 - Hyperventilation-Induced Hypotension during Cardiopulmonary Resuscitation
AU - Aufderheide, Tom P.
AU - Sigurdsson, Gardar
AU - Pirrallo, Ronald G.
AU - Yannopoulos, Demetri
AU - McKnite, Scott
AU - Von Briesen, Chris
AU - Sparks, Christopher W.
AU - Conrad, Craig J.
AU - Provo, Terry A.
AU - Lurie, Keith G
PY - 2004/4/27
Y1 - 2004/4/27
N2 - Background-A clinical observational study revealed that rescuers consistently hyperventilated patients during out-of-hospital cardiopulmonary resuscitation (CPR). The objective of this study was to quantify the degree of excessive ventilation in humans and determine if comparable excessive ventilation rates during CPR in animals significantly decrease coronary perfusion pressure and survival. Methods and Results-In humans, ventilation rate and duration during CPR was electronically recorded by professional rescuers. In 13 consecutive adults (average age, 63±5.8 years) receiving CPR (7 men), average ventilation rate was 30±3.2 per minute (range, 15 to 49). Average duration per breath was 1.0±0.07 per second. No patient survived. Hemodynamics were studied in 9 pigs in cardiac arrest ventilated in random order with 12, 20, or 30 breaths per minute. Survival rates were then studied in 3 groups of 7 pigs in cardiac arrest that were ventilated at 12 breaths per minute (100% O2), 30 breaths per minute (100% O 2), or 30 breaths per minute (5% CO2/95% O2). In animals treated with 12, 20, and 30 breaths per minute, the mean intrathoracic pressure (mm Hg/min) and coronary perfusion pressure (mm Hg) were 7.1±0.7, 11.6±0.7, 17.5±1.0 (P<0.0001), and 23.4±1.0, 19.5±1.8, and 16.9±1.8 (P=0.03), respectively. Survival rates were 6/7, 1/7, and 1/7 with 12, 30, and 30+ CO2 breaths per minute, respectively (P=0.006). Conclusions-Professional rescuers were observed to excessively ventilate patients during out-of-hospital CPR. Subsequent animal studies demonstrated that similar excessive ventilation rates resulted in significantly increased intrathoracic pressure and markedly decreased coronary perfusion pressures and survival rates.
AB - Background-A clinical observational study revealed that rescuers consistently hyperventilated patients during out-of-hospital cardiopulmonary resuscitation (CPR). The objective of this study was to quantify the degree of excessive ventilation in humans and determine if comparable excessive ventilation rates during CPR in animals significantly decrease coronary perfusion pressure and survival. Methods and Results-In humans, ventilation rate and duration during CPR was electronically recorded by professional rescuers. In 13 consecutive adults (average age, 63±5.8 years) receiving CPR (7 men), average ventilation rate was 30±3.2 per minute (range, 15 to 49). Average duration per breath was 1.0±0.07 per second. No patient survived. Hemodynamics were studied in 9 pigs in cardiac arrest ventilated in random order with 12, 20, or 30 breaths per minute. Survival rates were then studied in 3 groups of 7 pigs in cardiac arrest that were ventilated at 12 breaths per minute (100% O2), 30 breaths per minute (100% O 2), or 30 breaths per minute (5% CO2/95% O2). In animals treated with 12, 20, and 30 breaths per minute, the mean intrathoracic pressure (mm Hg/min) and coronary perfusion pressure (mm Hg) were 7.1±0.7, 11.6±0.7, 17.5±1.0 (P<0.0001), and 23.4±1.0, 19.5±1.8, and 16.9±1.8 (P=0.03), respectively. Survival rates were 6/7, 1/7, and 1/7 with 12, 30, and 30+ CO2 breaths per minute, respectively (P=0.006). Conclusions-Professional rescuers were observed to excessively ventilate patients during out-of-hospital CPR. Subsequent animal studies demonstrated that similar excessive ventilation rates resulted in significantly increased intrathoracic pressure and markedly decreased coronary perfusion pressures and survival rates.
KW - Cardiopulmonary resuscitation
KW - Death, sudden
KW - Heart arrest
KW - Hypotension
KW - Ventilation
UR - http://www.scopus.com/inward/record.url?scp=11144354509&partnerID=8YFLogxK
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U2 - 10.1161/01.CIR.0000126594.79136.61
DO - 10.1161/01.CIR.0000126594.79136.61
M3 - Article
C2 - 15066941
AN - SCOPUS:11144354509
SN - 0009-7322
VL - 109
SP - 1960
EP - 1965
JO - Circulation
JF - Circulation
IS - 16
ER -