The Effect of Chest Compression and Ventilation Coordination During Cardiopulmonary Resuscitation.

Overview

Airway management and maintaining adequate ventilation during cardiopulmonary resuscitation (CPR) are important. The rule of 30:2 compression-to-ventilation ratios before endotracheal intubation and keeping 1 breath every 6-8 seconds with advanced airway are generally accepted according to 2010 Advanced Cardiac Life Support (ACLS) guideline. This recommendation emphasizes on the timing and frequency of ventilation during CPR. However, poor clinical evidence had been established concerning adequate volume, airway flow and pressure in each cycle.

There are increasing evidence that hyperventilation during resuscitation reduces pulmonary venous return and, therefore, compromises cardiac output and circulation. Another research reported that using high flow oxygen mask alone during basic life support (BLS) results in better survival rate and overall outcome compared with conventional positive pressure ventilation.

Our study applies flowmeter to measure ventilation parameters as frequency, duration, exhaled volume and airway pressure on intubated patients who received artificial ventilation during CPR. The parameters will correlate with information from accelerometry and capnometry simultaneously during resuscitation. . Investigators also focus on the influence of chest compression, which increases intra-thoracic pressure considerably. This effect may act against positive pressure ventilation and probably minimize the efficiency in each ventilation or circulation..

Details about how to ventilate one patient during CPR include right timing, duration, adequate volume and coordination are in debate. Unfortunately, current practice based on clinical guidelines emphasizes little on this issue. Investigators are committed to refine contemporary practices and hopefully improve qualities of resuscitation.

Investigators proposed the hypothesis that coordinate chest compression and ventilation may minimize the increasement of airway pressure and improve the effect of circulation

Full Title of Study: “The Effect of Chest Compression and Ventilation Coordination During Cardiopulmonary Resuscitation”

Study Type

  • Study Type: Observational
  • Study Design
    • Time Perspective: Prospective
  • Study Primary Completion Date: February 2015

Arms, Groups and Cohorts

  • Out of hospital cardiac arrest
    • Out of hospital cardiac arrest of non-traumatic cause
  • Unexpected in-hospital cardiac arrest
    • Unexpected cardiac arrest during emergency department stay

Clinical Trial Outcome Measures

Primary Measures

  • rate of 2- hour recover of spontaneous circulation
    • Time Frame: 2 hours
    • Recover of spontaneous circulation lasting for 2 hours describe as successful recover of spontaneous circulation, otherwise failure.

Secondary Measures

  • End tidal carbon-dioxide level
    • Time Frame: Measured during and end of resuscitation
    • End tidal carbon-dioxide level correlates with successful recovery of spontaneous circulation event
  • Arterial blood gas data
    • Time Frame: measured during and end of resuscitaiton
    • Oxygen and carbon-dioxide tension changes in different ventilation strategy in cardiopulmonary resuscitation
  • 30-day survival rate
    • Time Frame: 30 days
  • 90-day neurologic outcome
    • Time Frame: 90 days
  • Survive to discharge
    • Time Frame: 90 days
    • Duration of hospital stay, usually will be recorded in 90 days, occasionally will more than 90 days
  • Timing of first shockable rhythm
    • Time Frame: measured during resuscitaion

Participating in This Clinical Trial

Inclusion Criteria

  • age > 20 years old, < 100 years old

Exclusion Criteria

  • Trauma related out of hospital cardiac arrest

Gender Eligibility: All

Minimum Age: 20 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • National Taiwan University Hospital
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Official(s)
    • Hui-Chih Wang, Principal Investigator, Emergency department, National Taiwan University Hospital
  • Overall Contact(s)
    • Hui-Chih Wang, +886-2-23123456, ticoer@ntuh.gov.tw

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