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RESEARCH PRODUCT
Ultra-low tidal volume ventilation-A novel and effective ventilation strategy during experimental cardiopulmonary resuscitation.
Alexander ZiebartChristian MoellmannAndreas Garcia-bardonErik K. HartmannFrances KuropkaJens KamufRobert RuemmlerBastian Duengessubject
MaleResuscitationSwinemedicine.medical_treatmentRespiratory physiology030204 cardiovascular system & hematologyEmergency NursingLung injuryAdvanced Cardiac Life SupportReal-Time Polymerase Chain ReactionIntermittent Positive-Pressure Ventilation03 medical and health sciencesRandom Allocation0302 clinical medicinemedicineTidal VolumeAnimalsHumansCardiopulmonary resuscitationTidal volumeAnalysis of VarianceContinuous Positive Airway Pressurebusiness.industryPulmonary Gas Exchange030208 emergency & critical care medicineOxygenationLung Injurymedicine.diseaserespiratory tract diseasesDisease Models AnimalTreatment OutcomeAnesthesiaVentricular fibrillationEmergency MedicineBreathingCardiology and Cardiovascular Medicinebusinessdescription
Abstract Background The effects of different ventilation strategies during CPR on patient outcomes and lung physiology are still poorly understood. This study compares positive pressure ventilation (IPPV) to passive oxygenation (CPAP) and a novel ultra-low tidal volume ventilation (ULTVV) regimen in an experimental ventricular fibrillation animal model. Study design Prospective randomized controlled trial. Animals 30 male German landrace pigs (16–20 weeks). Methods Ventricular fibrillation was induced in anesthetized and instrumented pigs and the animals were randomized into three groups. Mechanical CPR was initiated and ventilation was either provided by means of standard IPPV (RR: 10/min, Vt: 8–9 ml/kg, FiO2: 1,0, PEEP: 5 mbar), CPAP (O2-Flow: 10 l/min, PEEP: 5 mbar) or ULTVV (RR: 50/min, Vt: 2–3 ml/kg, FiO2: 1,0, PEEP: 5 mbar). Guideline-based advanced life support was applied for a maximum of 4 cycles and animals achieving ROSC were monitored for 6 h before terminating the experiment. Ventilation/perfusion ratios were performed via multiple inert gas elimination, blood gas analyses were taken hourly and extended cardiovascular measurements were collected constantly. Brain and lung tissue samples were taken and analysed for proinflammatory cytokine expression. Results ULTVV provided sufficient oxygenation and ventilation during CPR while demanding significantly lower respiratory and intrathoracic pressures. V/Q mismatch was significantly decreased and lung injury was mitigated in surviving animals compared to IPPV and CPAP. Additionally, cerebral cytokine expression was dramatically reduced. Conclusion Ultra-low-volume ventilation during CPR in a porcine model is feasible and may provide lung-protective benefits as well as neurological outcome improvement due to lower inflammation. Our results warrant further studies and might eventually lead to new therapeutic options in the resuscitation setting.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2018-11-01 | Resuscitation |