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Review ArticleNarrative Review

Mechanical Ventilation Management During Mechanical Chest Compressions

Daniele Orso, Luigi Vetrugno, Nicola Federici, Matteo Borselli, Savino Spadaro, Gianmaria Cammarota and Tiziana Bove
Respiratory Care February 2021, 66 (2) 334-346; DOI: https://doi.org/10.4187/respcare.07775
Daniele Orso
Department of Medicine, University of Udine, Udine, Italy.
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Luigi Vetrugno
Department of Medicine, University of Udine, Udine, Italy.
Department of Anesthesia and Intensive Care Clinic, ASUFC University Hospital Santa Maria della Misericordia, Udine, Italy.
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  • For correspondence: [email protected]
Nicola Federici
Department of Medicine, University of Udine, Udine, Italy.
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Matteo Borselli
Department of Emergency Medicine, Azienda Usl Toscana Sud-Est, Grosseto, Italy.
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Savino Spadaro
Department of Morphology, Surgery and Experimental Medicine, Intensive Care Unit, Sant'Anna Hospital, Ferrara, Italy.
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Gianmaria Cammarota
Department of Anaesthesia and General Intensive Care, “Maggiore della Carità” University Hospital, Novara, Italy.
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Tiziana Bove
Department of Medicine, University of Udine, Udine, Italy.
Department of Anesthesia and Intensive Care Clinic, ASUFC University Hospital Santa Maria della Misericordia, Udine, Italy.
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Abstract

Ventilation during chest compressions can lead to an increase in peak inspiratory pressure. High inspiratory pressure can raise the risk of injury to the respiratory system and make it challenging to deliver the required tidal volume. The utilization of mechanical devices for chest compression has exacerbated this challenge. The aim of this narrative review was to summarize the different mechanical ventilation strategies applied during mechanical cardiopulmonary resuscitation (CPR). To this end, we searched the PubMed and BioMed Central databases from inception to January 2020, using the search terms “mechanical ventilation,” “cardiac arrest,” “cardiopulmonary resuscitation,” “mechanical cardiopulmonary resuscitation,” and their related terms. We included all studies (human clinical or animal-based research studies, as well as studies using simulation models) to explore the various ventilation settings during mechanical CPR. We identified 842 relevant articles on PubMed and 397 on BioMed Central; a total of 38 papers were judged to be specifically related to the subject of this review. Of this sample, 17 studies were conducted on animal models, 6 considered a simulated scenario, 13 were clinical studies (5 of which were retrospective), and 2 studies constituted literature review articles. The main finding arising from the assessment of these publications is that a high Embedded Image must be guaranteed during CPR. Low-grade evidence suggests turning off inspiratory triggering and applying PEEP ≥ 5 cm H2O. The analysis also revealed that many uncertainties persist regarding the ideal choice of ventilation mode, tidal volume, the ventilation rate setting, and the inspiratory:expiratory ratio. None of the current international guidelines indicate the “best” mechanical ventilation strategy to apply during mechanical CPR. We propose an operating algorithm worthy of future discussion and study. Future studies specifically addressing the topics covered in this review are required.

  • mechanical CPR
  • mechanical ventilation
  • peak inspiratory pressure
  • out-of-hospital cardiac arrest

Footnotes

  • Correspondence: Luigi Vetrugno, Department of Anesthesia and Intensive Care Clinic, ASUFC University Hospital “Santa Maria della Misericordia,” p. le S. Maria della Misericordia 15, 33100 Udine, Italy. E-mail: luigi.vetrugno{at}asufc.sanita.fvg.it
  • Supplementary material related to this paper is available at http://www.rcjournal.com.

  • The authors have disclosed no conflicts of interest.

  • Copyright © 2021 by Daedalus Enterprises
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Respiratory Care: 66 (2)
Respiratory Care
Vol. 66, Issue 2
1 Feb 2021
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Mechanical Ventilation Management During Mechanical Chest Compressions
Daniele Orso, Luigi Vetrugno, Nicola Federici, Matteo Borselli, Savino Spadaro, Gianmaria Cammarota, Tiziana Bove
Respiratory Care Feb 2021, 66 (2) 334-346; DOI: 10.4187/respcare.07775

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Mechanical Ventilation Management During Mechanical Chest Compressions
Daniele Orso, Luigi Vetrugno, Nicola Federici, Matteo Borselli, Savino Spadaro, Gianmaria Cammarota, Tiziana Bove
Respiratory Care Feb 2021, 66 (2) 334-346; DOI: 10.4187/respcare.07775
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Keywords

  • mechanical CPR
  • mechanical ventilation
  • peak inspiratory pressure
  • out-of-hospital cardiac arrest

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